Two-dimensional echocardiography in patients with focal cerebral ischemia.

To assess the use of two-dimensional (2D) echocardiography in demonstrating a cardiac source for cerebral embolization, we studied 138 patients with one or more recent episodes of focal cerebral ischemia, in whom either a cardiac mechanism was suspected or no probable mechanism of ischemia was identified. Intracardiac thrombus was found in nine patients (6.5%); 32 (23.2%) had other cardiac disorders possibly related to the ischemia; and the remaining 97 (70.3%) had study results that were normal or added nothing to the clinical findings. Thus, 2D echocardiography was of limited value in patients with no clinical cardiac disease or hypertension only, and of greater value in patients with known cardiac disease, especially atrial fibrillation. Although 2D echocardiography can demonstrate a wide range of disorders that may be associated with ischemia, the overall low yield does not warrant routine use of this study in all patients with unexplained cerebral ischemic events.