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Transesophageal echocardiographic findings in subcortical and cortical stroke

      The anatomic location of stroke, namely, cortical or subcortical, has traditionally been considered dependent on the etiology. Cortical strokes, which account for up to 80% of cerebral infarcts, are believed to be due to carotid atherosclerotic disease or emboli from cardiac sources or thoracic aortic atherosclerotic plaque.
      • Kunitz S.C
      • Gross C.R
      • Hayman A
      • Kase C.S
      • Mohr J.P
      • Price T.R
      • Wolf P.A
      The pilot stroke data bank definition, design, and data.
      ,
      • Mohr J.P
      • Caplan L.R
      • Melski J.W
      • Goldstein J.R.J
      • Duncan G.W
      • Kistler J.P
      • Pessins M.S
      • Bleich H.L
      The Harvard Cooperative Stroke Registry a prospective registry.
      In contrast, subcortical strokes have historically been attributed to intracranial small vessel disease.
      • Fisher C.M
      Lacunes small, deep cerebral infarcts.
      ,
      • Bamford J.M
      • Warlow C.P
      Evolution and testing of the lacunar hypothesis.
      ,
      • Fisher C.M
      Capsular infarcts—the underlying vascular lesions.
      ,
      • Lodder J
      • Bamford J.M
      • Sandercock P.A.G
      • Jones L.N
      • Warlow C.P
      Are hypertension or cardiac embolism likely causes of lacunar infarction?.
      ,
      • Mohr J.P
      Lacunes.
      Transesophageal echocardiography (TEE), therefore, is not routinely performed in patients with subcortical stroke because a cardioembolic mechanism is not often considered an etiologic mechanism. The prevalence of aortic atherosclerotic disease and cardiac sources of emboli detected by TEE has not been specifically defined in patients with subcortical stroke. This study examines whether transesophageal echocardiographic evidence of potential aortic or cardiac sources of emboli are equally common in subcortical or cortical stroke.
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