Neurologic manifestations of cardiogenic embolism: An update

Cardiogenic embolism is increasingly appreciated as an important and preventable cause of stroke. The main advances in the past 5 years include the identification of different risk groups in patients with atrial fibrillation and additional characterization of the efficacy and toxicity of antithrombotic therapies. The importance of mitral valve prolapse as a primary embolic source is increasingly questioned. Antimicrobial rather than antithrombotic therapy is now recognized as the key to preventing embolism in native-valve endocarditis. Transesophageal echocardiography has opened a new window for the detection of "minor-risk" cardioembolic sources such as PFOs, but the clinical implications of their diagnosis are not entirely clear, and more evidence about the natural history of these abnormalities is needed. Once the absolute rate of stroke is established, randomized comparision of different treatments will be necessary to define the best management.