Neurology Central

New insights into protecting the brain from the heart

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One in about 400 people suffer a stroke each year and nearly one in six dies, making it one of the top five leading cause of death overall and the leading cause of serious disability [1]. Indeed, most older people fear disabling stroke more than death itself. At 6 months following a stroke, 50% of patients have remaining hemiparesis, 30% linger unable to walk without assistance, 46% have cognitive deficits, 35% have depressive symptoms, 19% have aphasia, 26% are dependent on others for activities of daily living and 26% are institutionalized in a nursing home [2]. The heart plays a pivotal role in about half of all ischemic strokes. As such, it may be either the origin of thrombi (cardioembolism) or act as the conduit for thrombi traveling from a venous source, such as deep vein thrombosis, to the brain (paradoxical embolism). In fact, due to the physical size of cardiogenic emboli, these strokes are more devastating than those related to atherosclerotic vascular disease resulting in 50% mortality after 1 year [3]. Over the past years, important insights have been gained to understand the impact and curtail the danger of the heart in embolic stroke with particular focus on atrial fibrillation (AF) and patent foramen ovale (PFO). Several other cardiac abnormalities, such as focal ventricular dyskinesia and congestive heart failure remain targets for future research.
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