Abstract
Echocardiography is a noninvasive and useful tool to detect cardiovascular source of cerebral embolism. Although transthoracic echocardiography is easy to detect cardiovascular abnormalities, transesophageal echocardiography is superior to transthoracic approach in terms of the image quality. We should use both of transthoracic and transesophageal echocardiography in a complementary way. Left ventricular thrombus is occasionally found in patients with myocardial infarction and dilated cardiomyopathy and is usually well ob-served by transthoracic echocardiography. Left atrial thrombus is a major source of embolism and trans-esophageal echocardiography is indispensable to detect it. Transesophageal echocardiography is also useful to detect aortic atheroma and vegetation in infective endocarditis. Atrial aneurysm is associated with paradoxical embolism. The presence of right-to-left shunting can be confirmed by contrast echocardiography and the Valsalva maneuver. Therefore, if a patient has stroke of unknown origin, this procedure should be done. Cardiac tumors also cause cerebral embolism. Myxoma is most common among cardiac tumors and soft and polypoid one with irregular surface is at a high risk of embolism. Papillary fibroelastoma incidentally found on the mitral or aortic valve in asymptomatic aged people may also be a source of cerebral embolism.
