1986 Volume 8 Issue 5 Pages 393-400
Eight patients (6 males and 2 females, mean age of 56, ranged 41 to 73 years) with idiopathic cardiomyopathy (ICM) admitted to our department because of cerebral embolism from 1979 to 1985.
In contrast, there were only 4 patients with mitral valve stenosis resulting in cerebral embolism, who admitted during the same period. Thus, ICM appears to be one of the most common heart diseases which might lead to cerebral emboli in recent years when rheumatic heart diseases extremely declined. Types of ICM were determined by echocardiography. The result was that 3 were dilated, 4 were hypertrophic and one was hypertrophic obstructive. Cerebral embolism, which has been thought to be rare, was found not uncommon in patients with obstructive ICM when associated with atrial fibrillation and/or congestive heart failure.
The characteristics of the clinical feature in stroke were as follows :
1) recurrence occurred frequently, 2) strokes began preferably at work, but occasionally at bed rest, 3) impairment of consciousness was absent or mild, and 4) prognosis was good provided no fatal complications occur in other organs, although the extent of residual symptoms was quite variable among individuals.
On CT scan, infarcts were shown in carotid system in 5 patients and vertebrobasilar system in one, and no abnormal density was found in 2 patients, in one of whom a delayed perfusion was exhibited over both systems of the affected side. Two of the 5 infarcts in the carotid territory were hemorrhagic.
Of hemostatic examinations, increases in plasma beta-thromboglobulin, platelet factor 4 and in blood viscosity were frequently observed. These results indicate that platelet activation and rheological abnormality exist, and might contribute to intracardiac thrombogenesis in ICM. Recurrence of strokes occurred in 4 of the 5 patients treated with antiplatelet agent, ticlopidine or aspirin. Thus, antiplatelet therapy appears to be less effective in stroke prevention in ICM. Instead, anticoagulant therapy should be attempted to prevent subsequent embolism in patients with ICM.
