A decreased left atrial strain (LAS), identified by two-dimensional speckle tracking echocardiography (2D-STE) in transthoracic echocardiography (TTE), has been associated with the onset of atrial fibrillation (AF). We conducted a retrospective study to assess the usefulness of LAS in 41 patients with cardiogenic cerebral embolism (CE) related to AF or paroxysmal AF (CE group), as well as in 238 patients with other types of ischemic stroke (non-CE group). We evaluated the left atrial dimension (LAD), left atrial volume index (LAVI), and left ventricular ejection fraction (LVEF) using TTE. The results showed that LAD and LAVI were significantly higher, while LAS was significantly lower in the CE group than those in the non-CE group. When using cutoff values of 40.2mm for LAD, 29.8ml/m2 for LAVI, and 21.9% for LAS, the accuracy rate for the CE group was 80.6%, 76.3%, and 84.6%, respectively. The odds ratio adjusted for confounding factors was 5.61, 3.49, and 5.43, respectively. These findings suggest that LAS may be useful for the diagnosis of CE.

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Cardiogenic cerebral embolism is a well-known cause of ischemic stroke, typically associated with conditions like atrial fibrillation and acute myocardial infarction. However, left ventricular noncompaction (LVNC) is a rare but recognized cause of ischemic stroke, particularly in younger individuals. Case 1: A man in his 30s presented with sudden right hemiplegia and articulation disorder. An MRI confirmed a new cerebral infarction, and transthoracic echocardiography (TTE) revealed a thickened and compacted layer at the apex of the left ventricle. Cardiac MRI supported the diagnosis of LVNC, indicating it as the likely source of embolism. Case 2: Another man in his 30s with worsening dyspnea was diagnosed with acute congestive heart failure. TTE showed reduced left ventricular contraction and trabecular formations. However, after 13 days, he developed right-sided weakness, and MRI confirmed the occurrence of a new cerebral infarction. LVNC was suspected as the underlying cause of the embolism in this case. LVNC is characterized by echocardiographic findings such as trabecular formations and blood-filled lesions within the myocardium. However, distinguishing true LVNC from remodeling-related trabecular-formation can be challenging. Therefore, when echocardiographic images resemble LVNC, it is crucial to consider the possibility of LVNC as a potential cause of ischemic stroke.

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Vertebral artery (VA) stump syndrome is a condition characterized by ischemic stroke in the posterior circulation caused by thrombi originating from occluded VA. Case: A 70-year-old male was admitted to our hospital with dizziness and dysarthria, score 4 on the National Institutes of Health Stroke Scale (NIHSS). Brain MRI revealed multiple embolic infarctions in the bilateral cerebellar hemispheres, and MRA showed poor delineation of the bilateral VA and basilar artery. Duplex ultrasonography demonstrated an antegrade flow pattern despite proximal occlusion of bilateral VAs. A delayed systolic upstroke flow was observed in the left VA, and collateral flow at the C5 level of the bilateral VA was detected. Based on these findings, the patient was diagnosed with VA stump syndrome. Abnormal duplex flow patterns associated with VA stump syndrome has been previously reported. Prompt diagnosis is crucial, as VA stump syndrome has a high risk of recurrence. This case highlights the importance of skilled carotid ultrasonography in accurately diagnosing VA stump syndrome.

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