Sources with high primary risk for ischemic stroke | Sources with low or uncertain primary risk for ischemic stroke |
Atrial fibrillation | Cardiac sources of embolism: |
Paroxysmal atrial fibrillation | Mitral annular calcification |
Left atrial thrombus | Patent foramen ovale |
Left ventricular thrombus | Atrial septal aneurysm |
Sick sinus syndrome | Atrial septal aneurysm and patent foramen ovale |
Atrial flutter | Left ventricular aneurysm without thrombus |
Recent myocardial infarction (within one month prior to stroke) | Left atrial spontaneous echo contrast ("smoke") |
Mitral stenosis or rheumatic valve disease | Congestive heart failure with ejection fraction <30% |
Mechanical heart valves | Bioprosthetic heart valves |
Chronic myocardial infarction together with low ejection fraction (<28%) | Apical akinesia |
Dilated cardiomyopathy (prior established diagnosis or left ventricular dilatation with an ejection fraction of <40% or fractional shortening of <25%) | Wall motion abnormalities (hypokinesia, akinesia, dyskinesia) other than apical akinesia |
Nonbacterial thrombotic endocarditis | Hypertrophic cardiomyopathy |
Infective endocarditis | Left ventricular hypertrophy |
Papillary fibroelastoma | Left ventricular hypertrabeculation/non-compaction |
Left atrial myxoma | Recent aortic valve replacement or coronary artery bypass graft surgery |
Presence of left ventricular assist device | Paroxysmal supraventricular tachycardia |
Aortic sources of embolism: | |
Complex atheroma in the ascending aorta or proximal arch (protruding with >4 mm thickness, or mobile debris, or plaque ulceration) |
Reproduced and modified with permission from: Ay H, Furie KL, Singhal A, et al. An evidence-based causative classification system for acute ischemic stroke. Ann Neurol 2005; 58:688. Copyright © 2005 American Neurological Association.
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