| 0 |
Cardiac pathology not detected or not suspected. Ruling out a cardiac source of embolism: minimum is negative ECG and examination by a cardiologist, maximum is negative ECG/telemetry/24-hour Holter ECG/long-term ECG recording (implantable device, transtelephonic ECG, loop recorder) and negative TEE for atrium, valves and septal abnormalities, negative TTE for PFO and assessment of left ventricle, negative cardiac CT/MRI, negative abdominal CT/MRI (search for old or simultaneous subdiaphragmatic visceral infarction) |
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Cardiac pathology not detected or not suspected. Ruling out a cardiac source of embolism: minimum is negative ECG and examination by a cardiologist, maximum is negative ECG/telemetry/24-hour Holter ECG/long-term ECG recording (implantable device, transtelephonic ECG, loop recorder) and negative TEE for atrium, valves and septal abnormalities, negative TTE for PFO and assessment of left ventricle, negative cardiac CT/MRI, negative abdominal CT/MRI (search for old or simultaneous subdiaphragmatic visceral infarction) |
| 1 |
Potentially causal. Cardiogenic stroke defined as acute, or recent and older bihemispheric or supra- and infratentorial territorial or cortical ischemic lesions and signs of systemic embolism with detection of at least one of the following potential causes: (1) mitral stenosis (surface <1.5 cm 2 ), (2) mechanical valve, (3) myocardial infarction within 4 weeks preceding the cerebral infarction, (4) mural thrombus in the left cavities, (5) aneurysm of the left ventricle, (6) history or presence of documented atrial fibrillation – whether paroxysmal (>60 s), persistent or permanent – or flutter, with or without left atrial thrombus or spontaneous echo, (7)atrial disease (tachycardia-bradycardia syndrome), (8) dilated or hypertrophic cardiomyopathies, (9) left ventricle ejection fraction <35%, (10) endocarditis, (11) intracardiac mass, (12) PFO and thrombus in situ, (13) PFO and concomitant pulmonary embolism or proximal DVT preceding the index cerebral infarction, (14) aforementioned cardiac pathologies (C1) with single or without obvious cerebral ischemic lesion |
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Potentially causal. Cardiogenic stroke defined as acute, or recent and older bihemispheric or supra- and infratentorial territorial or cortical ischemic lesions and signs of systemic embolism with detection of at least one of the following potential causes: (1) mitral stenosis (surface <1.5 cm 2 ), (2) mechanical valve, (3) myocardial infarction within 4 weeks preceding the cerebral infarction, (4) mural thrombus in the left cavities, (5) aneurysm of the left ventricle, (6) history or presence of documented atrial fibrillation – whether paroxysmal (>60 s), persistent or permanent – or flutter, with or without left atrial thrombus or spontaneous echo, (7)atrial disease (tachycardia-bradycardia syndrome), (8) dilated or hypertrophic cardiomyopathies, (9) left ventricle ejection fraction <35%, (10) endocarditis, (11) intracardiac mass, (12) PFO and thrombus in situ, (13) PFO and concomitant pulmonary embolism or proximal DVT preceding the index cerebral infarction, (14) aforementioned cardiac pathologies (C1) with single or without obvious cerebral ischemic lesion |
| 2 |
Causal link is uncertain. Regardless of stroke pattern: (1) PFO + atrial septal aneurysm, (2) PFO and pulmonary embolism or proximal DTV concomitant but NOT preceding the index cerebral infarction, (3) intracardiac spontaneous echo-contrast, (4) apical akinesia of the left ventricle and decreased ejection fraction (but >35%), (5) history of myocardial infarction or palpitation and multiple brain infarction, repeated either bilateral or in two different arterial territories (e.g. both anterior and posterior circulation), (6) no direct cardiac source identified, but multiple brain infarction, repeated either bilateral or in two different arterial territories (e.g. both anterior and posterior circulation) and/or evidence of systemic emboli: renal or splenic or mesenteric infarction (on CT, MRI or autopsy) or embolism in peripheral artery supplying arm or leg |
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Causal link is uncertain. Regardless of stroke pattern: (1) PFO + atrial septal aneurysm, (2) PFO and pulmonary embolism or proximal DTV concomitant but NOT preceding the index cerebral infarction, (3) intracardiac spontaneous echo-contrast, (4) apical akinesia of the left ventricle and decreased ejection fraction (but >35%), (5) history of myocardial infarction or palpitation and multiple brain infarction, repeated either bilateral or in two different arterial territories (e.g. both anterior and posterior circulation), (6) no direct cardiac source identified, but multiple brain infarction, repeated either bilateral or in two different arterial territories (e.g. both anterior and posterior circulation) and/or evidence of systemic emboli: renal or splenic or mesenteric infarction (on CT, MRI or autopsy) or embolism in peripheral artery supplying arm or leg |
| 3 |
Causal link is unlikely, but the disease is present. One of the following abnormalities present in isolation: PFO, ASA, strands, mitral annulus calcification, calcification aortic valve, nonapical akinesia of the left ventricle, transient atrial fibrillation |
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Causal link is unlikely, but the disease is present. One of the following abnormalities present in isolation: PFO, ASA, strands, mitral annulus calcification, calcification aortic valve, nonapical akinesia of the left ventricle, transient atrial fibrillation |
| 9 |
Incomplete workup. Minimum is ECG and examination by a trained cardiologist in the absence of cardiac imaging. |
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Incomplete workup. Minimum is ECG and examination by a trained cardiologist in the absence of cardiac imaging. |