This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Cheung, R. T.F. Articles by Kaposzta, Z. Search for Related Content PubMed Articles by Cheung, R. T.F. Articles by Kaposzta, Z.

(Stroke. 2000;31:1785-a.)
© 2000 American Heart Association, Inc.

Letters to the Editor

Clinical Relevance of Detecting Asymptomatic Embolic Signals in Acute Stroke

Raymond T.F. Cheung, MBBS, PhD, FRCPE

Division of Neurology, Department of Medicine, Queen Mary Hospital, Hong Kong

To the Editor:

Kaposzta and colleagues successfully performed bilateral transcranial Doppler (TCD) examination and other measurements in 100 of 119 patients with acute anterior circulation infarction within 72 hours of stroke onset.¹ Asymptomatic embolic signals (AES) were detected over the side of stroke in 16 patients; presence of AES was associated with significant carotid stenosis/occlusion, whereas absence of AES was associated with lacunar infarction in patients without significant carotid disease and potential cardiac embolic sources.¹ I wish to make the following comments.

First, the authors reported that 19 of the 119 consecutive patients did not have an acoustic window for the bilateral TCD examination.¹ Exclusion of other patients was not mentioned in the article. Did any patient/relative refuse to participate in the study? Was there any patient who could not tolerate the 1-hour TCD examination because of unstable conditions and/or restlessness?

Second, early use of aspirin has been shown to be beneficial in acute ischemic stroke,^{2 3} but antiplatelet agents and anticoagulants were withheld in the 30 patients who underwent the serial TCD examinations.¹ Although there was no difference in the frequency of prior use of aspirin between patients with AES and those without AES, I am interested to know whether the dosage of aspirin is related to the presence of AES.

Third, it is important to note how the authors classified the stroke subtypes according to the presumed etiology. Ten of the 16 patients positive for AES were classified under the etiological category of significant carotid artery disease, and 2 . . . [Full Text of this Article]

Hugh Markus, DM Zoltan Kaposzta, MD

Division of Clinical Neuroscience, St. George’s Hospital Medical School, London, UK