Neurology and the heart

[...]even older patients with significant extracranial vascular disease may harbour a possible cardiac source of embolism. [...]between 15% and 35% of stroke patients with a significant (>60%) stenosis of the extracranial vasculature demonstrated by arteriography may also have a probable cardiac embolic source. 2 3 Even lacunar infarcts (often thought to be secondary to disease of penetrating vessels in the brain as a result of hypertension) may be associated with potentially embolic cardiac pathology in 50% of cases. 3 This review considers the currently debated cardiac issues faced by neurologists and cardiologists in the prophylaxis and management of stroke patients: anticoagulation for atrial fibrillation; incidence of cerebral haemorrhage and infarction, together with its prevention in infective endocarditis; and the cognitive and focal neurological consequences of cardiac surgery. Many of the risk factors for atrial fibrillation also cause atherosclerosis. [...]Kanter et al reviewed the incidence of carotid stenosis>50% by ultrasound investigation in 676 patients in chronic atrial fibrillation. 7 In patients older than 70 years of age, 12% had significant concomitant carotid stenosis which may have been the dominant influence on occurrence of stroke.