Based on a new study, researchers urge more comprehensive imaging for patients presenting to hospitals with stroke symptoms. Using both MRI and echocardiography to image the heart greatly enhances the detection of the cause and selection of the best treatment of cardioembolic strokes, the "meanest" type of stroke.

A cardioembolic stroke occurs when a thrombus (clot) dislodges from the heart, travels through the cardiovascular system and lodges in the brain, first cutting off the blood supply and then often causing a hemorrhagic bleed -- a double whammy of both types of stroke, ischemic first and then hemorrhagic. The study found that MRI detected nearly twice as many sources of stroke in the heart than echocardiogram alone. It also showed the ability of MRI to reveal more heart disease conditions that contribute to clot formation in the first place. Echocardiography, however, was strong in the detection of heart valve lesions. Combined, these imaging systems can more clearly identify underlying causes of future stroke, helping doctors decide the best initial therapy and the best treatment to prevent a secondary stroke. The research was presented at the recent Society of Interventional Radiology meeting.

"This can revolutionize patient care because we can detect the underlying cause of the stroke and prevent it from occurring again," says lead author John Sheehan, M.D., an interventional radiologist at Northwestern University and Northwestern Memorial Hospital. "A potential cardiac source should be considered in all patients presenting with ischemic strokes. All stroke patients should routinely have an MRI and ultrasound of their heart, in addition to having their brain and carotids imaged with CT and MRI. It's nice to be on the front end of a stroke -- able to stop it, than on the back end, figuring out how to deal with its damage."
Stroke teams generally consist of emergency room physicians, neurologists, and interventional radiologists. Interventional radiologists are a critical part of the stroke team because they can diagnose and treat ischemic stroke with clot-busting drugs, or open a blocked carotid artery nonsurgically. They are also actively involved in creating more stroke teams across the country.

Cardioembolic strokes, which account for 20 percent of embolic strokes, have a worse prognosis, producing larger, more disabling strokes that are more likely to recur compared to other types of stroke. Blood clots can be treated with drugs before they can leave the heart, in conjunction with treating identified heart conditions, to prevent another life-threatening stroke. In the United States stroke is the leading cause of adult disability and the third leading cause of death; only heart disease and cancer cause more deaths annually.

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