Cerebral Embolism: Etiologies, Presentation, and Urgency

Cerebral embolism = occlusion of a cerebral artery by traveling material (embolus). Time is brain – treat as stroke emergency.

Major Embolic Sources

1. Cardiac (cardiogenic) – atrial fibrillation (most common), mural thrombus post-MI, valvular disease, cardiomyopathy, paradoxical via PFO.
2. Arterial (artery-to-artery) – atherosclerotic plaque rupture in carotid/vertebral arteries.
3. Other – fat (long bone fracture), air (surgery, trauma), tumor cells, septic (endocarditis), foreign material.

Clinical Presentation

• Sudden focal neurologic deficit (weakness, aphasia, vision loss, ataxia).
• Maximal at onset (vs. progressive in thrombosis).
• May have cardiac signs (irregular pulse, murmur).

Acute Management

• IV alteplase (tPA) within 4.5 hrs if eligible.
• Mechanical thrombectomy for large vessel occlusion (LVO) up to 24 hrs (selected).
• Anticoagulation for cardioembolic (delayed 1–14 days per infarct size).
• Secondary prevention: anticoag for AF, antiplatelet for atherosclerotic, statin, risk factor control.