Treatment of Cardiac problems in stroke

from table I NEJM 353:22:2361-72 "PFO in Young adults with unexplained stroke atrial myxoma-- sporadic or familial (Carney complex), most common primary cardiac tumor, 2:1 female predominance, less than 2 % of patients with cryptogenic stroke, rare but one third of cases present with systemic embolism. Treatment is surgical resection. No data regarding antiplatelet drugs or anticoagulation. Form papillary or pedicle may have gelatinous fragile extensions. papillary fibroelastoma (giant Lambl's excrescence)- hamartoma or reparative lesion of valves, usually left sided, aortic > mitral valve, much rarer cause of cryptogenic stroke, stroke risk is proportional to size and mobility, treatment is surgical if lesion > 1 cm, is mobile, otherwise best treatment not known. Valvular strands (Lambl's excrescence) filiform projections <> 2mm in systole, leads to MR; associations include CTD (Marfan's, EDS, others) 2.8 % of patients with cryptogenic stroke; rr stroke or TIA is 1.7 (age<> 50) with risk due to leaflet thickness, severity of MR, with strokes due to incident AF and mitral valve surgery. Treatment is antiplatelet therapy with anticoagulation not shown better; valve repair/replacement Intrapulmonary shunt-- very low occurrence with treatment is coil embolization aortic arch thrombosis-- thrombus attached to atheroma; very low occurrence; treatment is anticoagulation or surgery