The diagnosis of a cardiogenic embolic stroke may be difficult to make with certainty since about 25% of patients with brain ischaemia and a cardiac source of embolism have other identifiable causes of stroke.
The diagnostic 'gold standard' is to demonstrate embolic arterial occlusion in the absence of atherosclerosis using arteriography. This must be done very early and is seldom practical.
The cardiac source, patients age, and any existing vascular disease must therefore be considered in reaching a diagnosis.
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