Background and purpose: Ischemic stroke during hospitalization can occasionally be found, but the mechanisms and causes underlying stroke have not been investigated in detail. The present study aimed to identify differences in stroke etiology between in-hospital and out-of-hospital onset.
Methods: Subjects comprised 357 consecutive patients (221 men, 136 women) with ischemic stroke prospectively enrolled within 24 h of onset. Contrast saline transcranial Doppler ultrasonography (c-TCD) or transesophageal echocardiography (TEE) was performed in all participants to identify right-to-left shunts (RLS). Patients were divided into 2 groups: in-hospital onset (IHO group, n=49); and out-of-hospital onset (OHO group, n=308). Clinical characteristics were compared between groups.
Results: Mean age was 71.5+/-12.3 years. Mean National Institute of Health stroke scale score was 6.9+/-7.2. RLS, atrial fibrillation (AF) and malignancy were more frequent in the IHO group than in the OHO group (39% vs. 20%, p=0.006; 45% vs. 16%, p<0.001; 18% vs. 4%, p<0.001, respectively). AF and/or RLS was more frequent in the IHO group (61%) than in the OHO group (30%, p<0.001).
Conclusion: Ischemic stroke with in-hospital onset may be associated with AF and RLS.