Ischemic Stroke: Epidemiological and Etiological Profile of Patients Admitted to the Mohamed VI University Hospital of Marrakech, Morocco

Abstract

Introduction: Cerebrovascular stroke is a public health problem. They are dominated by ischemic origin, of which cardioembolic etiology is a significant cause. The aim of our study is to determine the in-hospital prevalence of cardiovascular disease in patients with cerebrovascular stroke and the diagnostic and therapeutic impact of all the complementary examinations carried out. Materials and Methods: This is a retrospective descriptive and analytical study carried out over a 7-year period (July 2017-June 2024) compiling cases of ischemic stroke admitted to the cardiology and neurology departments of the Mohamed VI University Hospital in Marrakech. Routine examinations included ECG, transthoracic cardiac echocardiography and echocardiography-doppler of the neck vessels, while transesophageal echocardiography (TEE) and Holter ECG were performed only in a select cases. Results: Three hundred cases were collected and evaluated. The mean age of the patients was 68.3 ± 8.9 years (21-90 years), with a clear male predominance (64.3%). Eighty percent had at least one cardiovascular risk factor. A cardiovascular history of hypokinetic cardiomyopathy at the dilated stage was found in 7.6% of cases. The average consultation time was 26 hours. Clinical presentation according to NIHSS score was as follows: a score below 10 in 65% of cases, between 10 and 20 in 21% and above 20 in 14%. ECG was abnormal in 67.6% of cases (203 patients); TTE was abnormal in 63%, with dilatation of the left atrium (LA) the main abnormality.  TEE in 8% of cases revealed 3 cases of inter-atrial aneurysm with patent foramen oval, seven cases of left atrial thrombus, one left atrial myxoma, 3 cases of mitral valve wing block and 2 cases of complex aortic atheroma exceeding 4 mm in thickness. Holter ECG revealed 27 cases of transition to atrial fibrillation Conclusion: Ischemic stroke etiologies are largely dominated by lacunar infarction and embolic heart disease, followed by atherosclerosis. This highlights the role of the cardiologist in both etiological management and in guiding the therapeutic approach. Thus, improving prognosis hinges on early diagnosis and a thorough etiological assessment before concluding a cryptogenic stroke.