Dr Hart is correct in emphasizing the continued controversy in the therapy of cardiogenic cerebral embolism. In our study of 60 hospitalized patients, 59 were treated with immediate (ie, within one to two hours of the initial CT scan) full-dose anticoagulation with heparin sodium; one patient with initial CT evidence of a hemorrhagic infarct was excluded. As reported in our study, one patient (1.7%) developed punctate hemorrhages in the area of infarction while on heparin therapy but remained clinically stable. While it is possible that hemorrhagic transformation is more common than detected, we cannot draw conclusions, because a CT scan was not repeated in all of our patients. Except for two patients with large infarcts on repeated study, we estimated the average size of the infarctions (maximum cross-section diameter) in our patients to be 5 × 3 cm. We have arbitrarily considered large or massive infarcts those associated with
Martin GJ, Biller J. Cerebral Emboli of Cardiac Origin-Reply. Arch Intern Med. 1985;145(7):1329–1330. doi:10.1001/archinte.1985.00360070211040
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