The improved yield of transesophageal echocardiography over transthoracic echocardiography in patients with neurological events is largely due to the detection of aortic protruding atheromas.

It is important to determine what, if any, the added contribution of transesophageal echocardiography is to the evaluation of patients with unexplained strokes and transient ischemic attacks. Transesophageal echocardiography was performed in 283 consecutive patients over an 8-month period. The reason for referral in 63 of these patients was unexplained stroke or transient ischemic attack. These 63 studies were evaluated for the presence of lesions that could be etiologic in these patients, including protruding aortic atheromas, spontaneous echo contrast, atrial septal aneurysms, and atrial clots. The transesophageal and transthoracic techniques were compared. The main finding was that there were 23 abnormal findings that might have been responsible for stroke or transient ischemic attacks seen on transesophageal echocardiography, which were not visualized on transthoracic echocardiography. Transthoracic echocardiography was false negative in 19 (30%) of 63 patients. None of the protruding aortic arch atheromas seen on transesophageal echocardiography were diagnosed with transthoracic echocardiography. Transesophageal echocardiography is indicated in the evaluation of patients with unexplained strokes and transient ischemic attacks, and the added yield of this technique is largely due to the finding of protruding aortic arch atheromas.