Autopsy series published a century ago, showed that cerebral emboli arising from the major vessels and the heart are an important pathophysiological cause of stroke.¹ Since then not much has changed. According to one recent and comprehensive textbook² embolism accounts for up to 60% of all ischemic strokes. Cardiac conditions associated with such cerebral emboli are atrial fibrillation in 45% of the cases, followed by acute myocardial infarction, ventricular aneurysm, rheumatic heart disease, prosthetic cardiac valves, aortic atheroma, and other causes.

With the availability of transesophageal echocardiography (TEE) in many stroke centres, intracardiac emboli resting in the left atrial appendage or left atrium can now be readily identified and treatment with anticoagulation can be installed.³ In this issue Sen et al ⁴ (see page 1421) have reassessed the cardiac risk …