ORIGINAL COMMUNICATION A novel prognostic marker in acute ischemic stroke: small pericardial effusion Murat Biteker • Ahmet I ˙ lker Tekkes ¸in • Akın Dayan • Cemile Handan Mısırlı Received: 11 March 2012 / Accepted: 27 March 2012 / Published online: 19 April 2012 Ó Springer-Verlag 2012 Abstract The study aimed to evaluate the prognostic importance of small pericardial effusion (SPE) found on echocardiography in a cohort of patients hospitalized for acute ischemic stroke. We prospectively followed a series of 408 consecutive first-ever acute ischemic stroke patients aged C50 years who were admitted to the hospital within 24 h of the onset of stroke symptoms. All of the patients underwent transthoracic echocardiography within the first 48 h. Exclusion criteria were cardiothoracic surgery or acute myocardial infarction within the previous 6 months, a moderate or greater pericardial effusion ( [ 1 cm if cir- cumferential), and inadequate visualization of the pericar- dial space. The patients were followed for 1 year or until death, whichever came first. SPE was noted in 64 (15.7 %) of the patients. Mortality at 1 year was greater for patients with a small effusion (n = 21, 32.8 %) compared to those without an effusion (n = 40, 11.6 %, p \ 0.001). After adjustment for age, demographics, medical history, and other echocardiographic findings, SPE remained associ- ated with higher mortality (OR 2.515; 95 % CI 1.188–5.477; p = 0.008). This study is the first to demonstrate that the presence of SPE is associated with increased mortality in patients with first-ever acute ischemic stroke. Keywords Acute ischemic stroke Á Transthoracic echocardiography Á Small pericardial effusion Introduction Pericardial effusion is the abnormal accumulation of fluid in the pericardial space which may occur as a result of a variety of clinical conditions, including infections, auto- immune, inflammatory or hematologic diseases, chronic renal failure, malignancy, radiation, aortic dissection, hypothyroidism, trauma, acute myocardial infarction or as an idiopathic pericardial effusion [1]. The mortality and morbidity of pericardial effusion depends on the underlying etiology and comorbid conditions [2, 3]. Although often asymptomatic, presence of small peri- cardial effusion is shown to be associated with increased mortality in patients with human immunodeficiency virus infection [4] and in a cohort of patients undergoing transthoracic echocardiography [5]. However, there are no data in the literature regarding the prevalence and importance of pericardial effusion in patients with acute ischemic stroke. Therefore, in this study we sought to examine the prevalence of small pericardial effusion (SPE) in acute ischemic stroke patients, and its association with all-cause mortality. M. Biteker (&) Á A. I ˙ . Tekkes ¸in Department of Cardiology, Haydarpas ¸a Numune Education and Research Hospital, Tıbbıye Cad. No. 40, Uskudar, Istanbul, Turkey e-mail: murbit2@yahoo.com A. Dayan Department of Family Medicine, Haydarpas ¸a Numune Education and Research Hospital, Tıbbıye Cad. No. 40, Uskudar, Istanbul, Turkey C. H. Mısırlı Department of 1st Neurology, Haydarpas ¸a Numune Education and Research Hospital, Tıbbıye Cad. No. 40, Uskudar, Istanbul, Turkey 123 J Neurol (2012) 259:2354–2359 DOI 10.1007/s00415-012-6501-y