Abstract
BACKGROUND: Stroke in athletes is believed to be rare given fewer traditional stroke risk factors in this population, although there is a distinct lack of data. We present a case series of 6 veteran endurance athletes who experienced symptomatic strokes and underwent cardiovascular magnetic resonance imaging. CASE SUMMARY: Underlying causes of the stroke were established in 5 athletes: atrial fibrillation (n = 2), likely apical hypertrophic cardiomyopathy with thrombus, patent foramen ovale, and carotid artery dissection. Nonischemic myocardial fibrosis was highly prevalent, while exercise-induced hypertension was present in approximately half of the cases. DISCUSSION: Our findings illustrate a range of etiologies causing stroke in athletes. They also highlight weaknesses with stroke risk-stratification methods in athletes with atrial fibrillation, along with possible modifiable risk factors including masked hypertension and exercise-induced hypertension. Our cases highlight the role of cardiovascular magnetic resonance in detecting the etiology of stroke and propose myocardial fibrosis as a potential novel marker of stroke risk in veteran endurance athletes.