Cryptogenic Stroke: Diagnostic Workup and Management

AbstractPurpose of reviewCryptogenic stroke describes a subset of ischemic stroke for which no cause can be found despite a structured investigation. There are a number of putative mechanisms of cryptogenic ischemic stroke including a covert structural cardiac lesion, paroxysmal atrial fibrillation, hypercoagulable state or undiagnosed malignancy. Because many of these proposed mechanisms are embolic – and based on studies of thrombus history showing commonalities between thrombus composition between cardioembolic and cryptogenic strokes – the concept of embolic stroke of undetermined source (ESUS) (Hart et al. Lancet Neurol. 13(4):429–38,2014; Stroke. 48(4):867 –72,2017) has been proposed to describe cryptogenic strokes that may warrant systemic anticoagulation. In this review, we discuss the phenomena of cryptogenic stroke, ESUS and a proposed management pathway.Recent findings1. The concept of ESUS was proposed in 2014 as a potentially useful therapeutic entity. Two recent trials – NAVIGATE-ESUS (Hart et al. N Engl J Med. 378(23):2191–201,2018) and RESPECT-ESUS (Diener2018) were proposed based on this concept. They were negative for their primary endpoint and for the secondary endpoint of ischemic stroke recurrence. Post-hoc analysis of the WARSS trial (Longstreth et al. Stroke. 44(3):714 –9,2013) suggested that people with elevated pro-BNP benefited from systemic anticoagulation whereas those with a normal pro-BNP did not. This le...
Source: Current Treatment Options in Cardiovascular Medicine - Category: Cardiology Source Type: research

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AbstractFew data are available on age-related burden and characteristics of embolic stroke of undetermined source (ESUS) in the real world clinical practice. The aim of our study was to provide information about it. We retrospectively analyzed data of patients consecutively admitted to our Stroke Unit along 1  year (2017, November 1st–2018, October 31st). The etiology of ischemic stroke was defined at hospital discharge; ESUS was considered as a subset of cryptogenic stroke, and defined according to the 2014 international criteria. In the analyzed period, 306 patients, 52.3% females, mean age ±&thi...
Source: Journal of Thrombosis and Thrombolysis - Category: Hematology Source Type: research
AbstractPurpose of ReviewThis review will discuss the most frequent sources of cardiac embolism and the role of echocardiography in these different clinical settings, and, in addition, provide suggestions about the choice between transthoracic (TTE) and transesophageal echocardiography (TEE).Recent FindingsStroke is the third leading cause of death in industrial countries, and 15 –40% of all ischemic strokes are due to cardioembolism. TTE and TEE are cornerstones in the detection of cardioembolic sources and provide fundamental information about the embolic risk and most suitable treatment of these patients, improvin...
Source: Current Cardiology Reports - Category: Cardiology Source Type: research
Abstract BACKGROUND: Previous randomized controlled trials (RCT) failed to demonstrate benefits of patent foramen ovale (PFO) closure (PFO-C) over medical therapy (MT) for secondary prevention of cryptogenic ischemic stroke. Three recently published RCTs, however, turned out positive for PFO-C and warrant an updated meta-analysis. METHODS: Data from all available RCTs on PFO-C vs. MT for secondary prevention of cryptogenic ischemic stroke up until October 2017 were abstracted and analyzed in a comprehensive meta-analysis. Clinical efficacy outcomes were recurrent stroke, recurrent TIA, and their combination; ...
Source: Clin Med Res - Category: Research Authors: Tags: Clin Res Cardiol Source Type: research
AbstractBackgroundPrevious randomized controlled trials (RCT) failed to demonstrate benefits of patent foramen ovale (PFO) closure (PFO-C) over medical therapy (MT) for secondary prevention of cryptogenic ischemic stroke. Three recently published RCTs, however, turned out positive for PFO-C and warrant an updated meta-analysis.MethodsData from all available RCTs on PFO-C vs. MT for secondary prevention of cryptogenic ischemic stroke up until October 2017 were abstracted and analyzed in a comprehensive meta-analysis. Clinical efficacy outcomes were recurrent stroke, recurrent TIA, and their combination; safety outcomes were...
Source: Clinical Research in Cardiology - Category: Cardiology Source Type: research
Conclusions:Approximately 1 in 6 patients who undergo percutaneous transcatheter closure of PFO after stroke or transient ischemic attack experience a serious complication or death within 5 years.Study Supported by:Dr. Gialdini is supported by the Feil Family Foundation.Dr. Navi is supported by NIH grant K23NS091395 and the Florence Gould Endowment for Discovery in Stroke.Dr. Iadecola is supported by NIH grants R37NS089323-02, R01NS034179-21, R01NS037853-19, and R01 NS073666-04.Dr. Kamel is supported by NIH grants K23NS082367 and R01NS097443 as well as the Michael Goldberg Research Fund.Disclosure: Dr. Merkler has nothing ...
Source: Neurology - Category: Neurology Authors: Tags: Cerebrovascular Disease and Interventional Neurology: Stroke Prevention and Translation Source Type: research
Background and Purpose— We hypothesized that formation of left atrial appendage (LAA) thrombi of unknown origin is associated with altered fibrin clot properties and blood hypercoagulability. Methods— In a case–control study, we investigated 32 patients with a history of LAA thrombus after successful anticoagulant treatment versus 32 control subjects matched for age, sex, and diabetes mellitus. All subjects had previous ischemic stroke, transient ischemic attack, or migraine associated with patent foramen ovale. Patients with documented atrial fibrillation were excluded. We determined plasma fibrin clot ...
Source: Stroke - Category: Neurology Authors: Tags: Ischemic Stroke Clinical Sciences Source Type: research
Please wait while the activity loads. If this activity does not load, try refreshing your browser. Also, this page requires javascript. Please visit using a browser with javascript enabled. If loading fails, click here to try again Click on the 'Start' button to begin the mock test. After answering all questions, click on the 'Get Results' button to display your score and the explanations. There is no time limit for this mock test. Start Congratulations - you have completed DM / DNB Cardiology Entrance Mock Test 19. You scored %%SCORE%% out of %%TOTAL%%. Your performance has been rat...
Source: Cardiophile MD - Category: Cardiology Authors: Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Please wait while the activity loads. If this activity does not load, try refreshing your browser. Also, this page requires javascript. Please visit using a browser with javascript enabled. If loading fails, click here to try again Click on the 'Start' button to begin the mock test. After answering all questions, click on the 'Get Results' button to display your score and the explanations. There is no time limit for this mock test. Start Congratulations - you have completed DM / DNB Cardiology Entrance Mock Test 7. You scored %%SCORE%% out of %%TOTAL%%. Your performance has been rate...
Source: Cardiophile MD - Category: Cardiology Authors: Tags: Cardiology MCQ DM / DNB Cardiology Entrance Featured Source Type: blogs
Conclusion: There may be a role for NOACs in stroke prevention and treatment beyond atrial fibrillation. Randomized controlled trials are needed to compare NOACs to current stroke prevention and treatment strategies in certain subgroups of patients with cerebrovascular disease.
Source: Neurology - Category: Neurology Authors: Tags: Stroke prevention, All Cerebrovascular disease/Stroke, Infarction, Cerebral venous thrombosis VIEWS & amp;amp; REVIEWS Source Type: research
ConclusionsThe Gore® Septal Occluder is an efficient device for patent foramen ovale closure in challenging anatomies, including longā€tunnel PFOs and atrial septal aneurysms.
Source: Journal of Interventional Cardiology - Category: Cardiology Authors: Tags: Original Investigation Source Type: research
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