7 Behaviors That Reduce the Risk of a Cryptogenic Stroke - Oren Zarif - Cryptogenic Stroke
While the exact cause of a cryptogenic stroke is not yet known, there are certain steps you can take to reduce the risk. These steps may include making sure your heart rate is monitored regularly, undergoing diagnostic testing, and adopting a healthier lifestyle. Listed below are seven behaviors that you can implement to reduce your risk. If you have experienced a cryptogenic stroke, you should call 911 right away. Your doctor will diagnose your stroke type and recommend appropriate treatment.
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While ESUS is the most common subtype of cryptogenic stroke, many other types are possible. Patients with multiple causes and atypical anatomical structures may fall into this category. Although most cryptogenic strokes have an embolic source, some patients may be misclassified as cryptogenic. To avoid such a situation, a patient should undergo standard MRI and CT scans. This can help rule out a variety of causes.
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Aortic arches can also be a cause of cryptogenic stroke. Symptomless atrial fibrillation may make it difficult to diagnose a stroke. Fortunately, new technologies may help. Wearable devices may be able to provide continuous monitoring. The use of such devices may help doctors diagnose fewer cases of cryptogenic strokes. These devices may also improve the ability to detect a cryptogenic stroke earlier in the course of a stroke.
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Although it accounts for approximately 25% of ischemic strokes, the incidence of cryptogenic stroke may be disproportionately high in minority and younger patients. A recent study of cryptogenic stroke in Finland found that a cryptogenic subtype accounted for a higher proportion of young adults than older patients. Interestingly, cryptogenic stroke is also more common in minorities than whites. For these reasons, a comprehensive study of ischemic stroke subtypes is critical to understanding the risk of recurrent cryptogenic stroke and improving patient care.
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Currently, the standard of care for cryptogenic stroke is aspirin. In addition, an implantable cardiac monitor is commonly used to detect occult atrial fibrillation. If it detects this condition, anticoagulation is started. Although no study has shown a definitive benefit, future research in this subpopulation will determine whether anticoagulation is useful in cryptogenic stroke. Further, the clinical significance of brief episodes of atrial fibrillation is unknown. Anticoagulation is not recommended for cryptogenic stroke patients unless the patient has underlying cardiac comorbidity.
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Although the exact causes of cryptogenic stroke are not known, contributing factors can be identified and corrected to reduce the risk of recurrence. The PFO is a hole in the heart that does not close after birth and is found in approximately 30 million people in the U.S. A PFO closure surgery is an outpatient procedure that reduces the risk of recurrence. Similarly, a condition known as A-Fib can be prevented with medications or an implantable device.
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For long-term monitoring of electrocardiograms after a cryptogenic stroke, it is important to obtain an implanted loop recorder. Holter monitoring studies range from 24 to 72 hours and are not always effective. However, continuous electrocardiographic monitoring with an ICM has been shown to be superior to other methods. Although, the use of extended monitoring remains at the discretion of the treating physician. It should be used only if the patient's symptoms persist after discharge.
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Another procedure that improves the prognosis of patients with cryptogenic stroke is the percutaneous closure of the PFO. In a randomized trial called CLOSE, patients with cryptogenic stroke were enrolled who had a PFO. Participants were compared to medical therapy, which included warfarin or antiplatelet agents, for up to six years. The results of the trial showed that the surgery significantly reduced the risk of recurrent cryptogenic stroke.
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Although there are many variables associated with CS, there are only a few studies evaluating potential etiologies. Because cryptogenic stroke has a wide spectrum of etiologies, poststroke outcomes can vary. Therefore, considering the potential causes of cryptogenic stroke is an important part of stroke prevention. It is important to consider all possible etiologies when choosing poststroke therapy. They may all result in a different post-stroke outcome.