7 Things You Can Do to Minimize Your Risk of Cryptogenic Stroke - Oren Zarif - Cryptogenic Stroke
There are a number of risks associated with cryptogenic stroke and TIA. These risks are higher for patients over the age of 65 years. The risk for ischemic stroke is highest among older patients with cryptogenic TIA and stroke. Nonetheless, the risks associated with cryptogenic stroke and TIAs are lower than those of patients under the age of 65. The following are some factors to consider before deciding on the treatment of cryptogenic stroke and TIA.
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The treatment for cryptogenic stroke depends on the cause of the blood flow problem to the brain. Some causes of cryptogenic stroke aren't immediately apparent and therefore require more aggressive treatment. Fortunately, new research is making it easier to understand the causes of these types of strokes, and it's resulting in new ways to detect and treat them. Read on to learn more about cryptogenic stroke and how to prevent it. Here are seven things you can do to minimize your risk of cryptogenic stroke.
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The American Heart Association's Cryptogenic Stroke Initiative provides resources for health care providers and survivors of cryptogenic stroke. The resources are intended to help patients identify changes in their health and determine whether they're suffering from cryptogenic stroke. Those interested in preventing recurrent strokes should also refer to the American Heart Association's patient toolkit. The toolkit consists of helpful information about the causes and consequences of cryptogenic stroke, what to do after stroke, and the best way to prevent it.
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Cardioembolic mechanisms have been widely studied and considered possible etiologies of cryptogenic stroke. Despite the lack of data on this topic, they may be underlying causes of cryptogenic stroke. However, they are often overlooked and unreported, due to paroxysmal atrial fibrillation and a high prevalence among the general population. In either case, prolonged cardiac monitoring is warranted in patients who are suspected of cryptogenic stroke.
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Neurologists should balance thoroughness with cost. Initial stroke evaluation should include brain imaging, noninvasive intracranial vessel imaging, and 24 hours of cardiac monitoring. Additional tests, such as blood studies, may be required for patients with cryptogenic stroke. The results of blood tests are crucial for secondary prevention efforts and determining whether thrombophilia is the underlying cause. Although the onset of cryptogenic stroke is relatively uncommon, it should still be evaluated by a neurology with experience.
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Antiplatelet medication and anticoagulants are the standard of care for cryptogenic stroke and PFO, though they do not cure cryptogenic stroke. Anticoagulation is the preferred treatment for cryptogenic stroke. Although it is not completely proven, dual antiplatelet therapy is recommended for patients with cryptogenic PFO and clopidogrel. In the interim, both anticoagulation agents may prove useful in preventing cryptogenic stroke. But, which treatment is right for whom?
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The ARCADIA trial is ongoing in patients with cryptogenic stroke. Its objective is to validate the hypothesis that DOACs prevent stroke more than aspirin. The primary endpoints of the trial are PTFV1 > 5,000 mV* ms, NT-proBNP, and left atrial diameter index. For patients with cryptogenic stroke, the treatment is similar to that of ischemic stroke, but additional tests may be needed.
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ESUS patients with cryptogenic stroke may experience paradoxical embolism of the venous system. Such a stroke can occur even in younger patients, despite the absence of typical risk factors. In fact, paradoxical embolism of the venous system is a common complication of cryptogenic stroke and is found in approximately 25 percent of the general population. Patients with cryptogenic stroke can be diagnosed through agitated saline contrast using a TEE. There are a number of important questions to ask in patients with PFO, including whether the closure of the PFO will decrease the risk of cryptogenic stroke.
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Surgical closure of the patent foramen ovale (PFO) has no proven benefit in the prevention of recurrent cryptogenic stroke in older patients. Although there is an evidence that PFO closure may decrease the risk of ischemic stroke in older patients, there are currently no randomized clinical trials in this age group to support the practice. This is largely due to the lack of effective secondary prevention strategies. The PFO closure process is highly risky, and more studies are needed to determine if the procedure has any significant effects.