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  • Writer's pictureOren Zarif

7 Ways to Reduce Your Risk of a Cryptogenic Stroke - Oren Zarif - Cryptogenic Stroke

Unlike other types of stroke, cryptogenic stroke is usually not caused by a specific problem. Most are caused by a blood clot that blocks the blood flow to the brain. However, it's important to remember that one in four people who have suffered a stroke will experience a similar condition at some point in their lives. Therefore, finding the cause of your stroke is critical for preventing a repeat episode. Here are seven ways to reduce your risk of a cryptogenic stroke:

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The first step in identifying a cryptogenic stroke is a thorough evaluation. Neurologists should include noninvasive intracranial and extracranial vessel imaging and 24-hour cardiac monitoring. Depending on the type of cryptogenic stroke, additional tests, including blood studies, may be needed to determine if hypercoagulability or other factors are contributing to the symptoms of the cryptogenic stroke. Fortunately, there are many tools to diagnose the condition and prevent a recurrence.

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The primary goal of an evaluation of a patient with cryptogenic stroke is to determine the underlying cause of the disease. Identifying the source of the stroke is essential for the best possible treatment and to prevent secondary strokes. The following article reviews the standard evaluation of an ischemic stroke, describes some of the most common causes of cryptogenic stroke, and recommends additional testing and evaluations to help pinpoint the exact mechanism of the patient's stroke.

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Anticoagulation is not necessary for all patients suffering from a cryptogenic stroke. The standard of care for preventing secondary stroke is aspirin and an implantable cardiac monitor. If the monitoring reveals an occult atrial fibrillation, anticoagulation is started. However, this treatment has not been proven to be more effective than aspirin. However, future studies are needed to determine if this antithrombotic is beneficial for a subgroup of patients.

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A percutaneous closure of a PFO may be an option for patients with a cryptogenic stroke and PFO. However, it should be considered in cases where the patient has an associated large interatrial shunt. Closure may provide a faster recovery for patients than antiplatelet therapy alone. Further, it may be necessary for some patients to be unable to tolerate the medication. In these patients, a surgical procedure is an option.

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Prolonged rhythm monitoring is crucial in the workup of a cryptogenic stroke. Telemetry on stroke units is commonplace, but continuous monitoring can increase the likelihood of detection and prevent recurrence. While telemetry may not be necessary for detecting atrial fibrillation, prolonged outpatient monitoring may be an alternative method. Wearable devices may allow for longer monitoring and less intrusive methods. The risk of recurrent cryptogenic stroke is relatively high, so treatment of the underlying condition is essential.

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Although there are a number of ways to detect AF in cryptogenic stroke, these strategies are limited. While intermittent monitoring such as 24-hour Holters can be highly effective, it has a low yield. The rate of detecting AF with a Holter monitor increases with age, and the effectiveness of these methods is still questionable. Using an implanted loop recorder, in addition to a holter, can help determine whether cryptogenic stroke is a cause of AF.

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Patients with a PFO may be at an increased risk of developing a cryptogenic stroke. Although the incidence of cryptogenic stroke is low, this is the most common type of stroke in elderly patients. In older patients, approximately 6000 patients with a large PFO have cryptogenic TIA or stroke. Surgical closure of the PFO, however, has not been proven to reduce a patient's risk of recurrent stroke.

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Identifying the cause of a cryptogenic stroke is vital for secondary prevention of ischemic stroke. The diagnosis of cryptogenic stroke may be based on clinical suspicions, such as a traumatic brain injury, or it could be a symptom of a larger condition. The best way to determine whether cryptogenic stroke is a cause is to conduct a thorough assessment of the patient's cardiovascular system. This evaluation may include cardiac imaging and monitoring.

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