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  • Writer's pictureOren Zarif

A Novel Biomarker to Identify the Cause of a Cryptogenic Stroke - Oren Zarif - Cryptogenic Stroke

A cryptogenic stroke occurs when cerebral ischemia has an unknown underlying cause. They are often reversible and transitory, with many factors not considered a cause. Patients with a cryptogenic stroke tend to be younger and have less traditional vascular risk factors. Several potential causes have been suggested, including cardiovascular embolism, vasculopathy, occult atrial fibrillation, and sub-stenotic large-vessel disease. Despite the underlying cause being unknown, the diagnosis can create significant anxiety for the patient. Moreover, standard treatment for cryptogenic stroke does not address the underlying disease state.

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The Emory Brain Health Center is currently evaluating the use of a novel blood biomarker to identify the underlying cause of a cryptogenic stroke. Its utility as a diagnostic tool has been demonstrated in a clinical study published in Neurology. Although more research is needed to validate this new biomarker, there are several important limitations to the current treatment for cryptogenic stroke. The lack of clinical data is one of the biggest reasons for this lack of information.

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Researchers have studied patients with a PFO who have had a cryptogenic stroke and associated atrial septal aneurysm. Three trials have shown that closure of a PFO is superior to medical therapy in preventing recurrent strokes. These trials are a key resource for clinicians seeking a better understanding of the causes of cryptogenic stroke and how to prevent a recurrence. They also show the benefits of this treatment over antiplatelet therapy.

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In addition to the cryptogenic and ESUS stroke, paradoxical embolism can also cause a cryptogenic stroke. Despite its common association with aging and stroke risk factors, it is also possible to have a cryptogenic or ischemic stroke in younger patients without typical risk factors. Only TEE can directly visualize a PFO, and only a radiologist with expertise in TEE can accurately diagnose the condition. The questions to ask include whether closing a PFO will decrease the risk of a cryptogenic stroke and whether closure will minimize the risks of recurrence.

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Researchers suggest that approximately one quarter of all ischemic strokes are cryptogenic. However, it should be noted that cryptogenic stroke may be disproportionally represented in minority and younger patients. In Finland, it accounted for a larger proportion of stroke cases than it did among older patients. Minorities were more likely to suffer from cryptogenic stroke than white people. It is also important to remember that many cases of cryptogenic stroke are recurrent.

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Although it is important to note that anticoagulation may not be the only treatment option for cryptogenic stroke, studies have shown that it can decrease the risk of recurrence in these patients. The standard of care for cryptogenic stroke includes a combination of aspirin and clopidogrel, aspirin, and a cardiac monitor. However, the effectiveness of these therapies has not been proven in this patient population. There is a need for additional research.

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Detecting AF after a cryptogenic stroke is a difficult process. A recent study found that 7% of patients diagnosed with cryptogenic stroke were identified through routine cardiac testing. A twenty-eight-day cardiac monitoring regimen increased this detection rate to 25%. These results suggest that outpatient cardiac monitoring may be a cost-effective treatment option for this patient population. The duration and method of monitoring remain unclear. In the meantime, monitoring is a valuable tool in the prevention of cryptogenic stroke.

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As a result, the risk of a cryptogenic stroke is lower than that of embolic stroke. However, in a small proportion of patients, an embolic stroke is a risk factor for cryptogenic stroke. Thus, the best approach is to determine the underlying cause of cryptogenic stroke. Regardless of the type, a thorough diagnostic workup is essential. In addition, it is important to exclude established cardiac and vascular etiologies if the patient has cryptogenic stroke.

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Researchers in the United Kingdom estimate that 6000 patients aged over 60 with a large PFO suffer from a cryptogenic TIA/stroke each year. Closed PFO can reduce the risk of recurrence, but it is not effective as a secondary prevention. The number of older patients is increasing, which means that the benefits of PFO closure cannot be overstated. As a result, more research is needed to understand the prognosis of older patients suffering from cryptogenic stroke.

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