A Review of the Aetiology of Cryptogenic Stroke - Oren Zarif - Cryptogenic Stroke
A recent review looked at the aetiology of cryptogenic stroke. Cryptogenic stroke is characterized by an absence of a clear aetiology. The condition is often caused by an atheroma of the aortic arch or a patent foramen ovale. The authors discussed the new evidence for these conditions in this context. However, these findings are not sufficient to fully explain the etiology of cryptogenic stroke.
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A PFO can cause a cryptogenic stroke. The average diameter is 4.9 mm, but large emboli can obstruct the middle cerebral artery stem. Each year, 345,000 people aged 18 to 60 years present with PFO. Patients with cryptogenic stroke have a nearly two-fold increased risk of developing a PFO. Further, young patients with cryptogenic stroke are nearly three times more likely to develop a PFO than older patients.
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In addition to the age-related risk factor, an older definition of cryptogenic stroke limits the range of patients who can have it. It has been estimated that as many as 30% of all strokes occur for unknown reasons. Although the causes of cryptogenic stroke are unclear, they share many risk factors, such as high blood pressure and cardiovascular disease. Regardless of the cause, it is essential to diagnose the stroke as soon as possible. This will help prevent secondary strokes from occurring.
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The use of antiplatelet therapy after cryptogenic stroke has shown promising results. Studies have shown that a PFO occluder is an effective treatment for cryptogenic stroke. In a recent trial, nineteen patients with cryptogenic stroke underwent percutaneous closure of the PFO. The trial included patients with PFO and TIA, and randomized them to either medical therapy or closure. In the end, patients who underwent cryptogenic stroke experienced less recurrence and improved health outcomes.
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Despite the low rate of recurrence, there are several causes of cryptogenic stroke. Although they are not fully understood, some research findings point to multiple causes of the disease. Research into the underlying event may help prevent recurrence. In addition, understanding the underlying cause of cryptogenic stroke may help doctors determine which treatments are most effective. If a cryptogenic stroke is not prevented, it may be difficult to detect and treat.
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Another risk factor for cryptogenic stroke is a patent foramen ovale (PFO). This anatomic abnormality is common in the general population, but it is associated with a higher risk of stroke in younger adults. One meta-analysis showed that the presence of a PFO was a risk factor for cryptogenic stroke in younger adults. However, the same did not hold true for patients aged 55 and older. A PFO may also be associated with a thrombus, but it is not necessarily a cause.
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A cryptogenic stroke is an ischemic stroke that has no clear etiology. It is defined as cerebral ischemia that is reversible or transitory. The underlying cause may have been missed during the investigation process. It is common in younger people, and it is associated with cardiovascular conditions. The most common causes of cryptogenic stroke include cardiac embolism, vasculopathy, complex aortic plaques, and Fabry's disease.
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The effectiveness of antiplatelet drugs and a recurrent stroke prevention strategy is not clear. The PICCS study, nested in the Warfarin-Aspirin Recurrent Stroke Study, randomized patients within 30 days of noncardioembolic stroke. The patients were randomly assigned to either aspirin 325 mg or warfarin INR 1.4-2.8 for 2 years. Similarly, in a study of cryptogenic stroke, patients with PFO and pseudo-PFO were included.
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For patients with a history of cryptogenic stroke, a neurology may recommend additional tests to confirm the cause of the event. While the use of antiplatelet medication and risk factor modification is the standard of care for most patients, further studies will help identify the best way to treat cryptogenic stroke. It is important to balance cost and thoroughness in the evaluation of cryptogenic stroke patients. If the diagnosis is based on a noninvasive imaging test, the patient should receive cardiac monitoring for 24 hours.