A Review of the Aetiology of Cryptogenic Stroke - Oren Zarif - Cryptogenic Stroke
A recent review highlighted the new evidence regarding the aetiology of cryptogenic stroke. This condition is associated with two specific medical conditions, atheroma of the aortic arch and patent foramen ovale. The study was designed to evaluate the efficacy of DOACs over aspirin as a preventive therapy for cryptogenic stroke. It is important to distinguish between these conditions, which can present with similar symptoms but are not necessarily related.
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The number of patients with cryptogenic TIA/stroke may be underestimated. Many older patients may be at a high risk of cryptogenic TIA. The researchers noted that 6000 cryptogenic TIA/strokes occur annually in older patients with large PFOs. Because of this, recruitment of older patients into future trials of PFO closure may be easier. But the number of patients who have this type of stroke is large and may represent a larger pool of potentially eligible participants.
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While there is no definitive way to determine the cause of a cryptogenic stroke, the first step in treating it is to call 911 and seek medical attention. An immediate evaluation will help a doctor determine which treatment is most effective for a patient with this type of stroke. In many cases, cryptogenic stroke cannot be ruled out, but it is important to follow the physician's recommendations and heart monitoring regimens to reduce the risk. If a cryptogenic stroke is suspected, there are seven behaviors that patients should follow to minimize the risk of developing a stroke.
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Another risk factor associated with cryptogenic stroke is a PFO (a hole in the heart that never closes after birth). This condition affects over 30 million Americans and is curable with surgery. The surgeon who performs this operation will reduce the risk of cryptogenic stroke. Other risk factors include A-Fib (an irregular heart rhythm), PFO, and cryptogenic stroke. While these are the least common causes, they are often overlooked when considering cryptogenic stroke.
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The data from this study has several limitations. Although PFOs are associated with increased risk of cryptogenic stroke, they were not statistically significant in patients with cryptogenic stroke. Approximately 50% of cryptogenic stroke patients have a PFO. The study found a significant risk of PFO-associated stroke in people younger than age 50. Furthermore, the younger the patient, the higher the risk of cryptogenic stroke. Moreover, the patients with PFO also had an associated atrial septal aneurysm.
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Long-term continuous electrocardiographic monitoring with an ICM is more effective than intermittent methods, such as Holter monitoring and serial electrocardiography. Holter monitoring studies can last anywhere from 24 to 72 hours, depending on the case. In addition, it is possible to detect AF through external events and long-term outpatient monitoring. Even with these low rates, however, it is important to note that the effectiveness of these monitoring methods is still unknown.
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Surgical closure of the patent foramen ovale (PFO) may be an option for older patients with a cryptogenic stroke. Although this procedure has shown some benefit in young patients, the risk of recurrence remains unclear. Therefore, data on the prognosis of older patients with cryptogenic stroke are needed in order to justify any potential trials involving PFO closure. The new treatment for cryptogenic stroke is highly controversial, as it may lead to irreversible complications and death.
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Most potential mechanisms of CS involve the cardiac system. Therefore, a comprehensive assessment of the cardiac system is necessary to pinpoint the underlying cause and improve secondary prevention strategies. This evaluation may involve imaging and cardiac monitoring. However, if no one can identify the underlying mechanism, the treatment of cryptogenic stroke will remain a challenge. This is not surprising, considering the complexity of the condition. The resulting stroke is often devastating. If it is possible to identify a patient's risk factors, the treatment may be tailored accordingly.