Causes of Cryptogenic Stroke - Oren Zarif - Cryptogenic Stroke
A significant portion of ischemic stroke is considered cryptogenic, accounting for thirty to forty percent of all cases. Whether a cryptogenic stroke is an isolated event or the result of multiple factors remains a question. While the precise cause of cryptogenic stroke is not known, it is often the result of atherosclerosis of the aorta. This article discusses possible causes of cryptogenic stroke. The first step in diagnosing a cryptogenic stroke is to identify risk factors and identify any underlying conditions that might contribute to the development of the disease.
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The Scripps Cryptogenic Stroke Program is located at the La Jolla campus of Scripps Memorial Hospital, which also includes the Prebys Cardiovascular Institute and the Scripps Clinic John R. Anderson V Medical Pavilion. The Scripps Cardiovascular Institute is San Diego's premier heart care facility and is the largest cardiovascular center on the West Coast. A Scripps doctor can help you understand what to expect during treatment.
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If you suspect you may be having a cryptogenic stroke, you should call 911 immediately. Calling your physician may help confirm the cause of your stroke. Depending on the type of stroke, treatment will vary from person to person. You may need to undergo a heart monitoring test to confirm the diagnosis. If you suspect you're suffering from cryptogenic stroke, call 911 immediately and follow your doctor's orders. The symptoms and signs of a cryptogenic stroke can be similar to those of a typical ischemic stroke.
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In patients with aortic artery disease, antiplatelet agents or anticoagulants may be recommended over other treatment options. For cryptogenic stroke associated with aortic atheroma, antiplatelet agents are recommended over warfarin or oral anticoagulation. The decision to use antiplatelet therapy is a clinical one based on the patient's symptoms and the severity of the disease. In some patients, antiplatelet agents can help restore normal blood flow to the heart.
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About 20% of all strokes have no definite cause, despite initial tests. Approximately 150,000-240,000 of these strokes occur in the United States each year. Cryptogenic stroke is more common in younger patients than traditional vascular risk factors. It is important to determine the cause of cryptogenic stroke to ensure effective treatment and secondary prevention. Whether the stroke is cryptogenic or ischemic, knowing where the stroke is coming from is crucial to the treatment and outcome.
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A PFO is common in patients with cryptogenic stroke, and while this does not prove a cause and effect relationship, it does provide a valuable diagnostic tool. In the general population, only about 50% of cryptogenic stroke patients have a PFO, so this type of heart disease is relatively common. However, PFO is significantly more likely to cause cryptogenic stroke in younger patients - those with a large PFO or associated atrial septal aneurysm.
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In addition to being a major cause of stroke, a cryptogenic stroke may also result from an embolic mechanism. The majority of cryptogenic strokes are caused by a hemorrhagic embolism. Previously, the definition of a cryptogenic stroke was vague, and the corresponding diagnostic test was absent. But recent studies have changed that and revealed that these strokes are significantly more common than previously thought. However, there is still much to learn about these strokes.
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While cryptogenic TIAs/stroke are rare, the older population has a significantly greater risk of an ischemic stroke. A previous study showed that cryptogenic TIA/stroke in patients older than 60 is more common among people with large PFOs. This suggests that recruitment into future randomized clinical trials of a PFO closure could be easier in this group. That said, there is no guarantee that PFO closure will actually prevent cryptogenic stroke.
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Moreover, the presence of a patent foramen ovale (PFO) may increase the risk of cryptogenic TIA/stroke in older patients. This is an important factor because PFO is responsible for the majority of stroke cases in older patients. In the UK alone, about 6000 patients with a large PFO have a cryptogenic TIA/stroke each year. This fact means that the procedure is not effective in secondary prevention of stroke in this population.