Embolic Stroke of Undetermined Source - Oren Zarif - Embolic Stroke
Embolic stroke of undetermined source (ESUS) is a term for nonlumen ischemic stroke. It was first used to describe patients with multiple etiologies and incomplete diagnostic work-ups. The ESUS definition helped facilitate randomized trials in this population. Although there is no consensus on the cause of ESUS, it is important to distinguish it from other causes of stroke. In this article, we will discuss the clinical characteristics and treatment options for patients with ESUS.
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Although many patients who have a vascular disorder, such as aortic stenosis, develop an embolic stroke, its diagnosis is more complicated. The disease is often associated with other underlying pathologies, such as atrial fibrillation, left ventricular dysfunction, and supraventricular tachycardia. For this reason, pathophysiological diagnosis is preferred over presumptive causes of embolic stroke.
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When an embolic stroke develops, it can cause an individual to lose the ability to move limbs or perform simple manipulations. Because symptoms can occur suddenly, it is essential to seek emergency medical care. The FAST method of detecting an embolic stroke requires extensive testing and analysis, and is not always straightforward. However, it can be useful in determining the severity of the stroke. You can get more information about preventing an embolic stroke by signing up for the Healthline Natural newsletter.
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As an embolic stroke is life-threatening, prompt treatment is vital. Several medications can reduce or eliminate clots and restore normal blood flow to the brain. A medical team may place catheters to restore blood flow to the brain. Depending on the type of embolic stroke, the treatment may include clot-busting medications. While embolic stroke has numerous risks, the best treatment depends on its cause.
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PFO is another potential source of embolic stroke. This condition affects the mitral and aortic valves. Patients with PFO often experience severe neurological complications including an embolic stroke. The best treatment is to control the underlying condition and prevent embolic stroke. However, this can be difficult if the PFO is undiagnosed or has already occurred. If you have a PFO, your health care professional may recommend an alternative treatment that would not interfere with the natural healing process.
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During an embolic stroke, a blood clot breaks free from its container in another part of the body and travels to the brain. The clot lodges in the artery and blocks the flow of blood to the brain. Because of the way the brain relies on nearby arteries to provide nutrients and oxygen, it is crucial to maintain healthy blood flow to prevent an embolic stroke. Once this happens, brain cells begin to die.
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Several randomized trials have been done using anticoagulants in the treatment of embolic stroke. One of the ongoing trials is Apixaban for Treatment of Embolic Stroke of Undetermined Source. Another ongoing trial is the NAVIGATE ESUS trial. There is a difference in outcome of treatment with these drugs, though the trial was not statistically significant. In the RE-SPECT ESUS trial, dabigatran significantly reduced the risk of recurrent stroke by 4.1%. Similarly, acetylsalicylic acid was not significantly different.
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Two recent randomized clinical trials showed that ESUS was associated with a lower stroke severity than cardioembolic stroke. The Athens Stroke Registry compared ESUS patients to cardioembolic stroke patients with different characteristics. Patients with ESUS had lower National Institutes of Health Stroke Scale scores than those with cardioembolic stroke. However, the existence of explanatory characteristics cannot be proved to be causal. In addition, ESUS patients face multiple risks and there is no clear beneficial therapy to prevent recurrent stroke.