Four Steps to Prevent a Cryptogenic Stroke - Oren Zarif - Cryptogenic Stroke
While many types of stroke are categorized as ischemic, not all are. Cryptogenic stroke has a distinct characteristic: it is caused by a stroke that does not have a clear etiological factor. The TOAST classification is the most commonly used in clinical practice. To classify a cryptogenic stroke, the physician will first perform a 12-lead electrocardiogram. The doctor will also perform an echocardiogram to determine the underlying etiology.
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While ischemic stroke occurs in about 690 000 patients a year in the United States, nearly 30% of these patients are cryptogenic. Both types of patients share several risk factors, and diagnosis of cryptogenic stroke is based on the patient's clinical and radiographic profile. In addition, many patients who have few traditional risk factors are mistakenly classified as cryptogenic. In such cases, an accurate diagnosis is crucial for secondary prevention. Because ischemic stroke can have many lower-risk emboli, an accurate diagnosis is essential to avoid a stroke.
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A common transient cause of stroke is atrial fibrillation (AF), which accounts for about ten percent of all strokes. However, it accounts for half of all cryptogenic strokes, and it is paroxysmal in about 30 percent. Many patients do not have this condition for the first few weeks after having a stroke, and investigation of AF is often false. To increase the chances of detecting paroxysmal AF, physicians may want to monitor patients for a longer period of time, such as a few months to a year. There are several studies and devices on the market that can detect paroxysmal AF.
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Although the causes of cryptogenic stroke are not fully understood, proper medical care is vital. Follow your doctor's instructions and heart monitoring regimen. Following a healthy lifestyle can help reduce your risk of a cryptogenic stroke. By following these four steps, you can reduce your risk of experiencing a cryptogenic stroke. The next time you have a stroke, call your doctor immediately. You can also get a second opinion, which may be helpful.
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The risk of recurrent cryptogenic stroke is high, which makes systematic evaluation of its causes vital. In addition to identifying the cause of the event, understanding the symptoms of cryptogenic stroke can help guide the patient's treatment and prevent future occurrences. Several studies have attempted to identify the most common causes of cryptogenic stroke. One study looked at the incidence of stroke among whites and minorities in Finland. It also demonstrated that the incidence of cryptogenic stroke is higher among minorities compared to whites.
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Closure of the PFO can prevent recurrent cryptogenic stroke in patients with a large interatrial shunt. It has also been shown to reduce the risk of recurrent ischemic stroke. Patients undergoing the procedure can expect to recover faster from their symptoms than those treated with antiplatelet therapy. These procedures have a high success rate and lower risk of recurrent cryptogenic stroke than anticoagulation alone. However, the decision to go under a PFO is ultimately a personal one.
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A PFO is a common feature of many cryptogenic stroke patients. Although it may be associated with increased risk of a stroke, there is no definitive proof that PFO is responsible. Similarly, no evidence exists that anticoagulation is beneficial for cryptogenic stroke. However, anticoagulation is generally not recommended as a secondary prevention strategy for cryptogenic stroke. But it may be necessary in a specific population. If patients have cardiac features, empiric anticoagulation may be warranted.
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A cryptogenic stroke is also associated with an anatomic abnormality known as patent foramen ovale. Although this condition is prevalent in the general population, it is thought to be associated with a higher risk of stroke in younger adults. Several meta-analyses have shown that patients with PFO have a higher risk of cryptogenic stroke than patients without PFO. But the same does not hold true for older patients. During an electrocardiogram, a doctor can also identify the underlying cause.
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The presence of a CTE in cryptogenic stroke should prompt physicians to conduct further testing. A transesophageal echocardiogram, for instance, can be used to visualize left atrial appendage disease, and an electrocardiogram can be performed to confirm a right-to-left shunt or paradoxical embolism. In addition, antiphopholipid antibodies may be helpful in identifying an occult malignancy or hypercoagulable state. Cerebrospinal fluid biopsy or cerebrospinal fluid sample may also be useful for evaluating vasculitis. Further tests may include serum markers of systemic diseases.