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Four Things You Should Do to Diagnose a Cryptogenic Stroke - Oren Zarif - Cryptogenic Stroke

A cryptogenic stroke is a type of stroke in which the exact cause cannot be determined. Because it is an atypical stroke, there is no proven risk factor or cause. The stroke team, however, will look for other causes, such as cardiovascular disease, smoking, and high blood pressure. The aim of a diagnostic workup is to determine the underlying cause of the cryptogenic stroke. A properly diagnosed cryptogenic stroke will have a significantly lower risk of recurrence.

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Although the causes of a cryptogenic stroke may not be determined, it is important to follow your doctor's advice and follow any heart monitoring regiment. You should also live a healthy lifestyle that reduces your risk of this stroke. Here are four things you should do to ensure that your medical team is taking the right steps to diagnose the cause of the cryptogenic stroke. When you have a cryptogenic stroke, the first thing you should do is call 911. This way, the doctor can determine the cause of the stroke and begin treatment.

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A follow-up study published in Neurology in 2020 looked at patients with a cryptogenic stroke. The study found that extended rhythm monitoring for 30 days improved detection of atrial fibrillation in patients with a thrombophilic state. This would require long-term anticoagulation if the patient had atrial fibrillation. The results of this study will allow physicians to decide whether a patient should undergo thromboprophytherapy or not.

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There have been four trials that demonstrate that percutaneous closure is beneficial for patients with cryptogenic stroke and associated PFO. The RESPECT trial, for instance, followed patients for nearly six years. This study showed a significant reduction in the risk of recurrent cryptogenic stroke. Another trial, called the ACCURATE-PFO Trial, compared closure with warfarin therapy, antiplatelet therapy, and medical therapy alone. The results of the CLOSE trial suggest that closure is superior to antiplatelet therapy, which could prevent the risk of recurrent cryptogenic stroke.

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Because of the high risk of recurrence of ischemic stroke, a broad differential evaluation is needed to identify the causes of cryptogenic stroke and develop treatment options. The incidence of this type of stroke may be disproportionately higher in minority patients, as well as younger patients. In Finland, cryptogenic stroke accounted for a greater percentage of the total number of ischemic stroke than in white people. The risk of recurrent cryptogenic stroke should be addressed immediately in a cryptogenic stroke.

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Although there are numerous causes for cryptogenic stroke, the majority of patients do not experience a definitive diagnosis of the cause. Most patients in this category have a younger age and fewer traditional vascular risk factors. Despite the fact that the majority of cryptogenic strokes are non-cardiac, the standard of care is to prescribe antiplatelet therapy and manage risk factors that may contribute to a cryptogenic stroke. These patients have a higher risk of recurrent cryptogenic stroke than patients with traditional vascular diseases.

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In addition to age and risk factors, other clinical and imaging studies should be performed to determine the source of the patient's cryptogenic stroke. In addition to imaging, a patient should undergo a standard minimal workup to determine the underlying cause of the stroke. MRI and CT scans can also be performed to rule out other possible sources of embolism. During a stroke, a physician should determine the underlying cause of the cryptogenic event based on the etiology.

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An implantable cardiac monitor may be necessary to confirm diagnosis and manage the condition. The use of an implantable cardiac monitor is helpful in detecting occult atrial fibrillation and anticoagulation is initiated if it is detected. Although anticoagulation is not recommended for secondary prevention in cryptogenic stroke, it may be an appropriate treatment for selected patients. Nevertheless, it remains unclear whether a prolonged period of atrial fibrillation is enough to trigger a cryptogenic stroke.

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In addition to a full workup, patients with a cryptogenic stroke will undergo specific investigations to rule out a traumatic brain injury or remote embolism. Some tests may include transesophageal echocardiography, long-term cardiac monitoring, and evaluation for occult malignancy or arterial hypercoagulability. Antiplatelet therapy is a standard treatment for cryptogenic stroke, and empiric anticoagulation is often used. A clinical trial of an NOAC or aspirin may also be conducted in the future.

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