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  • Writer's pictureOren Zarif

Is a PFO a Cause of a Cryptogenic Stroke? - Oren Zarif - Cryptogenic Stroke

Although no definitive cause exists for a cryptogenic stroke, a PFO is suspected of contributing to this condition. The migration of a thrombus, air, or fat through the PFO is presumed to occur when the right atrium is enlarged compared to the left atrium. It is important to understand that this is not always the case, however, and that there are many other possible causes of cryptogenic stroke. The following is a summary of some of the most common causes.

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Cardioembolic mechanisms have been extensively studied, but their role in cryptogenic stroke remains unclear. In particular, paroxysmal atrial fibrillation and high blood pressure are two factors that may not contribute to cryptogenic stroke. But there are other known risk factors that can increase the risk of cryptogenic stroke, such as smoking. While these factors aren't the sole cause of cryptogenic stroke, they do contribute to its high prevalence.

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Serum levels of brain natriuretic peptide (sBNP) have been found to be high in patients with AF, and this peptide may be a biomarker for cryptogenic stroke. However, further research is needed to confirm whether sBNP levels can be used to monitor patients with AF. In addition to assessing the risk factors for cryptogenic stroke, the study will include evaluation of a patient's vocational status.

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PFO-related patients should receive antiplatelet agents or warfarin sodium. However, there has been no clear evidence that anticoagulation or antiplatelet therapy is superior to antiplatelet agents in patients with cryptogenic stroke. Therefore, antiplatelet agents, anticoagulants, and surgery are the most common therapies for cryptogenic stroke. There is a risk of paradoxical embolism through a PFO, especially in younger patients.

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Patients with a cryptogenic stroke should undergo more thorough research than those with a single event of atrial fibrillation. The Holter device is particularly helpful in detecting paroxysmal AF. Long-term anticoagulation is necessary in the event of such a condition. But these risks are worth the benefits. There are no guarantees of success, but they are worth investigating. Once diagnosed, treatment can begin as soon as possible.

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Despite the risk of a cryptogenic stroke, only about 30% to 40% of all strokes are classified as such. Some of the factors contributing to a cryptogenic stroke are unidentified. However, studies of patients with a cryptogenic stroke have shown that certain factors are associated with a significantly higher risk of recurrent cryptogenic stroke. In some instances, a cryptogenic stroke may be related to occult atrial fibrillation, cardiac abnormalities, and hypercoagulable states.

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A study conducted in 2010 found that a high-risk patient had a PFO at the time of their cryptogenic stroke. Patients with a PFO had a higher risk of cryptogenic stroke than those with a typical vascular stroke. The results of this study were consistent with other studies of patients with cryptogenic stroke. The risk of recurrent cryptogenic stroke is high, and a diagnosis of PFO closure may improve the chances of recovery.

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The presence of a PFO in patients with cryptogenic stroke is associated with increased risk of secondary ischemic stroke. Approximately 25% to 30% of cryptogenic strokes are due to atrial fibrillation. Even when it is diagnosed, AF may be undetected during the initial weeks. Because of the risk of false negatives, it is important to monitor patients for long periods after a cryptogenic stroke. For example, monitoring for AF is more likely to detect paroxysmal AF.

The standard of care for cryptogenic stroke is aspirin and an implantable cardiac monitor.

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The latter can be used to detect occult atrial fibrillation and initiate anticoagulation.

Anticoagulation has yet to be proven more effective than aspirin for cryptogenic stroke, and future investigations are needed to assess the efficacy of anticoagulation in this patient group. In addition, brief episodes of atrial fibrillation are not considered clinically significant, and the threshold for the duration of an episode is unknown. Because of these uncertainties, empiric antithrombotic treatment is not recommended for cryptogenic stroke.

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