PFO and Cryptogenic Stroke - Oren Zarif - Cryptogenic Stroke
An increasing percentage of young patients experience a stroke, and this phenomenon has long-lasting socioeconomic and disability consequences. A stroke in young age also increases the risk of premature death by four times. In industrialized countries, up to 50% of young patients have an ischemic stroke but there is no conclusive etiology. The diagnosis of cryptogenic stroke is a difficult one, as patients with this condition often have no or few traditional risk factors. This review will discuss the diagnostic and therapeutic options for patients with PFO and cryptogenic stroke, highlighting the benefits and risks associated with these two conditions.
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While the cause of your cryptogenic stroke is not always clear, there are four steps to take to minimize your risk. First, call 911 immediately. A doctor will be able to determine the exact type of stroke you are suffering from, and can recommend a treatment plan accordingly. The second step is to consult another doctor. By determining which symptoms you are experiencing, you will be able to better determine whether you have a cryptogenic or non-cryptogenic stroke.
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Most patients will undergo telemetry on a stroke unit, but prolonged outpatient monitoring is also recommended. This type of testing can increase the detection rate of atrial fibrillation, but it can also be left undetected, and would require the use of anticoagulation treatment for the duration of the stroke. Besides increasing the odds of detection, prolonged outpatient monitoring may be the most cost-effective form of treatment. The most important issue is whether to prescribe anticoagulation during the recovery period after cryptogenic stroke.
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In one study, PFO closure was associated with decreased recurrent cryptogenic stroke. The authors of the trial followed 581 cryptogenic stroke patients for nearly six years. Compared to patients who received antiplatelet therapy alone, PFO closure was associated with a reduced risk of cryptogenic stroke. It was also associated with a lower risk of recurrence of the stroke. The study also noted that PFO closure was a superior treatment to anticoagulation alone.
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Ultimately, the SECRETO study, a clinical trial, will provide novel information on the risk factors and prognosis of young patients who experience a cryptogenic ischemic stroke. Researchers hope to identify the genetic background of the disease and find a target drug. The study will also assess the patient's functional status by using a questionnaire designed specifically for this purpose. And as the research continues, a novel blood biomarker may be developed that can help clinicians identify the underlying cause of the stroke.
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Another important study aims to determine the best diagnostic procedures for patients with cryptogenic stroke. It will include a randomized prospective trial of a new approach to long-term monitoring for AF detection in patients with cryptogenic stroke. The trial will enroll 450 patients from 50 sites in Canada and Europe. Participants in the study will have no previous history of AF, and will be given a subcutaneous cardiac monitor. Researchers will look at the rate of detecting AF within six months of a stroke. Patients will also have clinical follow-up for at least 12 months.
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In the United States, nearly 690 000 people suffer from ischemic stroke. About 30 percent of these patients may have a cryptogenic stroke. In addition to providing new diagnostic methods, ongoing research is advancing our understanding of cryptogenic stroke. In this article, Irene Katzan, MD, discusses the differences between ischemic and cryptogenic stroke and its causes. She also provides a detailed explanation of how to prevent a cryptogenic stroke.
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Lastly, PFO may be a risk factor for cryptogenic stroke. A high ROPE score may indicate a PFO-related risk for cryptogenic stroke. However, a low ROPE score might indicate that PFO is not the cause of the stroke. In cases where PFO is present, the PFO may be the source of the thrombus. As with cryptogenic stroke, PFO is a significant cause.
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Although the prevalence of cryptogenic stroke is extremely low, early identification of this cause can impact treatment. Identifying the gene and symptomatic symptoms may allow physicians to develop individualized strategies for counseling and management. Although the true prevalence of cryptogenic stroke remains unknown, it is more common in younger patients with conventional risk factors. This article will discuss some of the clinical implications of cryptogenic stroke and other sources. It may also help identify a patient's risk for ischemic stroke.
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Among the most common investigations in patients with CS is a transesophageal echocardiogram. This test can identify valvular or aortic pathology, or a left atrial appendage shunt. A bubble study may help identify a paradoxical embolism. Anti-phopholipid antibodies and occult malignancy are used to diagnose hypercoagulable states. Cerebrospinal fluid biopsy and cerebrospinal fluid sampling may also be helpful in assessing vasculitis and other systemic diseases.
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