The Diagnosis of Cryptogenic Stroke - Oren Zarif - Cryptogenic Stroke

The diagnosis of cryptogenic stroke is complex. Although it is the fifth most common cause of death and the number one neurological cause of disability, many strokes are not cryptogenic. Cryptogenic stroke is a subtype of embolic stroke and has many lower-risk causes. The International Working Group on Cryptogenic Stroke has proposed a number of diagnostic criteria to assist in identifying emboli. This article will discuss some of these criteria and their implications for stroke diagnosis.

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While the exact cause of a cryptogenic stroke may not always be known, the severity of the symptoms and the level of medical evaluation are crucial. Among other things, blood vessels in the head and neck are important signs of cryptogenic stroke, as is brain tissue. The first step in a cryptogenic stroke diagnosis is confirming the diagnosis with a doctor's examination. If the doctor does not feel confident in the diagnosis, it's time to seek a second opinion.

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Prolonged rhythm monitoring is a key component of the workup for cryptogenic stroke. While most patients undergo telemetry on stroke units, extended outpatient monitoring is warranted in these patients. Prolonged monitoring increases the yield of detection. A recent randomized study of patients with cryptogenic stroke compared to controls showed that the use of noninvasive cardiac monitoring for 30 days increased the likelihood of atrial fibrillation detection in 16.1% of cryptogenic stroke patients. However, this finding remains uncertain.

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In a clinical trial, PFO closure was found to be significantly more beneficial than antiplatelet therapy for patients with cryptogenic stroke. The RESPECT trial followed patients for nearly six years and found a reduction in recurrent stroke compared to anticoagulation alone. Moreover, patients with cryptogenic stroke were more likely to undergo closure as compared to those who underwent antiplatelet therapy alone. This trial is considered the gold standard of treatments for cryptogenic stroke.

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Despite these findings, cryptogenic stroke is a complication of ischemic stroke that requires a broad differential diagnosis and systematic investigation of potential causes. The high risk of recurrence is a compelling reason to identify etiological factors in cryptogenic stroke and identify treatments and prevention strategies. The incidence of cryptogenic stroke is significantly higher among minorities and in young adults than among whites in Finland. And while it is a rare type of ischemic stroke, it is associated with a higher risk of recurrent stroke.

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Detection of PFO is a useful first step in the diagnosis of cryptogenic stroke. However, detection of PFO alone does not prove a causal relationship. It is important to note that patients with cryptogenic stroke are typically younger and do not have typical risk factors for stroke. Therefore, it is important to assess the risk of PFO closure in patients with cryptogenic stroke by using agitated saline contrast and TEE.

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Several stroke risk factors may play a role in cryptogenic stroke. The main risk factor is cardiovascular disease. This condition is common, with approximately 690 thousand Americans prone to it each year. While the risk factors for cryptogenic stroke are similar, some of these patients have underlying conditions that may lead to the development of cryptogenic stroke. Consequently, it is important to distinguish between cryptogenic and ischemic stroke. When you're considering whether or not cryptogenic stroke is the correct diagnosis, be sure to discuss these factors with your doctor.

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If a patient has a cryptogenic stroke, it is important to exclude all possible causes of the condition. ESUS is an effective diagnostic procedure for cryptogenic stroke. Generally, ESUS requires a minimal workup and is not used in patients with noncryptogenic ischemic stroke. It is important to rule out any occult malignancy or arterial hypercoagulability before attempting a treatment plan. Antiplatelet therapy is the standard treatment for cryptogenic stroke. The use of NOACs such as aspirin is sometimes helpful for select patients with paradoxical embolization through the PFO.

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Identifying patients with CS is a complicated process. It is crucial to identify patients with a specific genetic abnormality before it leads to an ischemic stroke, as early diagnosis may impact treatment and counseling. While the true prevalence of cryptogenic stroke is unknown, the risk of genetic abnormality is increased in patients with young age, positive family history, and no conventional risk factors. Because of this, genetic testing may be more effective in identifying patients with a cryptogenic CS.