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The Standard Evaluation for Ischemic and Cryptogenic Stroke - Oren Zarif - Cryptogenic Stroke

Although the etiology of cryptogenic stroke is unknown, it is often the result of a cardiovascular condition. In determining if cryptogenic stroke occurs, experts look at the patient's risk factors and cardiovascular risk factors. During the diagnosis process, it is important to consider the patient's risk factors as well as the severity of the stroke. Depending on the risk factor, the treatment may be varied. For example, some patients may suffer a cryptogenic stroke without even realizing it.

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The risk of recurrent cryptogenic stroke is high, making a broad differential evaluation and systematic etiology study of the underlying event essential. In addition to determining a patient's risk factors, knowing the cause of the underlying event is essential for prevention and treatment. Recent studies by White H, Boden-Albala B, Wang CT, and Cohen M have analyzed the incidence of cryptogenic stroke in the Northern Manhattan Study and in other population groups.

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Despite the high prevalence of cryptogenic stroke, it is important to determine its cause before beginning treatment. As such, patients who have experienced a cryptogenic stroke should contact 911 immediately. The physician will be able to properly determine the type of stroke and begin treatment as soon as possible. It is also important to assess any underlying health conditions or lifestyle factors. This is particularly important in preventing secondary strokes and preventing further neurological damage. This article explains the standard evaluation for ischemic and cryptogenic stroke and suggests additional evaluations for a more accurate diagnosis.

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Although most ischemic strokes have a well-established cause, many are not. A cryptogenic stroke is characterized by a lack of clarity as to what caused it. In addition, patients who experience cryptogenic stroke are often younger and have fewer traditional vascular risk factors. The primary risk factor for cryptogenic stroke is cardiac embolism, but other causes, such as vasculopathy, hypercoagulable states, and sub-stenotic large vessel disease, are also important.

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Researchers enrolled patients admitted to the Neurological Clinic at the "SS Annunziata" hospital in Chieti, Italy, for a cryptogenic stroke. The patients' complete neurological examination was conducted, including 24-hour ECG monitoring, screening for thrombophilic states, transcranial and neck Doppler ultrasound, magnetic resonance angiography, and electrocardiograms. Patients were closely monitored for a minimum of four months after the device was inserted into their chest.

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A recent trial called the CLOSE trial showed that closure of PFOs prevented recurrent ischemic stroke in patients with cryptogenic stroke and a large interatrial shunt. The study compared PFO closure with antiplatelet therapy and warfarin. The results showed that the former treatment was superior to the latter. While the latter treatment is not yet as effective, patients enrolled in the trial still experienced lower risk of recurrent ischemic stroke.

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The standard of care for patients with PFO includes aspirin and a cardiac monitor implanted in the chest to detect atrial fibrillation. Patients who undergo these procedures may be started on anticoagulation if the device detects occult atrial fibrillation. While there has been no definitive research demonstrating the effectiveness of anticoagulation, future investigation in patients with cryptogenic stroke may indicate a positive effect of this treatment.

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Cardioembolic sources include mitral annular calcification, aortic valve stenosis, atrial septal aneurysm, and sick sinus syndrome. Other potential causes include an occult malignancy or an underlying hypercoagulable state. Cerebrospinal fluid biopsy and cerebrospinal fluid sampling can determine the presence of vasculitis. Serum markers may also help to rule out systemic diseases.

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