Cryptogenic Stroke.
N Engl J Med. 2016 May 26;374(21):2065-2074
Authors: Saver JL
Abstract
Key Clinical Points Cryptogenic Stroke One quarter of patients with ischemic stroke have no probable cause found after standard workup, including echocardiography, inpatient cardiac telemetry or 24-hour Holter monitoring, magnetic resonance imaging or computed tomographic (CT) imaging of topographic features of the infarct in the brain, and magnetic resonance or CT angiographic assessment of neck and brain arteries. Additional investigation identifies a likely mechanism in more than half these patients. Most cryptogenic ischemic strokes are embolic in origin, arising from proximal arterial sources, the heart, or venous sources (with right-to-left shunts). Investigation in patients with cryptogenic stroke typically includes evaluation for atherosclerotic and nonatherosclerotic arteriopathies, cardiac sources of embolism (structural and rhythm abnormalities), and disturbances of coagulation. Patent foramen ovale is found in up to half of young adults with cryptogenic stroke but is also found in one quarter of healthy persons. Occult, low-burden, paroxysmal atrial fibrillation is increasingly recognized as a source of cryptogenic stroke, especially in older patients.
PMID: 27223148 [PubMed - as supplied by publisher]