Associating cryptogenic ischemic stroke in the young with cardiovascular risk factor phenotypes

Abstract

Acute Ischemic Stroke (AIS) in the young is increasing in prevalence and the largest subtype within this cohort is cryptogenic. To curb this trend, new ways of defining cryptogenic stroke and associated risk factors are needed. We aimed to gain insights into the presence or absence of cardiovascular risk factors in cases of cryptogenic stroke. We conducted a retrospective cohort study of patients aged 18–49 who presented to an urban tertiary care center with AIS. We manually collected predefined demographic, clinical, laboratory and radiological variables. Clinical risk phenotypes were determined using these variables through multivariate analysis of patients with the small and large vessel disease subtypes (vascular phenotype) and cardioembolic subtype (cardiac phenotype). The resultant phenotype models were applied to cases deemed cryptogenic. Within the 449 patients who met criteria, patients with small and large vessel disease (vascular phenotype) had higher rates of hypertension, intracranial atherosclerosis, and diabetes mellitus, and higher admission glucose, HbA1c, admission blood pressure, and cholesterol compared to the patients with cardioembolic AIS. The cardioembolic subgroup (cardiac phenotype) had significantly higher rates of congestive heart failure (CHF), rheumatic heart disease, atrial fibrillation, clotting disorders, left ventricular hypertrophy, larger left atrial sizes, lower ejection fractions, and higher B-type natriuretic peptide and troponin levels. Adjusted multivariate analysis produced six variables independently associated with the vascular phenotype (age, male sex, hemoglobin A1c, ejection fraction (EF), low-density lipoprotein (LDL) cholesterol, and family history of AIS) and five independently associated with the cardiac phenotype (age, female sex, decreased EF, CHF, and absence of intracranial atherosclerosis). Applying these models to cryptogenic stroke cases yielded that 51.5% fit the vascular phenotype and 3.1% fit the cardiac phenotype. In our cohort, half of young patients with cryptogenic stroke fit the risk factor phenotype of small and large vessel strokes.

Cryptogenic Stroke in an Adult Sudanese Female with Interatrial Septal Aneurysm: A Case Report

“…Possible underlying mechanisms that we assume include: formation of a thrombus on the left atrial side of the aneurysm, or development of interatrial fenestrations that led to a right to left shunt. Hypertension has been associated with cryptogenic stroke; hence we assume that it also contributed to the aetiology of the cryptogenic stroke in our patient [9]. Our case highlights the importance of atrial septum aneurysm as a possible risk factor for cryptogenic ischemic strokes.…”

The experience of young stroke survivors: An interpretative phenomenological study

“…In approximately 40% of young stroke survivors, the cause of stoke is deemed as cryptogenic, indicating that no cause can be identi ed, despite extensive investigation [7,12]. The young stroke survivors in this study who were not able to identify the cause of their stroke did not feel buoyed by the belief they could address their needs into the future and prevent further risk of stroke.…”

“…Particularly as young people are less likely to exhibit standard risk factors [1,3] and are more likely to exhibit an atypical stroke phenotype [4,6]. In up to 40% of young people affected by stroke, no cause will be identitied -this is referred to as cryptogenic stroke which can be associated with increased fear of future strokes [7]. Thus younger people are less likely to receive the critical intervention needed in the event of a stroke and may face risks of future strokes [4,6,8].…”

Family history of stroke – a useful clue for the primary care physician and stroke neurologist: a narrative review

“…Etiology and risk factors [45,80,82,98,[104][105][106][107][108][109][110][111][112][113][114][115][116][117] FHS was consistently associated with small vessel disease [80,82,[104][105][106][107][108] and large vessel disease [80,98,[105][106][107][108], but not with cardioembolic etiology [45,116,117].…”

“…With regards to stroke etiology, authors consistently reported an association of FHS with small vessel disease [80,82,[104][105][106][107][108], subclinical lacunes [109,110], intracranial artery stenosis [111][112][113][114][115] and large vessel disease [80,98,[105][106][107][108], but not with cardioembolic stroke [45,116,117]. One paper found that FHS was related to lacunar stroke in older subjects and cryptogenic etiology in the younger [118].…”