Cryptogenic stroke

Abstract

Although in the last few years emerging conventional and unconventional radiological and laboratory techniques have shed light on different pathophysiologic causes of stroke, nowadays almost 25% of ischemic strokes results of undetermined etiology. Different diagnostic criteria have been developed to define cryptogenic stroke and to establish its prevalence in stroke units. Different studies tried to unravel mechanisms of cryptogenic stroke and to evaluate adequate primary and secondary preventive measures, but standardized diagnostic and therapeutic strategies are still missing. In this review we report the most relevant updated notions in cryptogenic stroke providing an overview of the definition, the recommendations for diagnostic evaluation and the updated treatment strategies for secondary prevention.

Cryptogenic strokes and embolic strokes of unknown source: lights and shadows of a new construct

“…The ESUS construct considers the potential of a number of minor-risk cardioembolic sources, as reported by Stornello et al 11 The long list contains structural cardiopathies (mitral valve myxomatous valvulopathy with prolapse, mitral annular calcification, aortic valve stenosis, aortic valve calcification, atrial appendage stasis with reduced flow velocities or spontaneous echodensities, atrial septal aneurysm, Chiari network, left ventricular moderate systolic or diastolic dysfunction both global or regional, left ventricular noncompaction, endomyocardial fibrosis), together with arrhythmic conditions as atrial asystole and sick-sinus syndrome, atrial flutter, and atrial high-rate episodes. 6 The spotlight is on covert AF or other embolic arrhythmias because they are frequently found in the follow-up of cryptogenic strokes.…”

“…9,10 Echocardiogram (transthoracic and/or transesophageal), prolonged hearth rhythm monitoring, intracranial echo-Doppler, intra and extracranial angio-computed tomography or magnetic resonance imaging including aortic arch, and laboratory evaluation of rare hypercoagulability causes are not currently recommended in a routine diagnostic work-up. In Tables 1 and 2 of their review, Stornello et al 11 report a complete list of genetic, traumatic, drug-related, inflammatory, and autoimmune diseases which are all potentially responsible for a stroke of rare etiology. A widespread searching program of all those causes in all patients would improve diagnostic precision but it would also make costs unsustainable.…”