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Embolic stroke of undetermined source

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https://www.readbyqxmd.com/read/29111018/embolic-stroke-of-undetermined-source-the-role-of-the-nonstenotic-carotid-plaque
#1
Zachary Bulwa, Ajay Gupta
Cryptogenic stroke, or stroke of undetermined cause, presents a remarkably challenging dilemma for the treating physician as there are limited therapeutic options to prevent recurrence. Roughly one third of transient ischemic attacks (TIAs) and ischemic strokes are classified as cryptogenic, with an even greater proportion in young patients. While classification systems have been successfully used in trials to refine therapeutic approaches specific to subtype, there has been little progress made in secondary prevention of cryptogenic stroke...
November 15, 2017: Journal of the Neurological Sciences
https://www.readbyqxmd.com/read/29111002/free-fatty-acid-as-a-determinant-of-ischemic-lesion-volume-in-nonarterial-origin-embolic-stroke
#2
Jong-Won Chung, Woo-Keun Seo, Gyeong-Moon Kim, Chin-Sang Chung, Kwang Ho Lee, Oh Young Bang
GOALS: This study aimed to determine whether the plasma levels of free fatty acid (FFA) are associated with ischemic lesion characteristics in nonarterial-origin embolic stroke. MATERIALS AND METHODS: We prospectively recruited 254 patients with acute cerebral infarction caused by cardioembolic stroke (CES, n=121) or with embolic stroke of undetermined source (ESUS, n=133). Plasma levels of FFA were measured during the acute stage (median of 2days after stroke onset)...
November 15, 2017: Journal of the Neurological Sciences
https://www.readbyqxmd.com/read/28939703/association-between-troponin-levels-and-embolic-stroke-of-undetermined-source
#3
Alexander E Merkler, Gino Gialdini, Santosh B Murthy, Setareh Salehi Omran, Antonio Moya, Michael P Lerario, Ji Chong, Peter M Okin, Jonathan W Weinsaft, Monika M Safford, Matthew E Fink, Babak B Navi, Costantino Iadecola, Hooman Kamel
BACKGROUND: Our aim was to determine whether patients with embolic strokes of undetermined source (ESUS) have higher rates of elevated troponin than patients with noncardioembolic strokes. METHODS AND RESULTS: CAESAR (The Cornell Acute Stroke Academic Registry) prospectively enrolled all adults with acute stroke from 2011 to 2014. Two neurologists used standard definitions to retrospectively ascertain the etiology of stroke, with a third resolving disagreements...
September 22, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/28862284/detection-of-atrial-fibrillation-in-patients-with-embolic-stroke-of-undetermined-source-by-prolonged-monitoring-with-implantable-loop-recorders
#4
Carsten Israel, Alkisti Kitsiou, Malik Kalyani, Sameera Deelawar, Lucy Ekosso Ejangue, Andreas Rogalewski, Christoph Hagemeister, Jens Minnerup, Wolf-Rüdiger Schäbitz
Recently, the clinical entity embolic stroke of undetermined source (ESUS) has been defined for patients with ischemic strokes, where neither a cardioembolic nor a non-cardiac source can be detected. These patients may suffer from asymptomatic atrial fibrillation (AF), terminating spontaneously and thus eluding detection. Implantable loop recorders (ILR) with automatic AF detection algorithms can detect short-lasting, subclinical AF. The aim of this study was to prospectively assess and predict AF detection in patients with ESUS using ILR with daily remote interrogation...
October 5, 2017: Thrombosis and Haemostasis
https://www.readbyqxmd.com/read/28859022/embolic-stroke-of-undetermined-source-in-latin-america-a-review
#5
Carlos Cantú-Brito, Gisele Sampaio Silva, Sebastián F Ameriso
BACKGROUND: Stroke is a major health concern throughout Latin America. As elsewhere, no precise cause can be determined for a substantial portion of strokes. In 6 studies since 2010 in the region, 16% to 43% of ischemic strokes were identified as cryptogenic. The term embolic stroke of undetermined source (ESUS) has been proposed as more clinically useful and positively defined than the vague term cryptogenic. The epidemiology of ESUS in Latin America is largely unknown. REVIEW SUMMARY: This article aims to provide a description of the epidemiology of ESUS in Latin America and practical information regarding available diagnostic procedures and current guidelines...
September 2017: Neurologist
https://www.readbyqxmd.com/read/28835326/juvenile-stroke
#6
Florian Schöberl, Peter Arthur Ringleb, Reza Wakili, Sven Poli, Frank Arne Wollenweber, Lars Kellert
BACKGROUND: So-called juvenile stroke, i.e., stroke in a person aged 18 to 55, affects approximately 30 000 persons per year in Germany and is thus an important cause of mortality and permanent morbidity. The spectrum of causes of stroke is broader in this age group than in older patients and is also differently distributed. METHODS: This review is based on pertinent publications retrieved by a selective search in PubMed and on current guideline recommendations...
August 7, 2017: Deutsches Ärzteblatt International
https://www.readbyqxmd.com/read/28818863/detection-of-left-ventricular-thrombus-by-cardiac-magnetic-resonance-in-embolic-stroke-of-undetermined-source
#7
Junji Takasugi, Hiroshi Yamagami, Teruo Noguchi, Yoshiaki Morita, Tomotaka Tanaka, Yoshinori Okuno, Satoshi Yasuda, Kazunori Toyoda, Yasufumi Gon, Kenichi Todo, Manabu Sakaguchi, Kazuyuki Nagatsuka
BACKGROUND AND PURPOSE: We aimed to use contrast-enhanced cardiac magnetic resonance (CE-CMR) imaging to elucidate the prevalence of left ventricular (LV) thrombus in patients suspected of embolic stroke of undetermined source (ESUS) with previous myocardial infarction or LV dysfunction (LV ejection fraction [LVEF] <50%). METHODS: We prospectively investigated 797 consecutive patients who presented to our hospital with acute ischemic stroke between 2014 and 2015...
September 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28756759/differential-characteristics-stroke-recurrence-and-predictors-of-covert-atrial-fibrillation-of-embolic-strokes-of-undetermined-source
#8
Maximiliano A Hawkes, Mauricio F Farez, Lucia Pertierra, Maia M Gomez-Schneider, José M Pastor-Rueda, Sebastián F Ameriso
Background and purpose Identifying embolic strokes of undetermined source (ESUS) patients likely to harbor atrial fibrillation may have diagnostic and therapeutic implications. Our aim was to examine differences between ESUS and cardioembolic strokes, to evaluate stroke recurrence rate among ESUS and to identify baseline characteristics of ESUS patients who were later diagnosed with atrial fibrillation. Materials and methods We assessed all ischemic stroke patients admitted between June 2012 and November 2013...
January 1, 2017: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/28733124/left-upper-lung-lobectomy-is-an-embolic-risk-factor-for-cerebral-infarction
#9
Yuya Kobayashi, Hiroyuki Yahikozawa, Ryota Takamatsu, Rie Watanabe, Kenichi Hoshi, Wataru Ishii, Shunichi Sato
Cerebral embolism is typically caused by a cardiogenic thrombus. The patent foramen ovale is a well-known cause of paradoxical embolism. However, some idiopathic cases of stroke have been reported. Such strokes are designated as embolic stroke of undetermined sources. Among them, lung lobectomy may be a new embolic risk factor for cerebral embolism. The risk of thrombus formation is high at the pulmonary vein stump after lung lobectomy, especially in the left upper lobe. Interestingly, the risk remains several years after surgery...
September 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28720658/ticagrelor-versus-aspirin-in-acute-embolic-stroke-of-undetermined-source
#10
RANDOMIZED CONTROLLED TRIAL
Pierre Amarenco, Gregory W Albers, Hans Denison, J Donald Easton, Scott R Evans, Peter Held, Michael D Hill, Jenny Jonasson, Scott E Kasner, Per Ladenvall, Kazuo Minematsu, Carlos A Molina, Yongjun Wang, K S Lawrence Wong, S Claiborne Johnston
BACKGROUND AND PURPOSE: Ticagrelor is an effective antiplatelet therapy among patients with atherosclerotic disease and, therefore, could be more effective than aspirin in preventing recurrent stroke and cardiovascular events among patients with embolic stroke of unknown source (ESUS), which includes patients with ipsilateral stenosis <50% and aortic arch atherosclerosis. METHODS: We randomized 13 199 patients with a noncardioembolic, nonsevere ischemic stroke or high-risk transient ischemic attack to ticagrelor (180 mg loading dose on day 1 followed by 90 mg twice daily for days 2-90) or aspirin (300 mg on day 1 followed by 100 mg daily for days 2-90) within 24 hours of symptom onset...
September 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28707135/secondary-stroke-prevention-in-cryptogenic-stroke-and-embolic-stroke-of-undetermined-source-esus
#11
REVIEW
Hans-Christoph Diener, Richard Bernstein, Robert Hart
PURPOSE OF THE REVIEW: The purpose of the study was to review the literature on cryptogenic stroke and embolic stroke of undetermined stroke (ESUS). Cryptogenic stroke according to TOAST criteria is a stroke which is not due to cardiogenic embolism, small vessel disease with lacunes or large vessel disease of brain supplying arteries. In the context of secondary stroke prevention studies, cryptogenic stroke is not operationally defined. RECENT FINDINGS: The new concept of "embolic stroke of undetermined source" (ESUS) provides an operational definition...
September 2017: Current Neurology and Neuroscience Reports
https://www.readbyqxmd.com/read/28687720/age-and-sex-specific-analysis-of-patients-with-embolic-stroke-of-undetermined-source
#12
George Ntaios, Gregory Y H Lip, Konstantinos Vemmos, Eleni Koroboki, Efstathios Manios, Anastasia Vemmou, Ana Rodríguez-Campello, Elisa Cuadrado-Godia, Jaume Roquer, Valentina Arnao, Valeria Caso, Maurizio Paciaroni, Exuperio Diez-Tejedor, Blanca Fuentes, Josefa Pérez Lucas, Antonio Arauz, Sebastian F Ameriso, Lucía Pertierra, Maia Gómez-Schneider, Maximiliano A Hawkes, Fabio Bandini, Beatriz Chavarria Cano, Ana Maria Iglesias Mohedano, Andrés García Pastor, Antonio Gil-Núñez, Jukka Putaala, Turgut Tatlisumak, Miguel A Barboza, George Athanasakis, Fotios Gioulekas, Konstantinos Makaritsis, Vasileios Papavasileiou
OBJECTIVE: To investigate whether the correlation of age and sex with the risk of recurrence and death seen in patients with previous ischemic stroke is also evident in patients with embolic stroke of undetermined source (ESUS). METHODS: We pooled datasets of 11 stroke registries from Europe and America. ESUS was defined according to the Cryptogenic Stroke/ESUS International Working Group. We performed Cox regression and Kaplan-Meier product limit analyses to investigate whether age (<60, 60-80, >80 years) and sex were independently associated with the risk for ischemic stroke/TIA recurrence or death...
August 8, 2017: Neurology
https://www.readbyqxmd.com/read/28687717/age-and-the-fuzzy-edges-of-embolic-stroke-of-undetermined-source-implications-for-trials
#13
EDITORIAL
Andreas Charidimou
No abstract text is available yet for this article.
July 7, 2017: Neurology
https://www.readbyqxmd.com/read/28596467/-embolic-stroke-of-undetermined-source
#14
REVIEW
Teruyuki Hirano
A new clinical construct, embolic stroke of undetermined source (ESUS) was established as a therapeutically relevant entity, which are defined as a non-lacunar infarction without proximal arterial stenosis or cardioembolic sources, with a clear indication for anticoagulation, especially with direct oral anticoagulant (DOAC). The possible embolic sources include covert atrial fibrillation, arterial stenosis with <50%, low-risk emboligenic cardiac sources, aortic plaque, cancer-associated, and paradoxical embolism...
June 2017: Brain and Nerve, Shinkei Kenkyū No Shinpo
https://www.readbyqxmd.com/read/28536667/association-between-embolic-stroke-patterns-esus-etiology-and-new-diagnosis-of-atrial-fibrillation-a-secondary-data-analysis-of-the-find-af-trial
#15
Ilko L Maier, Katharina Schregel, André Karch, Mark Weber-Krueger, Rafael T Mikolajczyk, Raoul Stahrenberg, Klaus Gröschel, Mathias Bähr, Michael Knauth, Marios-Nikos Psychogios, Rolf Wachter, Jan Liman
Background. Atrial fibrillation (AF) is an important cause of embolic stroke of undetermined source (ESUS). Imaging-patterns like multiple infarcts, simultaneous involvement of different circulations, infarcts of different ages, and isolated cortical infarcts are likely to indicate cardioembolic stroke. The aim of our study was to evaluate the association between embolic stroke patterns, ESUS, and the new diagnosis of AF. Methods. Stroke etiology and imaging characteristics from patients included in the Find-AF study were obtained...
2017: Stroke Research and Treatment
https://www.readbyqxmd.com/read/28476509/three-case-report-of-embolic-stroke-of-undetermined-source
#16
Jia Li, Xue-Zhi Yang, Yi-Ping Wang, Xiao-Li Chen, Xu Zhang
BACKGROUND: Embolic stroke of undetermined source (ESUS) is a new clinical construct. It signifies that the embolus in the thromboembolic ischemic stroke is of unknown origin. The anticoagulants are usually prescribed for antithrombotic prophylaxis, but whether it is appropriate for all patients with ESUS is still unknown. METHODS AND RESULTS: In this article, we describe 3 cases of ESUS, all of whose antithrombotic therapy was antiplatelet medication, and the 3 patients had no recurrence on 3- to 7-month follow-up...
July 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28431956/bilateral-cerebral-embolism-as-a-characteristic-feature-of-patients-with-trousseau-syndrome
#17
Takeru Umemura, Junkoh Yamamoto, Daisuke Akiba, Shigeru Nishizawa
Trousseau syndrome is defined as a variant of intravascular thromboembolism that is induced by cancer. It may manifest itself as cerebral embolisms in some cases; however, when the cancer is not diagnosed, this identification may be difficult. Therefore, cerebral embolisms are often treated without identifying the cancer, which can worsen a patient's condition. The purpose of this study was to determine the differences in clinical features between cerebral embolisms induced by cancer (Trousseau syndrome) and those that are due to other causes, such as cardiogenic embolisms and artery-to-artery stroke...
August 2017: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/28412318/nontraditional-lipid-variables-predict-recurrent-brain-ischemia-in-embolic-stroke-of-undetermined-source
#18
Patricia de la Riva, Maitane Zubikarai, Cristina Sarasqueta, Mikel Tainta, Amaia Muñoz-Lopetegui, Naiara Andrés-Marín, Félix González, Noemi Díez, Ana de Arce, Alberto Bergareche, Adolfo Lopez de Munain, Maite Martínez-Zabaleta
OBJECTIVE: The aims of this study are, first, to calculate the risk of brain ischemia recurrence and embolic source diagnosis in the follow-up of patients with ESUS (embolic stroke of undetermined source) and, second, to identify the predictors of these events including cardiologic, laboratory, and clinical factors. METHODS: A retrospective observational cohort study of stroke patients admitted to the stroke unit in a single tertiary hospital from 2012 to 2014 was performed...
April 13, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28411261/feasibility-and-diagnostic-value-of-cardiovascular-magnetic-resonance-imaging-after-acute-ischemic-stroke-of-undetermined-origin
#19
RANDOMIZED CONTROLLED TRIAL
Karl Georg Haeusler, Christian Wollboldt, Laura Zu Bentheim, Juliane Herm, Sebastian Jäger, Claudia Kunze, Holger-Carsten Eberle, Claudia Christina Deluigi, Oliver Bruder, Carolin Malsch, Peter U Heuschmann, Matthias Endres, Heinrich J Audebert, Andreas J Morguet, Christoph Jensen, Jochen B Fiebach
BACKGROUND AND PURPOSE: Etiology of acute ischemic stroke remains undetermined (cryptogenic) in about 25% of patients after state-of-the-art diagnostic work-up. METHODS: One-hundred and three patients with magnetic resonance imaging (MRI)-proven acute ischemic stroke of undetermined origin were prospectively enrolled and underwent 3-T cardiac MRI and magnetic resonance angiography of the aortic arch in addition to state-of-the-art diagnostic work-up, including transesophageal echocardiography (TEE)...
May 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28320124/the-p-wave-terminal-force-in-embolic-strokes-of-undetermined-source
#20
Simona Lattanzi, Claudia Cagnetti, Alessandra Pulcini, Marco Morelli, Simone Maffei, Leandro Provinciali, Mauro Silvestrini
BACKGROUND: The Embolic Stroke of Undetermined Source (ESUS) is a recently developed clinical construct which describes stroke patients for whom the embolic source remains undetermined despite recommended investigations. The aim of the study was to characterize the ESUS population according to the abnormality in the P-wave terminal force in lead V1 (PTFV1). METHODS: We retrospectively identified consecutive patients hospitalized for acute ischemic stroke who met the ESUS diagnostic criteria...
April 15, 2017: Journal of the Neurological Sciences
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