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Embolic stroke of undetermined source

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https://www.readbyqxmd.com/read/28596467/-embolic-stroke-of-undetermined-source
#1
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
#2
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
#3
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
#4
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...
April 19, 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
#5
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
#6
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)...
April 14, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28320124/the-p-wave-terminal-force-in-embolic-strokes-of-undetermined-source
#7
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
https://www.readbyqxmd.com/read/28265016/embolic-stroke-of-undetermined-source-a-systematic-review-and-clinical-update
#8
REVIEW
Robert G Hart, Luciana Catanese, Kanjana S Perera, George Ntaios, Stuart J Connolly
BACKGROUND AND PURPOSE: Embolic stroke of undetermined source (ESUS) designates patients with nonlacunar cryptogenic ischemic strokes in whom embolism is the likely stroke mechanism. It has been hypothesized that anticoagulation is more efficacious than antiplatelet therapy for secondary stroke prevention in ESUS patients. We review available information about ESUS. METHODS: Systematic literature review to assess the frequency of ESUS, patient features, and prognosis using PubMed from 2014 to present, unrestricted by language...
April 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28237125/biomarkers-of-atrial-cardiopathy-and-atrial-fibrillation-detection-on-mobile-outpatient-continuous-telemetry-after-embolic-stroke-of-undetermined-source
#9
Denise Sebasigari, Alexander Merkler, Yang Guo, Gino Gialdini, Benjamin Kummer, Morgan Hemendinger, Christopher Song, Antony Chu, Shawna Cutting, Brian Silver, Mitchell S V Elkind, Hooman Kamel, Karen L Furie, Shadi Yaghi
BACKGROUND: Biomarkers of atrial dysfunction or "cardiopathy" are associated with embolic stroke risk. However, it is unclear if this risk is mediated by undiagnosed paroxysmal atrial fibrillation or flutter (AF). We aim to determine whether atrial cardiopathy biomarkers predict AF on continuous heart-rhythm monitoring after embolic stroke of undetermined source (ESUS). METHODS: This was a single-center retrospective study including all patients with ESUS undergoing 30 days of ambulatory heart-rhythm monitoring to look for AF between January 1, 2013 and December 31, 2015...
June 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28178140/utility-of-duranta-a-wireless-patch-type-electrocardiographic-monitoring-system-developed-in-japan-in-detecting-covert-atrial-fibrillation-in-patients-with-cryptogenic-stroke-a-case-report
#10
Hisanao Akiyama, Saki Nukui, Takashi Araga, Masashi Hoshino, Keita Tanaka, Satoru Kashima, Rie Sasaki, Kenji Uchino, Yasuhiro Hasegawa
RATIONALE: Subcutaneous implantable electrocardiographs are highly effective in detecting covert atrial fibrillation (AF) in cryptogenic stroke. However, these invasive devices are not indicated for all cryptogenic stroke patients, and noninvasive improvements over conventional Holter-type ambulatory electrocardiography are needed. We evaluated the clinical application and effectiveness of Duranta (ImageONE Co., Ltd.), a wireless patch-type electrocardiographic monitoring system developed in Japan for chronically ill patients or home-based patients at the end of life...
February 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28154101/cardioembolic-stroke
#11
REVIEW
Hooman Kamel, Jeff S Healey
Cardiac embolism accounts for an increasing proportion of ischemic strokes and might multiply several-fold during the next decades. However, research points to several potential strategies to stem this expected rise in cardioembolic stroke. First, although one-third of strokes are of unclear cause, it is increasingly accepted that many of these cryptogenic strokes arise from a distant embolism rather than in situ cerebrovascular disease, leading to the recent formulation of embolic stroke of undetermined source as a distinct target for investigation...
February 3, 2017: Circulation Research
https://www.readbyqxmd.com/read/28049884/a-case-of-cardioembolic-stroke-due-to-intracardiac-papillary-fibroelastoma-evaluated-by-using-transesophageal-echocardiography
#12
Yuichiro Ohya, Shigeru Fujimoto, Makoto Kanazawa, Naoki Tagawa, Masato Osaki, Takanari Kitazono
A 62-year-old woman had a prior ischemic stroke in the right temporal lobe with dysarthria and dysesthesia of the left hand. Embolic stroke of undetermined source (ESUS) was diagnosed and warfarin was administered. However, transient ischemic attack recurred upon admission to our hospital. Paroxysmal atrial fibrillation and cerebral arterial stenotic lesions were absent. Transesophageal echocardiography revealed a mobile hyperechoic structure on the aortic valve indicating papillary fibroelastoma. She was diagnosed with a brain embolism due to the intracardiac tumor which was surgically excised and pathologically confirmed as papillary fibroelastoma...
January 31, 2017: Rinshō Shinkeigaku, Clinical Neurology
https://www.readbyqxmd.com/read/27881833/apixaban-for-treatment-of-embolic-stroke-of-undetermined-source-atticus-randomized-trial-rationale-and-study-design
#13
Tobias Geisler, Sven Poli, Christoph Meisner, Juergen Schreieck, Christine S Zuern, Thomas Nägele, Johannes Brachmann, Werner Jung, Georg Gahn, Elisabeth Schmid, Hansjörg Bäezner, Timea Keller, Gabor C Petzold, Jan-Wilko Schrickel, Jan Liman, Rolf Wachter, Frauke Schön, Martin Schabet, Alfred Lindner, Albert C Ludolph, Hubert Kimmig, Sebastian Jander, Uwe Schlegel, Meinrad Gawaz, Ulf Ziemann
RATIONALE: Optimal secondary prevention of embolic stroke of undetermined source is not established. The current standard in these patients is acetylsalicylic acid, despite high prevalence of yet undetected paroxysmal atrial fibrillation. AIM: The ATTICUS randomized trial is designed to determine whether the factor Xa inhibitor apixaban administered within 7 days after embolic stroke of undetermined source, is superior to acetylsalicylic acid for prevention of new ischemic lesions documented by brain magnetic resonance imaging within 12 months after index stroke...
November 23, 2016: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/27836915/cardiac-diagnostic-work-up-of-ischaemic-stroke
#14
REVIEW
Hayang Yang, Martina Nassif, Paul Khairy, Joris R de Groot, Yvo B W E M Roos, Robbert J de Winter, Barbara J M Mulder, Berto J Bouma
Cardioembolic sources account for 20-30% of ischaemic strokes and are important to identify considering their prognostic and therapeutic implications. During the past years, new developments have been made in the cardiac diagnostic evaluation and management of patients with ischaemic stroke, especially regarding strokes of unknown aetiology. These recent advances have had a major impact on our understanding of embolic strokes, their diagnostic work-up, and clinical management. Herein, we propose a cardiac diagnostic work-up scheme for patients with ischaemic stroke from definite cardioembolic sources and embolic strokes of undetermined source...
November 10, 2016: European Heart Journal
https://www.readbyqxmd.com/read/27832136/comparison-of-functional-outcome-and-stroke-recurrence-in-patients-with-embolic-stroke-of-undetermined-source-esus-vs-cardioembolic-stroke-patients
#15
Antonio Arauz, Eugenia Morelos, Jonathan Colín, Javier Roldán, Miguel A Barboza
BACKGROUND: Embolic stroke of undetermined source (ESUS) recurrence and functional outcome from long-term follow-up is not well delineated. The purpose of this study is to compare these functional variables between ESUS vs. cardioembolic stroke (CS) patients. METHODS: We analyzed data of consecutive ESUS and CS patients from our institutional database, from January 2003 until April 2015. The endpoints were stroke recurrence, mortality and poor clinical outcome (Modified Rankin Score 3-6), at discharge, 6 months and final follow-up...
2016: PloS One
https://www.readbyqxmd.com/read/27733026/association-of-left-atrial-enlargement-with-cortical-infarction-in-subjects-with-patent-foramen-ovale
#16
Mi Ji Lee, Sung-Ji Park, Chang Hyo Yoon, Ji-Won Hwang, Sookyung Ryoo, Suk Jae Kim, Gyeong-Moon Kim, Chin-Sang Chung, Kwang Ho Lee, Oh Young Bang
BACKGROUND AND PURPOSE: Left atrial dysfunction has been reported in patients with patent foramen ovale (PFO). Here we investigated the role of left atrial dysfunction in the development of embolic stroke in patients with PFO. METHODS: We identified consecutive patients with embolic stroke of undetermined sources except for PFO (PFO+ESUS). Healthy subjects with PFO served as controls (PFO+control). A stratified analysis by 10-year age group and an age- and sex- matching analysis were performed to compare echocardiographic markers between groups...
September 2016: Journal of Stroke
https://www.readbyqxmd.com/read/27703086/emerging-risk-factors-for-recurrent-vascular-events-in-patients-with-embolic-stroke-of-undetermined-source
#17
Yuji Ueno, Kazuo Yamashiro, Ryota Tanaka, Takuma Kuroki, Kenichiro Hira, Naohide Kurita, Takao Urabe, Nobutaka Hattori
BACKGROUND AND PURPOSE: Underlying embolic causes diagnosed by transesophageal echocardiography could be implicated in mechanisms of embolic stroke of undetermined source. We aimed to explore factors, including underlying embolic causes, related to recurrent vascular events in embolic stroke of undetermined source. METHODS: Patients who fulfilled the diagnostic criteria for embolic stroke of undetermined source and whose potential embolic sources were examined by transesophageal echocardiography were included...
November 2016: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/27630613/recurrent-embolic-strokes-of-undetermined-source-in-a-patient-with-extreme-lipoprotein-a-levels
#18
Zachary Bulwa, Audrey Kim, Karandeep Singh, Alexander Kantorovich, Faten Suhail
Lipoprotein(a) is a plasma lipoprotein and known cardiovascular risk factor, most recently implicated in the development of high-risk carotid atherosclerotic plaques without significant carotid stenosis. We present a case of a young African-American female with recurrent embolic strokes of undetermined source. After our thorough investigation, we identified the link between a small, irregular plaque in the right internal carotid artery, and an extremely elevated plasma level of lipoprotein(a) as the source of her embolic strokes...
2016: Frontiers in Neurology
https://www.readbyqxmd.com/read/27624118/ischemic-stroke-classification-and-risk-of-embolism-in-patients-with-chagas-disease
#19
Vinícius Viana Abreu Montanaro, Creuza Maria da Silva, Carla Verônica de Viana Santos, Maria Inacia Ruas Lima, Edson Marcio Negrão, Gabriel R de Freitas
Ischemic stroke (IS) and Chagas disease are strongly related. Nevertheless, little attention has been paid to this association and its natural history. The current guidelines concerning the management and secondary prevention of IS are largely based on the incomplete information or extrapolation of knowledge from other stroke etiologies. We performed a retrospective study which compared stroke etiologies among a cohort of hospitalized patients with IS and Chagas disease. The Instituto de Pesquisa Evandro Chagas/Fundação Oswaldo Cruz (IPEC/FIOCRUZ) embolic score was also used to identify and evaluate the risk of embolism in this population...
December 2016: Journal of Neurology
https://www.readbyqxmd.com/read/27623683/spotlight-on-unmet-needs-in-stroke-prevention-the-pioneer-af-pci-navigate-esus-and-galileo-trials
#20
Melanie Hemmrich, Eric D Peterson, Karen Thomitzek, Jeffrey I Weitz
Atrial fibrillation (AF) is a major healthcare concern, being associated with an estimated five-fold risk of ischaemic stroke. In patients with AF, anticoagulants reduce stroke risk to a greater extent than acetylsalicylic acid (ASA) or dual antiplatelet therapy (DAPT) with ASA plus clopidogrel. Non-vitamin K antagonist oral anticoagulants (NOACs) are now a widely-accepted therapeutic option for stroke prevention in non-valvular AF (NVAF). There are particular patient types with NVAF for whom treatment challenges remain, owing to sparse clinical data, their high-risk nature or a need to harmonise anticoagulant and antiplatelet regimens if co-administered...
September 28, 2016: Thrombosis and Haemostasis
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