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Embolic stroke of undetermined source

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
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...
October 4, 2016: Stroke; a Journal of Cerebral Circulation
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
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...
September 13, 2016: Journal of Neurology
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 14, 2016: Thrombosis and Haemostasis
Riccardo Cappato, Robert Welsh
The vast clinical research programme for the direct, oral factor Xa inhibitor rivaroxaban has generated a wealth of data since the first rivaroxaban approval in 2008 for the prevention of venous thromboembolism (VTE) in patients undergoing elective hip or knee replacement surgery. While rivaroxaban is widely used across a spectrum of seven indications, there is continuous commitment to investigating its wider benefits in new indications and attempts to refine current evidence. Key data from recently completed randomised controlled trials (RCTs) have shown that rivaroxaban is a feasible anticoagulation option for patients with non-valvular atrial fibrillation (NVAF) undergoing cardioversion or catheter ablation...
September 28, 2016: Thrombosis and Haemostasis
George Ntaios, Vasileios Papavasileiou, Gregory Y H Lip, Haralampos Milionis, Konstantinos Makaritsis, Anastasia Vemmou, Eleni Koroboki, Efstathios Manios, Konstantinos Spengos, Patrik Michel, Konstantinos Vemmos
BACKGROUND: There is increasing debate whether atrial fibrillation (AF) episodes during follow-up in patients with embolic stroke of undetermined source (ESUS) are causally associated with the event. AF-related strokes are more severe than strokes of other etiologies. In this context, we aimed to compare stroke severity between ESUS patients diagnosed with AF during follow-up and those who were not. We hypothesized that, if AF episodes detected during follow-up are indeed causally associated with the index event, stroke severity in the AF group should be higher than the non-AF group...
September 6, 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Prasanna V Eswaradass, Emmad Qazi, Bijoy K Menon
No abstract text is available yet for this article.
September 2016: Canadian Journal of Neurological Sciences. le Journal Canadien des Sciences Neurologiques
Kanjana S Perera, Thomas Vanassche, Jackie Bosch, Balakumar Swaminathan, Hardi Mundl, Mohana Giruparajah, Miguel A Barboza, Martin J O'Donnell, Maia Gomez-Schneider, Graeme J Hankey, Byung-Woo Yoon, Artemio Roxas, Philippa Lavallee, Joao Sargento-Freitas, Nikolay Shamalov, Raf Brouns, Rubens J Gagliardi, Scott E Kasner, Alessio Pieroni, Philipp Vermehren, Kazuo Kitagawa, Yongjun Wang, Keith Muir, Jonathan M Coutinho, Stuart J Connolly, Robert G Hart
BACKGROUND AND PURPOSE: Atrial fibrillation (AF) is increasingly recognized as the single most important cause of disabling ischemic stroke in the elderly. We undertook an international survey to characterize the frequency of AF-associated stroke, methods of AF detection, and patient features. METHODS: Consecutive patients hospitalized for ischemic stroke in 2013 to 2014 were surveyed from 19 stroke research centers in 19 different countries. Data were analyzed by global regions and World Bank income levels...
September 2016: Stroke; a Journal of Cerebral Circulation
George Ntaios, Konstantinos Vemmos, Gregory Y H Lip, Eleni Koroboki, Efstathios Manios, Anastasia Vemmou, Ana Rodríguez-Campello, Elisa Cuadrado-Godia, Eva Giralt-Steinhauer, Valentina Arnao, Valeria Caso, Maurizio Paciaroni, Exuperio Diez-Tejedor, Blanca Fuentes, Josefa Pérez Lucas, Antonio Arauz, Sebastian F Ameriso, Maximiliano A Hawkes, Lucía Pertierra, Maia Gómez-Schneider, Fabio Bandini, Beatriz Chavarria Cano, Ana Maria Iglesias Mohedano, Andrés García Pastor, Antonio Gil-Núñez, Jukka Putaala, Turgut Tatlisumak, Miguel A Barboza, George Athanasakis, Konstantinos Makaritsis, Vasileios Papavasileiou
BACKGROUND AND PURPOSE: The risk of stroke recurrence in patients with Embolic Stroke of Undetermined Source (ESUS) is high, and the optimal antithrombotic strategy for secondary prevention is unclear. We investigated whether congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, and stroke or transient ischemic attack (TIA; CHADS2) and CHA2DS2-VASc scores can stratify the long-term risk of ischemic stroke/TIA recurrence and death in ESUS. METHODS: We pooled data sets of 11 stroke registries from Europe and America...
September 2016: Stroke; a Journal of Cerebral Circulation
Aristeidis H Katsanos, Rohini Bhole, Alexandra Frogoudaki, Sotirios Giannopoulos, Nitin Goyal, Agathi-Rosa Vrettou, Ignatios Ikonomidis, Ioannis Paraskevaidis, Konstantinos Pappas, John Parissis, Athanassios P Kyritsis, Anne W Alexandrov, Nikos Triantafyllou, Marc D Malkoff, Konstantinos Voumvourakis, Andrei V Alexandrov, Georgios Tsivgoulis
OBJECTIVE: Our aim was to evaluate the diagnostic yield of transesophageal echocardiography (TEE) in consecutive patients with ischemic stroke (IS) fulfilling the diagnostic criteria of embolic strokes of undetermined source (ESUS). METHODS: We prospectively evaluated consecutive patients with acute IS satisfying ESUS criteria who underwent in-hospital TEE examination in 3 tertiary care stroke centers during a 12-month period. We also performed a systematic review and meta-analysis estimating the cumulative effect of TEE findings on therapeutic management for secondary stroke prevention among different IS subgroups...
September 6, 2016: Neurology
Bryan Eckerle, Ayrton Massaro
No abstract text is available yet for this article.
September 6, 2016: Neurology
Jonathan M Coutinho, Sheldon Derkatch, Alphonse R J Potvin, George Tomlinson, Tim-Rasmus Kiehl, Frank L Silver, Daniel M Mandell
OBJECTIVE: To determine whether large (≥3 mm thick) but nonstenotic (<50%) carotid artery atherosclerotic plaque predominantly occurs ipsilateral rather than contralateral to cryptogenic stroke. METHODS: This was a cross-sectional observational study. Using a stroke registry, we identified consecutive patients with anterior circulation embolic stroke of undetermined source (ESUS). Using CT angiography, we measured carotid plaque size (thickness, mm) and carotid artery stenosis (North American Symptomatic Carotid Endarterectomy Trial method) for each patient...
August 16, 2016: Neurology
Kazuo Kitagawa
Cryptogenic stroke is one-fourth among cerebral infarction, but most of them could be ascribed to embolic stroke. ESUS was proposed for unifying embolic stroke of undetermined sources by Hart et al. in 2014. The etiologies underlying ESUS included minor-risk potential cardioembolic sources, covert paroxysmal atrial fibrillation, cancer-associated coagulopathy and embolism, arteriogenic emboli, and paroxysmal embolism. Extensive evaluation including transesophageal echocardiography and cardiac monitoring for long time could identify the etiology of these patients...
April 2016: Nihon Rinsho. Japanese Journal of Clinical Medicine
Kanjana S Perera, Thomas Vanassche, Jackie Bosch, Mohana Giruparajah, Balakumar Swaminathan, Katie R Mattina, Scott D Berkowitz, Antonio Arauz, Martin J O'Donnell, Sebastian F Ameriso, Graeme J Hankey, Byung-Woo Yoon, Philippa Lavallee, Luis Cunha, Nikolay Shamalov, Raf Brouns, Rubens J Gagliardi, Scott E Kasner, Alessio Pieroni, Philipp Vermehren, Kazuo Kitagawa, Yongjun Wang, Keith Muir, Jonathan Coutinho, Ildiko Vastagh, Stuart J Connolly, Robert G Hart
BACKGROUND: Recent evidence supports that most non-lacunar cryptogenic strokes are embolic. Accordingly, these strokes have been designated as embolic strokes of undetermined source (ESUS). AIMS: We undertook an international survey to characterize the frequency and clinical features of ESUS patients across global regions. METHODS: Consecutive patients hospitalized for ischemic stroke were retrospectively surveyed from 19 stroke research centers in 19 different countries to collect patients meeting criteria for ESUS...
July 2016: International Journal of Stroke: Official Journal of the International Stroke Society
Amre Nouh, Mohammed Hussain, Tapan Mehta, Shadi Yaghi
Up to a third of strokes are rendered cryptogenic or of undetermined etiology. This number is specifically higher in younger patients. At times, inadequate diagnostic workups, multiple causes, or an under-recognized etiology contributes to this statistic. Embolic stroke of undetermined source, a new clinical entity particularly refers to patients with embolic stroke for whom the etiology of embolism remains unidentified despite through investigations ruling out established cardiac and vascular sources. In this article, we review current classification and discuss important clinical considerations in these patients; highlighting cardiac arrhythmias and structural abnormalities, patent foramen ovale, paradoxical sources, and potentially under-recognized, vascular, inflammatory, autoimmune, and hematologic sources in relation to clinical practice...
2016: Frontiers in Neurology
Sookyung Ryoo, Jong-Won Chung, Mi Ji Lee, Suk Jae Kim, Jin Soo Lee, Gyeong-Moon Kim, Chin-Sang Chung, Kwang Ho Lee, Ji Man Hong, Oh Young Bang
BACKGROUND: From a therapeutic viewpoint, it is important to differentiate the underlying causes of embolism in patients with cryptogenic stroke, such as aortic arch atheroma, patent foramen ovale, and paroxysmal atrial fibrillation. We investigated the clinical and radiological characteristics of these 3 common causes of cryptogenic embolism to develop models for decision making in etiologic workups. METHODS AND RESULTS: A total of 321 consecutive patients with acute infarcts from cryptogenic embolism were included...
March 2016: Journal of the American Heart Association
Y Kim, T J Kim, J-B Park, S Lee, Y-J Kim, J S Lee, S-H Lee
BACKGROUND AND PURPOSE: In many cardioembolic strokes (CSs), the specific embolic source is uncertain. Despite the high mortality of CS, not enough attention is paid to its potential source. Although atrial fibrillation (AF) is the most common source of embolism, more complex and dynamic multiplicities may influence CS. The aim of this study was to evaluate novel indicators of transthoracic echocardiography (TTE) that have additional value for detecting CS. METHODS: In total, 1878 patients with acute ischaemic stroke who had TTE during admission were identified...
March 2016: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
Oh Young Bang, Mi Ji Lee, Sookyung Ryoo, Suk Jae Kim, Ji Won Kim
Patent foramen ovale (PFO) is growing in clinical interest because of a renewed focus on embolic stroke of undetermined source (ESUS), the PFO attributable fraction (the 10-point Risk of Paradoxical Embolism score), technical advances in PFO diagnosis, and the emergence of endovascular device closure as a treatment option. However, recent randomized controlled trials of the management of patients with ESUS and PFO failed to demonstrate the superiority of closure over medical treatment. The mechanisms of stroke other than paradoxical embolism may be important in patients with ESUS and PFO...
September 2015: Journal of Stroke
Hans-Christoph Diener, J Donald Easton, Christopher B Granger, Lisa Cronin, Christine Duffy, Daniel Cotton, Martina Brueckmann, Ralph L Sacco
RATIONALE: Cryptogenic ischemic strokes constitute 20-30% of ischemic strokes, the majority of which are embolic strokes of undetermined source. The standard preventive treatment in these patients is usually acetylsalicylic acid. AIM: The Randomized, double-blind, Evaluation in secondary Stroke Prevention comparing the EfficaCy and safety of the oral Thrombin inhibitor dabigatran etexilate vs. acetylsalicylic acid in patients with Embolic Stroke of Undetermined Source (RE-SPECT ESUS) is designed to determine whether the oral thrombin inhibitor dabigatran, taken within three-months after embolic stroke of undetermined source, is superior to acetylsalicylic acid for prevention of recurrent stroke and to characterize the safety of dabigatran in this setting...
December 2015: International Journal of Stroke: Official Journal of the International Stroke Society
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