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Cryptogenic stroke

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https://www.readbyqxmd.com/read/29051340/attenuation-of-myeloid-specific-tgf%C3%AE-signaling-induces-inflammatory-cerebrovascular-disease-and-stroke
#1
M C Hollander, Lawrence L Latour, Dan Yang, Hiroki Ishii, Zhiguang Xiao, Yongfen Min, Abhik Ray-Choudhury, Jeeva Munasinghe, Anand S Merchant, P C Lin, John Hallenbeck, Manfred Boehm, Li Yang
Rationale: Cryptogenic strokes, those of unknown cause, have been estimated as high as 30-40% of strokes. Inflammation has been suggested as a critical etiological factor. However, there is lack of experimental evidence. Objective: In this study, we investigated inflammation associated stroke etiology using a mouse model that developed spontaneous stroke due to myeloid deficiency of TGFβ signaling. Methods and Results: We report that mice with deletion of Tgfbr2 in myeloid cells (Tgfbr2(Myeko)) developed cerebrovascular inflammation in the absence of significant pathology in other tissues, culminating in stroke and severe neurological deficits with 100% penetrance...
October 19, 2017: Circulation Research
https://www.readbyqxmd.com/read/29032886/prevalence-and-risk-factors-for-paroxysmal-atrial-fibrillation-and-flutter-detection-after-cryptogenic-ischemic-stroke
#2
Claire Carrazco, Daniel Golyan, Michael Kahen, Karen Black, Richard B Libman, Jeffrey M Katz
INTRODUCTION: Long-term cardiac monitoring with implantable loop recorders (ILRs) has revealed occult paroxysmal atrial fibrillation and flutter (PAF) in a substantial minority of cryptogenic ischemic stroke (CIS) patients. Herein, we aim to define the prevalence, clinical relevance, and risk factors for PAF detection following early poststroke ILR implantation. MATERIALS AND METHODS: A retrospective study of CIS patients (n = 100, mean age 65.8 years; 52.5% female) who underwent ILR insertion during, or soon after, index stroke admission...
October 9, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/29018133/carotid-web-intimal-fibromuscular-dysplasia-has-high-stroke-recurrence-risk-and-is-amenable-to-stenting
#3
Diogo C Haussen, Jonathan A Grossberg, Mehdi Bouslama, Gustavo Pradilla, Samir Belagaje, Nicolas Bianchi, Jason W Allen, Michael Frankel, Raul G Nogueira
BACKGROUND AND PURPOSE: Carotid webs have been increasingly recognized as a cause of recurrent stroke, but evidence remains scarce. We aim to report the clinical outcomes and first series of carotid stenting in a cohort of patients with strokes from symptomatic carotid webs. METHODS: Prospective and consecutive data of patients <65 years old with cryptogenic stroke admitted within September 2014 to May 2017. Carotid web was defined by a shelf-like/linear filling defect in the posterior internal carotid artery bulb by computed tomographic angiography...
October 10, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/29018013/stroke-resulting-from-an-isolated-pulmonary-arteriovenous-malformation
#4
Jakob Saidman, Hossam Abdou, Sridhar Sampath Kumar
Isolated pulmonary arteriovenous malformations (PAVM) are rare, but can be responsible for paradoxical embolic events. It is important to recognise these situations early and intervene quickly to attain the best outcome. We describe the case of a 45-year-old woman with a long-standing history of migraines with aura who presented to the emergency department with left-sided weakness and slurred speech. Work-up was unclear and she was diagnosed with cryptogenic stroke. Follow-up transoesophageal echocardiogram was suggestive of an atrial septal defect, though no clear defect was evident...
October 10, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28980575/-ischemic-stroke-in-young-adults
#5
L A Kalashnikova, L A Dobrynina
The authors have analyzed the causes of ischemic stroke (IS) in more than 600 young patients examined in the cerebrovascular department of the Neurological Research Center (Moscow) during the period 2003-2016 years. It has been suggested that a wider use of high-resolution MRI and T1 weighted db-fs images as well as intracranial CTA will help to verify more often intracranial dissection and primary cerebral vasculitis that will result in a decrease of cryptogenic IS frequency.
2017: Zhurnal Nevrologii i Psikhiatrii Imeni S.S. Korsakova
https://www.readbyqxmd.com/read/28973402/2017-update-on-medical-overuse-a-systematic-review
#6
Daniel J Morgan, Sanket S Dhruva, Eric R Coon, Scott M Wright, Deborah Korenstein
Importance: Overuse of medical care is a well-recognized problem. Objective: To identify and highlight original research articles published in 2016 that are most relevant to understanding medical overuse or strategies to reduce it. Evidence Review: A structured review of English-language articles on PubMed published in 2016 coupled with examination of tables of contents of high-impact journals to identify articles related to medical overuse in adults...
October 2, 2017: JAMA Internal Medicine
https://www.readbyqxmd.com/read/28966317/young-paradoxical-stroke-treated-successfully-with-mechanical-thrombectomy-using-solitaire-and-transcatheter-closure-of-patent-foramen-oval
#7
Qiang Fu, Xiaobin Guo, Dapeng Mo, Buxing Chen
Paradoxical embolization is the mechanism for patent foramen ovale (PFO) -associated cryptogenic stroke and transcatheter closure of PFO may prevent recurrent ischemic stroke. Mechanical thrombectomy is promising to treat acute ischemic stroke due to high rates of reperfusion and reduced intracranial hemorrhage complications. We report the case of a 27-year-old woman with a massive cerebral infarction but no evidence for any atherosclerosis, who received an urgent mechanical thrombectomy with a Solitaire device...
September 30, 2017: International Heart Journal
https://www.readbyqxmd.com/read/28961330/atrial-dyssynchrony-and-left-atrial-stiffness-are-risk-markers-for-cryptogenic-stroke-in-patients-with-patent-foramen-ovale
#8
Ragab A Mahfouz, Waleed S Alawady, Abdelhakem Salem, Adel S Abdelghafar
OBJECTIVE: The clinical and echocardiographic parameters associated with the risk predictors of cryptogenic stroke (CS) in patients with patent foramen ovale (PFO) still diverse and with a great debate. We hypothesized that left atrial stiffness (LASt) and atrial dyssynchrony may increase the risk of CS in patients with PFO. METHODS: A total of 129 consecutive patients presented without clinical reasoning of stroke were recruited. Transesophageal echocardiographic assessment was performed to investigate the presence of PFO...
September 29, 2017: Echocardiography
https://www.readbyqxmd.com/read/28957815/clinical-relevance-of-patent-foramen-ovale-and-atrial-septum-aneurysm-in-stroke-findings-of-a-single-center-cross-sectional-study
#9
Marlena Schnieder, Tariq Siddiqui, André Karch, Mathias Bähr, Gerd Hasenfuss, Jan Liman, Marco R Schroeter
BACKGROUND: A significant proportion of ischemic strokes are cryptogenic. In this context, the clinical pertinence of patent foramen ovale (PFO) with and without atrial septum aneurysm (ASA) remains controversial. The aim of this study was to identify how PFO +/-ASA and cryptogenic stroke are associated in a representative sample of stroke patients. METHODS: We enrolled all patients (n = 909) with ischemic stroke or transient ischemic attack admitted to the certified stroke unit or neurological intensive care unit of our university medical center who underwent transesophageal echocardiography (TEE) between 2012 and 2014...
September 28, 2017: European Neurology
https://www.readbyqxmd.com/read/28928046/new-directions-for-ambulatory-monitoring-following-2017-hrs-ishne-expert-consensus
#10
Emanuela T Locati
The main role of ambulatory electrocardiography (AECG) in clinical practice is to detect and characterize the behavior of cardiac electrical activity during ordinary daily life activities. Because certain rhythm abnormalities may be infrequent and paroxysmal, and may occur only during sleep or in association with mental, emotional, or exercise-induced perturbation in cardiac function, AECG needs to be recorded over a long period of time, originally lasting 24h and now expanding up to several weeks and even to months...
August 12, 2017: Journal of Electrocardiology
https://www.readbyqxmd.com/read/28919876/peptide-composition-of-stroke-causing-emboli-correlate-with-serum-markers-of-atherosclerosis-and-inflammation
#11
Neal M Rao, Joseph Capri, Whitaker Cohn, Maram Abdaljaleel, Lucas Restrepo, Jeffrey A Gornbein, William H Yong, David S Liebeskind, Julian P Whitelegge
INTRODUCTION: The specific protein composition of stroke-causing emboli is unknown. Because ischemic stroke has a varied etiology, it is possible that the composition of the thrombus from which an embolus originated will have distinctive molecular characteristics reflective of the underlying pathophysiology. We used mass spectrometry to evaluate the protein composition of retrieved emboli from patients with differing stroke etiologies and correlated the protein levels to serum predictors of atherosclerosis...
2017: Frontiers in Neurology
https://www.readbyqxmd.com/read/28902595/patent-foramen-ovale-after-cryptogenic-stroke-assessing-the-evidence-for-closure
#12
Andrew Farb, Nicole G Ibrahim, Bram D Zuckerman
The Amplatzer PFO Occluder was approved by the Food and Drug Administration (FDA) on October 28, 2016. The device is indicated for percutaneous transcatheter closure of a patent foramen ovale to reduce the risk of recurrent ischemic stroke in patients who’ve had a cryptogenic stroke that a..
September 14, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28902593/patent-foramen-ovale-closure-or-anticoagulation-vs-antiplatelets-after-stroke
#13
RANDOMIZED CONTROLLED TRIAL
Jean-Louis Mas, Geneviève Derumeaux, Benoît Guillon, Evelyne Massardier, Hassan Hosseini, Laura Mechtouff, Caroline Arquizan, Yannick Béjot, Fabrice Vuillier, Olivier Detante, Céline Guidoux, Sandrine Canaple, Claudia Vaduva, Nelly Dequatre-Ponchelle, Igor Sibon, Pierre Garnier, Anna Ferrier, Serge Timsit, Emmanuelle Robinet-Borgomano, Denis Sablot, Jean-Christophe Lacour, Mathieu Zuber, Pascal Favrole, Jean-François Pinel, Marion Apoil, Peggy Reiner, Catherine Lefebvre, Patrice Guérin, Christophe Piot, Roland Rossi, Jean-Luc Dubois-Randé, Jean-Christophe Eicher, Nicolas Meneveau, Jean-René Lusson, Bernard Bertrand, Jean-Marc Schleich, François Godart, Jean-Benoit Thambo, Laurent Leborgne, Patrik Michel, Luc Pierard, Guillaume Turc, Martine Barthelet, Anaïs Charles-Nelson, Christian Weimar, Thierry Moulin, Jean-Michel Juliard, Gilles Chatellier
BACKGROUND: Trials of patent foramen ovale (PFO) closure to prevent recurrent stroke have been inconclusive. We investigated whether patients with cryptogenic stroke and echocardiographic features representing risk of stroke would benefit from PFO closure or anticoagulation, as compared with antiplatelet therapy. METHODS: In a multicenter, randomized, open-label trial, we assigned, in a 1:1:1 ratio, patients 16 to 60 years of age who had had a recent stroke attributed to PFO, with an associated atrial septal aneurysm or large interatrial shunt, to transcatheter PFO closure plus long-term antiplatelet therapy (PFO closure group), antiplatelet therapy alone (antiplatelet-only group), or oral anticoagulation (anticoagulation group) (randomization group 1)...
September 14, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28902590/long-term-outcomes-of-patent-foramen-ovale-closure-or-medical-therapy-after-stroke
#14
RANDOMIZED CONTROLLED TRIAL
Jeffrey L Saver, John D Carroll, David E Thaler, Richard W Smalling, Lee A MacDonald, David S Marks, David L Tirschwell
BACKGROUND: Whether closure of a patent foramen ovale reduces the risk of recurrence of ischemic stroke in patients who have had a cryptogenic ischemic stroke is unknown. METHODS: In a multicenter, randomized, open-label trial, with blinded adjudication of end-point events, we randomly assigned patients 18 to 60 years of age who had a patent foramen ovale (PFO) and had had a cryptogenic ischemic stroke to undergo closure of the PFO (PFO closure group) or to receive medical therapy alone (aspirin, warfarin, clopidogrel, or aspirin combined with extended-release dipyridamole; medical-therapy group)...
September 14, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28902580/patent-foramen-ovale-closure-or-antiplatelet-therapy-for-cryptogenic-stroke
#15
RANDOMIZED CONTROLLED TRIAL
Lars Søndergaard, Scott E Kasner, John F Rhodes, Grethe Andersen, Helle K Iversen, Jens E Nielsen-Kudsk, Magnus Settergren, Christina Sjöstrand, Risto O Roine, David Hildick-Smith, J David Spence, Lars Thomassen
BACKGROUND: The efficacy of closure of a patent foramen ovale (PFO) in the prevention of recurrent stroke after cryptogenic stroke is uncertain. We investigated the effect of PFO closure combined with antiplatelet therapy versus antiplatelet therapy alone on the risks of recurrent stroke and new brain infarctions. METHODS: In this multinational trial involving patients with a PFO who had had a cryptogenic stroke, we randomly assigned patients, in a 2:1 ratio, to undergo PFO closure plus antiplatelet therapy (PFO closure group) or to receive antiplatelet therapy alone (antiplatelet-only group)...
September 14, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28886846/transcatheter-closure-of-patent-foramen-ovale-devices-and-technique
#16
REVIEW
Matthew J Price
Transcatheter closure of a patent foramen ovale (PFO) reduces the risk of recurrent cryptogenic stroke compared with medical therapy. PFO closure is a prophylactic procedure, and will not provide the patient with symptomatic improvement, except in cases of hypoxemia due to right-to-left shunt or possibly migraine headaches. Therefore, appropriate patient selection is critical, and procedural safety is paramount. Herein, we review key characteristics of the devices currently available for transcatheter PFO closure within the United States, and highlight key technical aspects of the PFO closure procedure that will maximize procedural success...
October 2017: Interventional cardiology clinics
https://www.readbyqxmd.com/read/28886843/current-dataset-for-patent-foramen-ovale-closure-in-cryptogenic-stroke-randomized-clinical-trials-and-observational-studies
#17
REVIEW
Olufunso W Odunukan, Matthew J Price
Approximately one-third of all strokes have no apparent cause. A patent foramen ovale (PFO) is present in as many as 60% of these patients with cryptogenic strokes, which is significantly more frequent than that of the general population. The presumed biologic mechanisms of ischemic stroke in the setting of a PFO are paradoxic embolism from the peripheral venous system through this interatrial shunt or embolism from in situ thrombosis. In this review, the authors summarize and critically assess the contemporary studies evaluating the efficacy and safety of PFO closure for prevention of recurrent cryptogenic strokes...
October 2017: Interventional cardiology clinics
https://www.readbyqxmd.com/read/28886840/cryptogenic-stroke-and-patent-foramen-ovale-risk-assessment
#18
REVIEW
Emiliya Melkumova, David E Thaler
Stroke is a devastating condition. It is the fifth leading cause of death in the United States, and a leading cause of serious long-term disability. Stroke occurs at any age. Younger patients tend to have strokes of undetermined cause, termed cryptogenic. Herein, the authors describe the classification of stroke cause; the risk of recurrent cryptogenic stroke with patent foramen ovale (PFO); a risk assessment model to stratify incidental versus a pathogenic PFO in patients presenting with stroke; and patient selection for device occluder therapy in the context of the long-term follow-up of the RESPECT randomized clinical trial...
October 2017: Interventional cardiology clinics
https://www.readbyqxmd.com/read/28885101/association-between-the-maximal-distance-of-atrial-septal-protrusion-and-cryptogenic-stroke
#19
Keisuke Tokunaga, Masahiro Yasaka, Takahiro Kuwashiro, Seiji Gotoh, Asako Nakamura, Go Takaguchi, Tetsuro Ago, Masahiro Kamouchi, Takanari Kitazono, Yasushi Okada
Background and purpose Previous studies have suggested that atrial septal aneurysm is a potential risk factor for cerebral embolism. However, the association between the level of atrial septal protrusion and cerebral embolism is still unclear. The purpose of the present study was to assess the association between the maximal distance of atrial septal protrusion and cryptogenic stroke. Methods A total of 588 consecutive acute ischemic stroke patients (70 ± 11 (mean ± SD) years, 401 men) who underwent transesophageal echocardiography were enrolled...
December 20, 2016: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/28877718/aortic-atheroma-as-a-source-of-stroke-assessment-of-embolization-risk-using-3d-cmr-in-stroke-patients-and-controls
#20
Thomas Wehrum, Iulius Dragonu, Christoph Strecker, Florian Schuchardt, Anja Hennemuth, Johann Drexl, Thomas Reinhard, Daniel Böhringer, Werner Vach, Jürgen Hennig, Andreas Harloff
BACKGROUND: It was our purpose to identify vulnerable plaques in the thoracic aorta using 3D multi-contrast CMR and estimate the risk of cerebral embolization using 4D flow CMR in cryptogenic stroke patients and controls. METHODS: One hundred patients (40 with cryptogenic stroke, 60 ophthalmologic controls matched for age, sex and presence of hypertension) underwent a novel 3D multi-contrast (T1w, T2w, PDw) CMR protocol at 3 Tesla for plaque detection and characterization within the thoracic aorta, which was combined with 4D flow CMR for mapping potential embolization pathways...
September 6, 2017: Journal of Cardiovascular Magnetic Resonance
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