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Cryptogenic stroke

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https://www.readbyqxmd.com/read/28436306/cardiac-magnetic-resonance-imaging-has-limited-additional-yield-in-cryptogenic-stroke-evaluation-after-transesophageal-echocardiography
#1
Ava L Liberman, Rizwan E Kalani, Jessie Aw-Zoretic, Matthew Sondag, Vistasp J Daruwalla, Sumeet S Mitter, Richard Bernstein, Jeremy D Collins, Shyam Prabhakaran
Background The use of cardiac magnetic resonance imaging is increasing, but its role in the diagnostic work-up following ischemic stroke has received limited study. We aimed to explore the added yield of cardiac magnetic resonance imaging to identify cardio-aortic sources not detected by transesophageal echocardiography among patients with cryptogenic stroke. Methods A retrospective single-center cohort study was performed from 01 January 2009 to 01 March 2013. Consecutive patients who had both a stroke protocol cardiac magnetic resonance imaging and a transesophageal echocardiography preformed during a single hospitalization were included...
January 1, 2017: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/28431610/duration-of-paroxysmal-atrial-fibrillation-in-cryptogenic-stroke-is-not-associated-with-stroke-severity-and-early-outcomes
#2
Chrissoula Liantinioti, Konstantinos Tympas, Aristeidis H Katsanos, John Parissis, Maria Chondrogianni, Christina Zompola, Georgios Papadimitropoulos, Michael Ioakeimidis, Sokratis Triantafyllou, Andromaxi Roussopoulou, Konstantinos Voumvourakis, John Lekakis, Gerasimos Filippatos, Leonidas Stefanis, Georgios Tsivgoulis
The current definition of paroxysmal atrial fibrillation (PAF) requires an arbitrary cut-off of >30s, but in clinical practice cryptogenic stroke (CS) patients with PAF duration of ≤30s are not usually excluded from anticoagulation therapy. We sought to evaluate the clinical relevance of short-duration (≤30s) PAF in CS. Consecutive CS patients with no prior AF history and sinus-rhythm on baseline electrocardiography (ECG) were prospectively evaluated over a three-year period. Baseline stroke severity was assessed by NIHSS-scores...
May 15, 2017: Journal of the Neurological Sciences
https://www.readbyqxmd.com/read/28415099/p594contrast-transthoracic-echocardiography-as-a-gatekeeper-for-patent-foramen-ovale-closure
#3
M Muratori, G Italiano, E Innocenti, L Fusini, M Mapelli, G Tamborini, S Ghulam Ali, P Gripari, A Maltagliati, F Celeste, M Pepi
Background.: The presence of patent foramen ovale (PFO) has been linked to many illness, including cryptogenic stroke, transient ischemic attack, migraine, platypnea-orthodeoxia syndrome and decompression sickness in scuba divers. Transesophageal echocardiography is the gold standard technique for the visualization of atrial septal anatomy, but it is a secondary level exam, not always available, with additional associated costs and not completely free from procedural risks. Standard transthoracic echocardiography (TTE) has a too low sensitivity for PFO screening...
December 1, 2016: European Heart Journal Cardiovascular Imaging
https://www.readbyqxmd.com/read/28411261/feasibility-and-diagnostic-value-of-cardiovascular-magnetic-resonance-imaging-after-acute-ischemic-stroke-of-undetermined-origin
#4
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/28409234/clinical-role-of-von-willebrand-factor-in-acute-ischemic-stroke
#5
Marija Menih, Miljenko Križmarić, Tanja Hojs Fabjan
BACKGROUND: An elevated level of von Willebrand factor (VWF) is associated with an increased risk for coronary heart disease and ischemic stroke. The objective of the study was to determine whether the level of VWF is associated with the cardioembolic subtype of ischemic stroke, stroke severity, and clinical outcome. PATIENTS AND METHODS: In this study 108 patients suffering from acute ischemic stroke (AIS) were included. According to the etiology of the stroke, patients were classified into the subtype of cardioembolic (CE) stroke and the group with non-CE stroke...
April 13, 2017: Wiener Klinische Wochenschrift
https://www.readbyqxmd.com/read/28386716/importance-of-variants-in-cerebrovascular-anatomy-for-potential-retrograde-embolization-in-cryptogenic-stroke
#6
Michael Markl, Edouard Semaan, LeRoy Stromberg, James Carr, Shyam Prabhakaran, Jeremy Collins
OBJECTIVES: To test the hypothesis that variants in cerebrovascular anatomy will affect the number of patients demonstrating a plausible retrograde embolization mechanism from plaques in the descending aorta (DAo). METHODS: Thirty-five patients (aged 63 ± 17 years) with cryptogenic stroke underwent 4D flow MRI for the assessment of aortic 3D blood flow and MR angiography for the evaluation of circle of Willis, posterior circulation, and aortic arch architecture...
April 6, 2017: European Radiology
https://www.readbyqxmd.com/read/28373797/refractory-lesional-parietal-lobe-epilepsy-clinical-electroencephalographic-and-neurodiagnostic-findings
#7
Oğuzhan Kurşun, Hülya Karataş, Neşe Dericioğlu, Serap Saygi
INTRODUCTION: Specialized centers, in the management and surgical treatment of medically refractory epilepsy, emphasize the importance of differentiating the varieties of localization related epilepsies. There has been considerable recent interest in temporal and frontal lobe epileptic syndromes and less attention has been paid to parietal and occipital lobe epilepsies. METHODS: Here we report the clinical, electroencephalographic and neuroimaging characteristics of 46 patients with medically refractory lesional parietal lobe epilepsy who have been followed up for 1-10 years...
September 2016: Noro Psikiyatri Arsivi
https://www.readbyqxmd.com/read/28372708/acute-stroke-and-transient-ischemic-attack-in-the-outpatient-clinic
#8
REVIEW
Salvador Cruz-Flores
Ischemic stroke is cause of substantial death and disability in the United States. Transient ischemic attack, a precursor to ischemic stroke, conveys a high risk of recurrent stroke within 90 days from event. These conditions are highly preventable and treatable. The cause is heterogenous and includes atherothrombosis, cardioembolism, lacunar disease, or cryptogenic, and some uncommon causes, such as arterial dissection and prothrombotic states. The emergent evaluation includes establishing time of onset, vital signs, glucose level, and severity of the deficit...
May 2017: Medical Clinics of North America
https://www.readbyqxmd.com/read/28366054/advanced-imaging-in-acute-ischemic-stroke
#9
REVIEW
Craig Kilburg, J Scott McNally, Adam de Havenon, Philipp Taussky, M Yashar S Kalani, Min S Park
The evaluation and management of acute ischemic stroke has primarily relied on the use of conventional CT and MRI techniques as well as lumen imaging sequences such as CT angiography (CTA) and MR angiography (MRA). Several newer or less-established imaging modalities, including vessel wall MRI, transcranial Doppler ultrasonography, and 4D CTA and MRA, are being developed to complement conventional CT and MRI techniques. Vessel wall MRI provides high-resolution analysis of both extracranial and intracranial vasculature to help identify previously occult lesions or characteristics of lesions that may portend a worse natural history...
April 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/28363514/voxel-based-lesion-mapping-of-cryptogenic-stroke-in-patients-with-advanced-cancer-a-detailed-magnetic-resonance-imaging-analysis-of-distribution-pattern
#10
Takamune Achiha, Masatoshi Takagaki, Hiroshi Oe, Mio Sakai, Hitoshi Matsui, Katsuhiko Nakanishi, Tomohiko Ozaki, Yasunori Fujimoto, Toshiki Yoshimine, Katsuyuki Nakanishi, Manabu Kinoshita
BACKGROUND: Ischemic stroke is one form of cancer-associated thrombosis that can greatly worsen a patient's performance status. The present investigation aimed to elucidate the characteristic distribution pattern(s) of cryptogenic stroke lesions using a voxel-based lesion-mapping technique and examine the differences in clinical manifestations between cryptogenic and conventional strokes in patients with advanced cancer. METHODS: Data from 43 patients with advanced cancer who developed acute ischemic stroke were retrospectively collected...
March 28, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28356180/nocturnal-desaturation-is-associated-with-atrial-fibrillation-in-patients-with-ischemic-stroke-and-obstructive-sleep-apnea
#11
Chung-Yao Chen, Chien-Hui Ho, Chia-Ling Chen, Chung-Chieh Yu
STUDY OBJECTIVES: Both atrial fibrillation (AF) and obstructive sleep apnea (OSA) are risk factors for ischemic stroke. Previous studies suggested that OSA is associated with AF in individuals who have not had a stroke. For better secondary prevention of stroke, this study determined the association between OSA and AF among patients with ischemic stroke. METHODS: This cross-sectional study recruited consecutive patients with subacute ischemic stroke admitted for neurorehabilitation...
March 14, 2017: Journal of Clinical Sleep Medicine: JCSM: Official Publication of the American Academy of Sleep Medicine
https://www.readbyqxmd.com/read/28348599/a-rare-case-of-stroke-secondary-to-iron-deficiency-anemia-in-a-young-female-patient
#12
Kavitha Gopalratnam, Kevin Andrew Woodson, Jigarkumar Rangunwala, Kanaga Sena, Manisha Gupta
Ischemic strokes occur when there is a sudden obstruction of an artery supplying blood flow to an area of the brain, leading to a focal neurological deficit. Strokes can be thrombotic or embolic in etiology and are associated with underlying conditions such as hypertension and atherosclerosis. Possible etiologies of strokes include cardioembolic disease, hematologic disorders, connective tissue disorders, and substance abuse or can be cryptogenic. Most stroke cases are seen in patients over 65 years of age...
2017: Case Reports in Medicine
https://www.readbyqxmd.com/read/28295858/non-obstructive-carotid-atherosclerosis-and-patent-foramen-ovale-in-young-adults-with-cryptogenic-stroke
#13
A Jaffre, B Guidolin, J-B Ruidavets, N Nasr, V Larrue
BACKGROUND AND PURPOSE: Up to 50% of ischaemic strokes in young adults are classified as cryptogenic despite extensive work-up. We sought to evaluate the prevalence of non-obstructive carotid atherosclerosis (NOCA) and its association with patent foramen ovale (PFO) in young adults with cryptogenic stroke (CS). METHODS: Patients aged 18-54 years, consecutively treated for first-ever CS in an academic stroke service, were included. NOCA was assessed using carotid ultrasound examination and was defined as carotid plaque with <50% stenosis...
March 15, 2017: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
https://www.readbyqxmd.com/read/28286853/paradoxical-embolism-due-to-persistent-foramen-ovale-a-case-report
#14
Dormar David Barrios, Jonathan Roncancio, Albert Alejandro Avila, Jaime Andrés Alvarado, Ana Cristina Montenegro
The mean percentage of cryptogenic strokes among ischemic strokes is 31%, of which one-third may be associated with patent foramen ovale. The foramen ovale is required for blood flow through the fetal atrial septum. It is formed as of the fourth week of gestation, and this leads to right-left interatrial shunt that allows the passage of oxygenated blood to systemic circulation. In 75% of cases, its closure is complete by 2 years of age, but it may persist in 25% of patients. We present the case of a patient with paradoxical embolism in the lower extremities and ischemic stroke in the clinical context of a patent foramen ovale...
2017: Emergency (Tehran, Iran)
https://www.readbyqxmd.com/read/28283366/the-frequency-of-fabry-disease-among-young-cryptogenic-stroke-patients-in-the-city-of-sakarya
#15
Aslı Aksoy Gündoğdu, Dilcan Kotan, Murat Alemdar
BACKGROUND: Fabry disease (FD) is known as a rare cause of stroke. Recent studies suggested that FD is an underdiagnosed entity among young stroke patients. We aimed to investigate the frequency of FD in young cryptogenic stroke patients who lived in the City of Sakarya and to define the clinical features that help in recognizing patients with FD. METHODS: Acute ischemic stroke patients aged 18-55 years who were admitted to our hospital between October 2013 and September 2016 were evaluated for inclusion...
March 7, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28282389/4d-flow-mri-assessment-of-right-atrial-flow-patterns-in-the-normal-heart-influence-of-caval-vein-arrangement-and-implications-for-the-patent-foramen-ovale
#16
Jehill D Parikh, Jayant Kakarla, Bernard Keavney, John J O'Sullivan, Gary A Ford, Andrew M Blamire, Kieren G Hollingsworth, Louise Coats
AIM: To investigate atrial flow patterns in the normal adult heart, to explore whether caval vein arrangement and patency of the foramen ovale (PFO) may be associated with flow pattern. MATERIALS AND METHODS: Time-resolved, three-dimensional velocity encoded magnetic resonance imaging (4D flow) was employed to assess atrial flow patterns in thirteen healthy subjects (6 male, 40 years, range 25-50) and thirteen subjects (6 male, 40 years, range 21-50) with cryptogenic stroke and patent foramen ovale (CS-PFO)...
2017: PloS One
https://www.readbyqxmd.com/read/28282388/predictors-of-30-day-mortality-and-the-risk-of-recurrent-systemic-thromboembolism-in-cancer-patients-suffering-acute-ischemic-stroke
#17
Ki-Woong Nam, Chi Kyung Kim, Tae Jung Kim, Sang Joon An, Kyungmi Oh, Heejung Mo, Min Kyoung Kang, Moon-Ku Han, Andrew M Demchuk, Sang-Bae Ko, Byung-Woo Yoon
BACKGROUND: Stroke in cancer patients is not rare but is a devastating event with high mortality. However, the predictors of mortality in stroke patients with cancer have not been well addressed. D-dimer could be a useful predictor because it can reflect both thromboembolic events and advanced stages of cancer. AIM: In this study, we evaluate the possibility of D-dimer as a predictor of 30-day mortality in stroke patients with active cancer. METHODS: We included 210 ischemic stroke patients with active cancer...
2017: PloS One
https://www.readbyqxmd.com/read/28275245/prevalence-of-fabry-disease-and-gla-c-196g-c-variant-in-japanese-stroke-patients
#18
Kiyoshiro Nagamatsu, Yoshiki Sekijima, Katsuya Nakamura, Kimitoshi Nakamura, Kiyoko Hattori, Masao Ota, Yusaku Shimizu, Fumio Endo, Shu-Ichi Ikeda
Fabry disease is an important underlying disease in young cryptogenic stroke patients. However, little is known regarding the frequency of Fabry disease in the general stroke population, especially in elderly patients. A total of 588 stroke patients (61.7% men; average age 74.1±12.5 years) were enrolled in this prospective study. Blood samples were obtained to produce blood spots to determine α-galactosidase A (α-GalA) activity and for GLA gene analysis. One 65-year-old female patient had a known GLA gene mutation, c...
March 9, 2017: Journal of Human Genetics
https://www.readbyqxmd.com/read/28265016/embolic-stroke-of-undetermined-source-a-systematic-review-and-clinical-update
#19
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/28236567/the-left-atrial-septal-pouch-as-a-risk-factor-for-stroke-a-systematic-review
#20
REVIEW
Mihai Strachinaru, Jose Castro-Rodriguez, Thierry Verbeet, Marie-Dominique Gazagnes
The left atrial septal pouch (LASP) is formed by incomplete fusion of the septum primum and septum secundum, leaving a cavity open towards the left atrium, but without interatrial shunting. There is no recommendation concerning strategy in the presence of a LASP, especially in the setting of stroke. The aim of this review was to determine whether the LASP could be incriminated as the aetiology of a stroke. We included all pertinent publications on the subject, and calculated hazard ratios for ischaemic stroke and cryptogenic stroke...
February 21, 2017: Archives of Cardiovascular Diseases
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