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Cryptogenic stroke

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https://www.readbyqxmd.com/read/28718666/atrial-cardiopathy-a-mechanism-of-cryptogenic-stroke
#1
Shadi Yaghi, Hooman Kamel, Mitchell S V Elkind
Cryptogenic stroke accounts for approximately 30% of all ischemic strokes. Recently, atrial cardiopathy diagnosed by the presence of one of its serum, imaging, or electrocardiogram biomarkers has been shown to be associated with ischemic stroke, particularly of embolic subtypes. Areas covered: This paper aims to summarize data on occult atrial fibrillation and stroke, provide an overview on mechanisms, such as inflammation and fibrosis, of stroke in atrial cardiopathy, critically review data on biomarkers of atrial cardiopathy and their association with stroke, and suggest therapeutic implications, including directions for future research...
July 18, 2017: Expert Review of Cardiovascular Therapy
https://www.readbyqxmd.com/read/28718277/clinical-implications-of-long-term-ecg-monitoring-from-loop-recorder-to-devices-remote-control
#2
Andrea DI Cori, Raffaele DE Lucia
Long term ECG monitoring has become nowadays an indispensable technology for prevention, management and treatment of many cardiac issues. Today long term ECG monitoring is achievable through loop recorders (LR) and cardiac devices (CIED) like pacemaker (PM), implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy device-defibrillators (CRT- Ds), all of which associated with remote monitoring (RM). Targeted long term ECG monitoring Patients who have recurrent non documented episodes of palpitations, unexplained episodes of syncope, cryptogenic stroke or patients with a cardiomiopathy needing a risk stratification, may benefit from long term ECG monitoring...
July 18, 2017: Minerva Cardioangiologica
https://www.readbyqxmd.com/read/28717529/daily-variation-in-the-occurrence-of-different-subtypes-of-stroke
#3
Luciana Ripamonti, Roberto Riva, Fabiola Maioli, Corrado Zenesini, Gaetano Procaccianti
Three thousand two hundred and ninety-eight patients admitted to our Stroke Unit with hemorrhagic, large artery atherosclerosis, cardioembolic, small-vessel occlusion, and undetermined etiology-cryptogenic strokes were included in the study. The circadian variability in onset in each stroke subgroup and the associations with various risk factors were analyzed. In each subgroup, a significant minority of patients suffered from stroke during sleep. In the ischemic group, hypercholesterolemia, paroxysmal atrial fibrillation, and previous myocardial infarction facilitated the onset during waking...
2017: Stroke Research and Treatment
https://www.readbyqxmd.com/read/28716584/p-wave-terminal-force-in-lead-v1-predicts-paroxysmal-atrial-fibrillation-in-acute-ischemic-stroke
#4
Toshiaki Goda, Yukio Sugiyama, Nobuyuki Ohara, Takeshi Ikegami, Kotaro Watanabe, Junya Kobayashi, Daisuke Takahashi
BACKGROUND: Detection of paroxysmal atrial fibrillation (PAF) in cryptogenic stroke is critical to selecting an antithrombotic therapy for preventing recurrent stroke. However, the predictor of PAF in patients with acute ischemic stroke is not well elucidated. P-wave terminal force in lead V1 (PTFV1) is a standard electrocardiogram marker of left atrial abnormality. In this study, we aimed to investigate the utility of PTFV1 for the prediction of PAF in patients with acute ischemic stroke...
July 14, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28709812/patent-foramen-ovale-and-cryptogenic-stroke
#5
REVIEW
Koki Nakanishi, Minoru Yoshiyama, Shunichi Homma
The presence of a patent foramen ovale (PFO) has been found to be associated with an increased risk of cryptogenic stroke in many case-control studies. This paper reviews the current understanding of the pathophysiology and diagnosis of PFO, and therapeutic options of patients with PFO and cryptogenic stroke.
July 4, 2017: Trends in Cardiovascular Medicine
https://www.readbyqxmd.com/read/28707135/secondary-stroke-prevention-in-cryptogenic-stroke-and-embolic-stroke-of-undetermined-source-esus
#6
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/28705105/clinical-outcomes-of-secondary-prevention-strategies-for-young-patients-with-cryptogenic-stroke-and-patent-foramen-ovale
#7
Alessandra Danese, Chiara Stegagno, Giampaolo Tomelleri, Anna Piccoli, Giulia Turri, Monica Carletti, Andrea Variola, Maurizio Anselmi, Sara Mazzucco, Angela Ferrara, Paolo Bovi, Nicola Micheletti, Manuel Cappellari, Salvatore Monaco, Corrado Vassanelli, Flavio Ribichini
Background The aim of this study was to compare the immediate and long-term clinical outcomes of medical therapy and percutaneous patent foramen ovale (PFO) closure as secondary prevention strategies in patients younger than 55 years of age presenting with cryptogenic stroke and PFO. Methods Between January 2006 and April 2015, all patients with the diagnosis of cryptogenic stroke and PFO were analysed and prospectively followed. Stroke was confirmed in 159 out of 309 patients (51%). In the remaining cases, other neurological conditions were found and therefore excluded from further analysis...
July 14, 2017: Acta Cardiologica
https://www.readbyqxmd.com/read/28687720/age-and-sex-specific-analysis-of-patients-with-embolic-stroke-of-undetermined-source
#8
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...
July 7, 2017: Neurology
https://www.readbyqxmd.com/read/28684051/patent-foramen-ovale-closure-to-prevent-secondary-neurologic-events
#9
REVIEW
Rosie Jasper, James C Blankenship
In October of 2016 the United States Food and Drug Administration approved the Amplatzer Patent Foramen Ovale (PFO) occluder device for use in patients with cryptogenic stroke, to reduce the risk of recurrent stroke. This event followed 15years of off-label use of atrial septal occluder devices, 3 randomized trials, and enormous controversy over the efficacy of this procedure. While none of the trials reached the primary endpoint needed to prove the efficacy of PFO closure in preventing recurrent stroke, meta-analyses and 5-year follow-up of 1 trial suggest that PFO closure decreases the risk of recurrent stroke, especially in sub-groups with large shunts and atrial septal aneurysms, and especially when the Amplatzer device (rather than other devices) is used...
July 3, 2017: European Journal of Internal Medicine
https://www.readbyqxmd.com/read/28666990/gene-expression-profiles-for-the-identification-of-prevalent-atrial-fibrillation
#10
Sébastien Thériault, Richard Whitlock, Kripa Raman, Jessica Vincent, Salim Yusuf, Guillaume Paré
BACKGROUND: Diagnosis of atrial fibrillation (AF) can be difficult, requiring cumbersome investigations. We aimed to determine the association of established whole-blood gene expression scores with prevalent AF and to evaluate their performance for the identification of AF in a SIRS (Steroids in Cardiac Surgery) trial cohort. METHODS AND RESULTS: Whole-blood, transcriptome-wide gene expression profiling was performed using the Illumina HumanHT-12 Expression BeadChip in 416 participants (65% men) before surgery, including 91 with a diagnosis of AF...
June 30, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/28666806/pr-interval-prolongation-and-cryptogenic-stroke-a-multicenter-retrospective-study
#11
Mayra Montalvo, Prasanna Tadi, Alexander Merkler, Gino Gialdini, Sheryl Martin-Schild, Digvijaya Navalkele, Alyana Samai, Amre Nouh, Mohammad Hussain, Steven Goldblatt, Morgan Hemendinger, Antony Chu, Christopher Song, Hooman Kamel, Karen L Furie, Shadi Yaghi
BACKGROUND: Atrial dysfunction or "cardiopathy" has been recently proposed as a mechanism in cryptogenic stroke. A prolonged PR interval may reflect impaired atrial conduction and thus may be a biomarker of atrial cardiopathy. We aim to compare the prevalence of PR interval prolongation in patients with cryptogenic stroke (CS) when compared with known non-cryptogenic non-cardioembolic stroke (NCNCS) subtypes. METHODS: We used prospective ischemic stroke databases of 3 comprehensive stroke centers to identify patients 18 years or older with a discharge diagnosis of ischemic non-cardioembolic stroke between December 1, 2013 and August 31, 2015...
June 27, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28664480/usefulness-of-left-ventricular-speckle-tracking-echocardiography-and-novel-measures-of-left-atrial-structure-and-function-in-diagnosing-paroxysmal-atrial-fibrillation-in-ischemic-stroke-and-transient-ischemic-attack-patients
#12
Kristoffer Grundtvig Skaarup, Hanne Christensen, Nis Høst, Masti Mahdy Mahmoud, Christian Ovesen, Flemming Javier Olsen, Jan Skov Jensen, Tor Biering-Sørensen
Asymptomatic paroxysmal atrial fibrillation (PAF) is often assumed to be the cause of cryptogenic ischemic strokes (IS) and transient ischemic attacks (TIA). We examined the usefulness of measures obtained by 2D speckle tracking echocardiography and novel left atrial measurements, in the diagnosis of PAF in patients with IS and TIA. We retrospectively included 205 patients who after acute IS or TIA underwent an echocardiogram in sinus rhythm. Patients were designated as PAF-patients if they had one or more reported incidents of AF before or after their echocardiographic examination...
June 29, 2017: International Journal of Cardiovascular Imaging
https://www.readbyqxmd.com/read/28660209/intravenous-thrombolysis-in-acute-ischemic-stroke-with-active-cancer
#13
Ki-Woong Nam, Chi Kyung Kim, Tae Jung Kim, Sang Joon An, Kyungmi Oh, Sang-Bae Ko, Byung-Woo Yoon
Ischemic stroke patients with active cancer are known to have poor clinical outcomes. However, the efficacy and safety of intravenous alteplase (IV t-PA) in this group are still unclear. In this study, we aimed to evaluate whether stroke patients with cancer had poor clinical outcomes after use of IV t-PA. We reviewed ischemic stroke patients with active cancer treated with isolated IV t-PA between April 2010 and March 2015 at three national university hospitals from the registry for ischemic stroke in Korea...
2017: BioMed Research International
https://www.readbyqxmd.com/read/28657357/ecg-markers-associated-with-ischemic-stroke-at-young-age-a-case-control-study
#14
Jani Pirinen, Antti Eranti, Paul Knekt, Mika Lehto, Nicolas Martinez-Majander, Aapo L Aro, Harri Rissanen, Markku Heliövaara, Markku Kaste, Turgut Tatlisumak, Heikki Huikuri, Jukka Putaala
INTRODUCTION: Certain electrocardiographic (ECG) abnormalities are associated with ischemic stroke (IS), especially cardioembolic subtype. Besides atrial fibrillation, markers of left ventricular hypertrophy (LVH) or atrial pathology also reflect elevated risk. We studied the association of ECG markers with IS in young adults. METHODS: We performed a case-control study including 567 consecutive IS patients aged 15-49 years (inclusion period: 1994-2007) and one or two age- and sex-matched control subjects enrolled during 1978-1980 (n = 1033), and investigated also the stroke aetiologic subgroups...
July 14, 2017: Annals of Medicine
https://www.readbyqxmd.com/read/28654919/a-clinical-score-for-predicting-atrial-fibrillation-in-patients-with-cryptogenic-stroke-or-transient-ischemic-attack
#15
Calvin Kwong, Albee Y Ling, Michael H Crawford, Susan X Zhao, Nigam H Shah
OBJECTIVES: Detection of atrial fibrillation (AF) in post-cryptogenic stroke (CS) or transient ischemic attack (TIA) patients carries important therapeutic implications. METHODS: To risk stratify CS/TIA patients for later development of AF, we conducted a retrospective cohort study using data from 1995 to 2015 in the Stanford Translational Research Integrated Database Environment (STRIDE). RESULTS: Of the 9,589 adult patients (age ≥40 years) with CS/TIA included, 482 (5%) patients developed AF post CS/TIA...
June 28, 2017: Cardiology
https://www.readbyqxmd.com/read/28647417/recurrent-thromboembolic-events-after-ischemic-stroke-in-patients-with-primary-brain-tumors
#16
Neal S Parikh, Jaclyn E Burch, Hooman Kamel, Lisa M DeAngelis, Babak B Navi
BACKGROUND: Stroke mechanisms and the risk of recurrent thromboembolism are incompletely understood in patients with primary brain tumors. We sought to better delineate these important clinical features. METHODS: We performed a retrospective cohort study of adults with primary brain tumors diagnosed with magnetic resonance imaging-confirmed acute ischemic stroke at the Memorial Sloan Kettering Cancer Center from 2005 to 2015. Study neurologists collected data on patients' cancer history, stroke risk factors, treatments, and outcomes...
June 21, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28645938/practice-patterns-for-acute-ischemic-stroke-workup-a-longitudinal-population-based-study
#17
Matthew C Loftspring, Brett M Kissela, Matthew L Flaherty, Jane C Khoury, Kathleen Alwell, Charles J Moomaw, Dawn O Kleindorfer, Daniel Woo, Opeolu Adeoye, Simona Ferioli, Joseph P Broderick, Pooja Khatri
BACKGROUND: We examined practice patterns of inpatient testing to identify stroke etiologies and treatable risk factors for acute ischemic stroke recurrence. METHODS AND RESULTS: We identified stroke cases and related diagnostic testing from four 1-year study periods (July 1993 to June 1994, 1999, 2005, and 2010) of the Greater Cincinnati/Northern Kentucky Stroke Study. Patients aged ≥18 years were included. We focused on evaluation of extracranial arteries for carotid stenosis and assessment of atrial fibrillation because randomized controlled trials supported treatment of these conditions for stroke prevention across all 4 study periods...
June 23, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/28626055/ischemic-stroke-what-does-the-histological-composition-tell-us-about-the-origin-of-the-thrombus
#18
Peter B Sporns, Uta Hanning, Wolfram Schwindt, Aglaé Velasco, Jens Minnerup, Tarek Zoubi, Walter Heindel, Astrid Jeibmann, Thomas Ulrich Niederstadt
BACKGROUND AND PURPOSE: The introduction of stent retrievers allows for a complete extraction and histological analysis of human thrombi. Ischemic stroke is a major health issue, and differentiation of underlying causes is highly relevant to prevent recurrent stroke. Therefore, histopathologic analysis of the embolic clots after removal may provide valuable information about underlying pathologies. This study analyzes histological clot composition and aims to identify specific patterns that might help to distinguish causes of ischemic stroke...
June 16, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28624331/long-term-detection-of-atrial-fibrillation-with-insertable-cardiac-monitors-in-a-real-world-cryptogenic-stroke-population
#19
Paul D Ziegler, John D Rogers, Scott W Ferreira, Allan J Nichols, Mark Richards, Jodi L Koehler, Shantanu Sarkar
BACKGROUND: The long-term incidence of atrial fibrillation (AF) in cryptogenic stroke (CS) patients has been explored in carefully controlled clinical trials but real-world data are limited. We investigated the two-year incidence of AF in real-world clinical practice among a large cohort of patients with an insertable cardiac monitor (ICM) placed for AF detection following CS. METHODS: Patients in the de-identified Medtronic Discovery™ Link database who received an ICM (Reveal LINQ™) for the purpose of AF detection following CS were included and monitored for up to 2years...
June 10, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28596458/prevalence-of-fabry-disease-and-outcomes-in-young-canadian-patients-with-cryptogenic-ischemic-cerebrovascular-events
#20
Sylvain Lanthier, Gustavo Saposnik, Gerald Lebovic, Karen Pope, Daniel Selchen, David F Moore
BACKGROUND AND PURPOSE: Previous studies reported Fabry disease in 0% to 4% of young patients with cryptogenic ischemic stroke (IS). We sought to determine the prevalence of Fabry and outcomes among young Canadians with cryptogenic IS or transient ischemic attack (TIA). METHODS: We prospectively enrolled individuals aged 18 to 55 with IS or speech or motor TIA, and no cause identified despite predetermined investigation. α-galactosidase-A gene was sequenced for Fabry diagnosis...
July 2017: Stroke; a Journal of Cerebral Circulation
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