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Cryptogenic stroke

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https://www.readbyqxmd.com/read/29229471/patent-foramen-ovale-closure-for-secondary-prevention-of-cryptogenic-stroke-updated-meta-analysis-of-randomized-clinical-trials
#1
Muthiah Vaduganathan, Arman Qamar, Ankur Gupta, Navkaranbir Bajaj, Harsh B Golwala, Ambarish Pandey, Deepak L Bhatt
BACKGROUND: Patent foramen ovale closure represents a potential secondary prevention strategy for cryptogenic stroke, but available trials have varied by size, device studied, and follow-up. METHODS: We conducted a systematic search of published randomized clinical trials (RCTs) evaluating patent foramen ovale closure vs. medical therapy in patients with recent stroke or transient ischemic attack using PubMED, EMBASE, and Cochrane through September 2017. Weighting was by random effects models...
December 8, 2017: American Journal of Medicine
https://www.readbyqxmd.com/read/29205690/refinement-of-detecting-atrial-fibrillation-in-stroke-patients-results-from-the-track-af-study
#2
Florian Reinke, Markus Bettin, Linda Sarah Ross, Simon Kochhäuser, Ilka Kleffner, Martin Ritter, Jens Minnerup, Dirk Dechering, Lars Eckardt, Ralf Dittrich
BACKGROUND: Detection of occult atrial fibrillation (AF) is crucial for optimal secondary prevention in stroke patients. We determined the AF detection rate by implantable cardiac monitor (ICM) compared to the prediction rate of the probability of incident AF by software based analysis of continuously monitored ECG at follow up (Stroke risk analysis=SRA) and propose an optimized AF detection algorithm by combining both tools. METHODS: In a monocentric prospective study we investigated 105 out of 389 patients with cryptogenic stroke despite extensive diagnostic workup with two additional cardiac monitoring tools: (a) 20 month monitoring by ICM and (b) SRA during hospitalization at the Stroke Unit...
December 4, 2017: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
https://www.readbyqxmd.com/read/29204774/percutaneous-closure-of-a%C3%A2-patent-foramen-ovale-after-cryptogenic-stroke
#3
REVIEW
R J R Snijder, M J Suttorp, J M Ten Berg, M C Post
A patent foramen ovale is a common intracardiac finding that is located between the left and right atrium. It can cause right-to-left shunting and has a high prevalence in patients who suffer a cryptogenic stroke. Earlier trials did not show superiority of percutaneous patent foramen ovale closure with standard medical therapy over standard medical therapy alone in the treatment of cryptogenic stroke. Interestingly, several meta-analyses show positive results regarding closure, suggesting underpowering of the individual trials...
December 4, 2017: Netherlands Heart Journal
https://www.readbyqxmd.com/read/29179276/-analysis-of-contrast-echocardiography-for-detecting-right-to-left-shunt-in-adults-with-patent-foramen-ovale
#4
X J Kong, Q F Chai, K Guo, Y F Zhao, Y H Wang
Objective: To analyze the contrast echocardiography for detecting right to left shunt in adults with patent foramen ovale(PFO), and study the relationship between PFO and cryptogenic stroke. Methods: Clinical data of forty-six adults patients with PFO diagnosed by transesophageal echocardiography(TEE)from March, 2012 to March, 2017 were retrospectively collected, and the patients were divided to 3 groups according to the direction and brightness of the color Doppler shunts: obvious left-to-right shunt (OLRS, group A), weak left-to-right shunt(WLRS, group B), bi-directional shunt(BDS, group C)...
November 21, 2017: Zhonghua Yi Xue za Zhi [Chinese medical journal]
https://www.readbyqxmd.com/read/29175238/which-patent-foramen-ovales-need-closure-to-prevent-cryptogenic-strokes
#5
REVIEW
James E Dalen, Joseph S Alpert
Patients with cryptogenic strokes are more likely to have a patent foremen ovale than in the general population. It is speculated that these strokes are due to paradoxical embolism- that is passage of a venous thrombus across the patent foremen ovale to enter the arterial circulation, resulting in an embolic stroke. Venous thromboembolism is rarely present in these cases of cryptogenic stroke. Thousands of patients with cryptogenic strokes have undergone transcatheter closure of their patent foremen ovale via a variety of devices...
November 22, 2017: American Journal of Medicine
https://www.readbyqxmd.com/read/29132836/prevalence-of-fabry-disease-in-young-patients-with-stroke-in-argentina
#6
Ricardo C Reisin, Julieta Mazziotti, Luciana León Cejas, Alberto Zinnerman, Pablo Bonardo, Manuel Fernández Pardal, Alejandra Martínez, Patricia Riccio, Sebastián Ameriso, Eduardo Bendersky, Pedro Nofal, Patricia Cairola, Lorena Jure, Andrea Sotelo, Paula Rozenfeld, Romina Ceci, Ignacio Casas-Parera, Analía Sánchez Luceros
BACKGROUND: Fabry disease (FD) is an underdiagnosed cause of stroke in young adults, but the frequency of this association is largely unknown. We estimated the prevalence of FD in a nationwide cohort of young adults who had stroke and transient ischemic attack (TIA) in Argentina. METHODS: This was a prospective, multicenter study of stroke and FD in young adults (18-55 years) conducted in Argentina between 2011 and 2015. Patients were enrolled if they had had a TIA or an ischemic or hemorrhagic stroke within the previous 180 days...
November 10, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/29111018/embolic-stroke-of-undetermined-source-the-role-of-the-nonstenotic-carotid-plaque
#7
Zachary Bulwa, Ajay Gupta
Cryptogenic stroke, or stroke of undetermined cause, presents a remarkably challenging dilemma for the treating physician as there are limited therapeutic options to prevent recurrence. Roughly one third of transient ischemic attacks (TIAs) and ischemic strokes are classified as cryptogenic, with an even greater proportion in young patients. While classification systems have been successfully used in trials to refine therapeutic approaches specific to subtype, there has been little progress made in secondary prevention of cryptogenic stroke...
November 15, 2017: Journal of the Neurological Sciences
https://www.readbyqxmd.com/read/29107360/yield-of-atrial-fibrillation-detection-with-textile-wearable-holter-from-the-acute-phase-of-stroke-pilot-study-of-crypto-af-registry
#8
Jorge Pagola, Jesus Juega, Jaume Francisco-Pascual, Angel Moya, Mireia Sanchis, Alejandro Bustamante, Anna Penalba, Maria Usero, Elisa Cortijo, Juan F Arenillas, Ana I Calleja, Maria Sandin-Fuentes, Jeronimo Rubio, Fernando Mancha, Irene Escudero-Martinez, Francisco Moniche, Reyes de Torres, Soledad Pérez-Sánchez, Carlos E González-Matos, Ángela Vega, Alonso A Pedrote, Eduardo Arana-Rueda, Joan Montaner, Carlos A Molina
BACKGROUND: We describe the feasibility of monitoring with a Textile Wearable Holter (TWH) in patients included in Crypto AF registry. METHODS: We monitored cryptogenic stroke patients from stroke onset (<3days) continuously during 28days. We employed a TWH composed by a garment and a recorder. We compared two garments (Lead and Vest) to assess rate of undiagnosed Atrial Fibrillation (AF) detection, monitoring compliance, comfortability (1 to 5 points), skin lesions, and time analyzed...
October 22, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/29090662/cryptogenic-stroke
#9
Geoffrey A Donnan
No abstract text is available yet for this article.
December 2017: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/29090661/patent-foramen-ovale-closure-with-gore-helex-or-cardioform-septal-occluder-vs-antiplatelet-therapy-for-reduction-of-recurrent-stroke-or-new-brain-infarct-in-patients-with-prior-cryptogenic-stroke-design-of-the-randomized-gore-reduce-clinical-study
#10
Scott E Kasner, Lars Thomassen, Lars Søndergaard, John F Rhodes, Coby C Larsen, Joth Jacobson
Rationale The utility of patent foramen ovale (PFO) closure for secondary prevention in patients with prior cryptogenic stroke is uncertain despite multiple randomized trials completed to date. Aims The Gore REDUCE Clinical Study (REDUCE) aims to establish superiority of patent foramen ovale closure in conjunction with antiplatelet therapy over antiplatelet therapy alone in reducing the risk of recurrent clinical ischemic stroke or new silent brain infarct in patients who have had a cryptogenic stroke. Methods and design This controlled, open-label trial randomized 664 subjects with cryptogenic stroke at 63 multinational sites in a 2:1 ratio to either antiplatelet therapy plus patent foramen ovale closure (with GORE® HELEX® Septal Occluder or GORE® CARDIOFORM Septal Occluder) or antiplatelet therapy alone...
December 2017: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/29081978/device-closure-for-patent-foramen-ovale-following-cryptogenic-stroke-a-survey-of-current-practice-in-the-uk
#11
Katherine Von Klemperer, Aleksander Kempny, Christopher William Pavitt, John C Janssen, Anselm Uebing, Edward Nicol
Patent foramen ovale (PFO) closure for cryptogenic stroke remains controversial due to a lack of conclusive randomised controlled data. Many experts feel PFO closure is indicated in selected cases; however, national and international guideline recommendations differ. We surveyed the UK cardiologists, stroke physicians and neurologists, seeking to determine specialist interpretation of the evidence base, and to gain an insight into the current UK practice. The British Cardiac Society and British Society of Stroke physicians distributed our survey which was performed using an online platform...
2017: Open Heart
https://www.readbyqxmd.com/read/29068141/interventional-closure-of-patent-foramen-ovale-with-nit-occlud%C3%A2-device-in-prevention-of-recurrent-neurologic-events-long-term-results
#12
Aleksander Araszkiewicz, Sylwia Sławek, Olga Trojnarska, Maciej Lesiak, Marek Grygier
BACKGROUND: Patent foramen ovale (PFO) was found to be associated with the increased risk of recurrent strokes or transient ischemic attacks (TIA) and there is a need of secondary prevention. Numerous devices have been developed and used for treatment. OBJECTIVES: The aim of the study was to evaluate the safety and effectiveness of a new PFO occluder Nit-Occlud PFO Occlusion Device (PFM medical, Germany). METHODS: Between January 2012 and August 2016, 151 patients (mean age 41 ± 11 years) who had suffered from a cryptogenic thromboembolic event underwent transcatheter PFO closure with the PFM Nit-Occlud PFO device...
October 25, 2017: Catheterization and Cardiovascular Interventions
https://www.readbyqxmd.com/read/29056952/acute-inferior-st-segment-elevation-myocardial-infarction-and-previous-cryptogenic-stroke-caused-by-a-paradoxical-embolism-with-a-concomitant-pulmonary-embolism
#13
Hong-Yu Zhang, Yan Zhang, Yan-Jun Cao, Lian-Lian Mei, Xia Zhang, Zhi-Guo Wu, Bao-Hua Qiu, Shu-Jing Wang
No abstract text is available yet for this article.
June 2017: Journal of Geriatric Cardiology: JGC
https://www.readbyqxmd.com/read/29051340/attenuation-of-myeloid-specific-tgf%C3%AE-signaling-induces-inflammatory-cerebrovascular-disease-and-stroke
#14
M Christine Hollander, Lawrence L Latour, Dan Yang, Hiroki Ishii, Zhiguang Xiao, Yongfen Min, Abhik Ray-Choudhury, Jeeva Munasinghe, Anand S Merchant, P Charles Lin, John Hallenbeck, Manfred Boehm, Li Yang
RATIONALE: Cryptogenic strokes, those of unknown cause, have been estimated as high as 30% to 40% of strokes. Inflammation has been suggested as a critical etiologic factor. However, there is lack of experimental evidence. OBJECTIVE: In this study, we investigated inflammation-associated stroke using a mouse model that developed spontaneous stroke because of myeloid deficiency of TGF-β (transforming growth factor-β) signaling. METHODS AND RESULTS: We report that mice with deletion of Tgfbr2 in myeloid cells (Tgfbr2Myeko) developed cerebrovascular inflammation in the absence of significant pathology in other tissues, culminating in stroke and severe neurological deficits with 100% penetrance...
December 8, 2017: Circulation Research
https://www.readbyqxmd.com/read/29032886/prevalence-and-risk-factors-for-paroxysmal-atrial-fibrillation-and-flutter-detection-after-cryptogenic-ischemic-stroke
#15
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
#16
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...
November 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/29018013/stroke-resulting-from-an-isolated-pulmonary-arteriovenous-malformation
#17
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
#18
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
#19
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
#20
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...
October 21, 2017: International Heart Journal
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