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Cryptogenic stroke

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https://www.readbyqxmd.com/read/28295858/non-obstructive-carotid-atherosclerosis-and-patent-foramen-ovale-in-young-adults-with-cryptogenic-stroke
#1
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
#2
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
#3
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
#4
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
#5
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
#6
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
#7
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...
March 6, 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
#8
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
https://www.readbyqxmd.com/read/28178140/utility-of-duranta-a-wireless-patch-type-electrocardiographic-monitoring-system-developed-in-japan-in-detecting-covert-atrial-fibrillation-in-patients-with-cryptogenic-stroke-a-case-report
#9
Hisanao Akiyama, Saki Nukui, Takashi Araga, Masashi Hoshino, Keita Tanaka, Satoru Kashima, Rie Sasaki, Kenji Uchino, Yasuhiro Hasegawa
RATIONALE: Subcutaneous implantable electrocardiographs are highly effective in detecting covert atrial fibrillation (AF) in cryptogenic stroke. However, these invasive devices are not indicated for all cryptogenic stroke patients, and noninvasive improvements over conventional Holter-type ambulatory electrocardiography are needed. We evaluated the clinical application and effectiveness of Duranta (ImageONE Co., Ltd.), a wireless patch-type electrocardiographic monitoring system developed in Japan for chronically ill patients or home-based patients at the end of life...
February 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28157747/cardioembolic-stroke
#10
Cumara B O'Carroll, Kevin M Barrett
PURPOSE OF REVIEW: Cardioembolic stroke is common and disproportionately more disabling than nonembolic mechanisms of stroke. Its incidence is expected to rise because of the age-related incidence of atrial fibrillation and an aging population. This article summarizes the different causes of cardioembolism and outlines current management guidelines. RECENT FINDINGS: Since cardioembolic stroke is not a single disease entity, its diagnosis requires initial clinical suspicion and a comprehensive evaluation, including ECG, echocardiography, brain imaging, and cardiac monitoring...
February 2017: Continuum: Lifelong Learning in Neurology
https://www.readbyqxmd.com/read/28154102/cryptogenic-stroke-research-and-practice
#11
Shadi Yaghi, Richard A Bernstein, Rod Passman, Peter M Okin, Karen L Furie
BACKGROUND: Cryptogenic stroke accounts for 30% to 40% of ischemic stroke. It is essential to determine the possible culprit because this will improve secondary stroke prevention strategies. METHODS: We performed a narrative nonsystematic review of the literature that included randomized trials, exploratory comparative studies, and case series on cryptogenic stroke. RESULTS: There are several possible mechanisms implicated in cryptogenic stroke, including occult paroxysmal atrial fibrillation, patent foramen ovale, aortic arch atherosclerosis, atrial cardiopathy, and substenotic atherosclerosis...
February 3, 2017: Circulation Research
https://www.readbyqxmd.com/read/28154101/cardioembolic-stroke
#12
Hooman Kamel, Jeff S Healey
Cardiac embolism accounts for an increasing proportion of ischemic strokes and might multiply several-fold during the next decades. However, research points to several potential strategies to stem this expected rise in cardioembolic stroke. First, although one-third of strokes are of unclear cause, it is increasingly accepted that many of these cryptogenic strokes arise from a distant embolism rather than in situ cerebrovascular disease, leading to the recent formulation of embolic stroke of undetermined source as a distinct target for investigation...
February 3, 2017: Circulation Research
https://www.readbyqxmd.com/read/28153345/usefulness-of-the-mrwallets-scoring-system-to-predict-first-diagnosed-atrial-fibrillation-in-patients-with-ischemic-stroke
#13
Antonio Muscari, Andrea Bonfiglioli, Luca Faccioli, Marco Ghinelli, Donatella Magalotti, Francesco Manzetto, Anna Pontarin, Giovanni M Puddu, Luca Spinardi, Eleonora Tubertini, Marco Zoli
Some cryptogenic strokes are caused by undetected paroxysmal atrial fibrillation (AF) and could benefit from oral anticoagulation. In this study, we searched for echocardiographic parameters associated with first diagnosed AF, to form a scoring system for the identification of patients with AF. We examined 571 patients with ischemic stroke (72.7 ± 13.5 years, 50.6% women), subdivided into 4 groups: documented cause without AF, first diagnosed AF, known paroxysmal AF, and permanent AF. All patients underwent transthoracic echocardiography, brain computed tomography scan, carotid/vertebral ultrasound, and continuous electrocardiographic monitoring...
April 1, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/28139007/case-report-of-male-child-with-elevated-lipoprotein-a-leading-to-acute-ischemic-stroke
#14
Patrick M Moriarty, Heather Tennant, Nandhini Sehar, Lauryn Denney, Paola Luna, Francesca Perez-Marques, Apurva Panchal, Michael Abraham, John Leever
Acute ischemic stroke (AIS) in children is rare with almost 40% diagnosed as cryptogenic. One possible mechanism associated with AIS is an elevated Lipoprotein (a) [Lp(a)] level. Here, we discuss the case of an 11-year old boy who presented with multiple thrombotic strokes secondary to elevated Lp(a), which was identified as the only risk factor and immediately treated with lipoprotein apheresis (LA). Eighteen months post-AIS, he is still receiving LA treatments and has made remarkable progress in his recovery without another cerebrovascular event...
January 31, 2017: Journal of Clinical Apheresis
https://www.readbyqxmd.com/read/28123762/percutaneous-pfo-closure-for-cryptogenic-stroke-in-the-setting-of-a-systematic-cardiac-and-neurological-screening-and-a-standardised-follow-up-protocol
#15
Stéphane Noble, Robert F Bonvini, Fabio Rigamonti, Roman Sztajzel, Fabienne Perren, Philippe Meyer, Hajo Müller, Marco Roffi
BACKGROUND: There are no uniform workup and follow-up (FU) protocols for patients presenting with cryptogenic embolism (CE) who undergo percutaneous closure of a patent foramen ovale (PFO). METHODS: We prospectively performed a systematic cardiac and neurological FU protocol in all patients who underwent percutaneous PFO closure in order to assess the incidence of subsequent cardiac and neurological adverse events. All patients received dual antiplatelet therapy for 6 months and were systematically included in a 12-month standardised FU protocol including: clinical evaluation-transthoracic and transoesophageal echocardiography, 24-hour Holter monitoring and/or 1-week R-test, and transcranial Doppler...
2017: Open Heart
https://www.readbyqxmd.com/read/28116864/pfo-closure-end-of-an-era-or-beginning-of-a-new-chapter
#16
EDITORIAL
Mahmoud I Traina, E Murat Tuzcu
This large long-term retrospective cohort study shows that percutaneous patent foramen ovale (PFO) closure is safe. Higher rates of recurrent stroke or TIA were noted in older patients (age>55) and those with diabetes and hypertension Randomized trials have failed to show significant benefit from PFO closure for cryptogenic stroke though pooled analyses and longer-term follow-up have revealed significant reduction in recurrent strokes. Future studies and longer-term follow-up will need to elucidate which subgroups of patients will benefit from closure...
January 2017: Catheterization and Cardiovascular Interventions
https://www.readbyqxmd.com/read/28106015/relationship-between-mean-platelet-volume-and-ischemic-stroke-in-patients-with-patent-foramen-ovale
#17
Nermin Bayar, Selçuk Küçükseymen, Zehra Erkal, Ramazan Güven, Erkan Köklü, Çağın Mustafa Üreyen, Şakir Arslan
OBJECTIVE: Patent foramen ovale (PFO) is commonly encountered in patients with cryptogenic stroke. Mean platelet volume (MPV), an indicator of platelet reactivity, has been reported in recent trials to be higher in patients with PFO than in normal population. The aim of this study was to investigate whether there is a difference in MPV between patients with PFO and stroke or transient ischemic attack (TIA) and that of patients with asymptomatic PFO. METHODS: Patients with PFO who were younger than 55 years of age were enrolled in this retrospective study...
January 2017: Türk Kardiyoloji Derneği Arşivi: Türk Kardiyoloji Derneğinin Yayın Organıdır
https://www.readbyqxmd.com/read/28049202/aortic-atherosclerosis-determines-increased-retrograde-blood-flow-as-a-potential-mechanism-of-retrograde-embolic-stroke
#18
Thomas Wehrum, Felix Guenther, Werner Vach, Beryl Primrose Gladstone, Sarah Wendel, Alexander Fuchs, Kehzong Wu, Christoph Johannes Maurer, Andreas Harloff
BACKGROUND: Retrograde brain embolization from complex plaques of the proximal descending aorta (DAo) has been identified as a new potential mechanism of stroke. Our purpose was to identify predictors of increased retrograde aortic blood flow indicating an elevated risk of brain embolization from the DAo. METHODS: A total of 485 patients with acute ischemic stroke were prospectively included and underwent transesophageal echocardiography. Blood flow velocities in the proximal DAo were studied using 2D pulse-wave Doppler ultrasound...
January 4, 2017: Cerebrovascular Diseases
https://www.readbyqxmd.com/read/28028400/transcatheter-closure-of-patent-foramen-ovale-a-single-center-experience
#19
Ivan Milev, Planinka Zafirovska, Zan Zimbakov, Shpend Idrizi, Vilma Ampova-Sokolov, Emilija Gorgieva, Liljana Ilievska, Goce Tosheski, Nikola Hristov, Ljubica Georgievska-Ismail, Tanja Anguseva, Zan Mitrev
BACKGROUND: Percutaneous transcatheter closure (PTC) of patent foramen ovale (PFO) is implicated in cryptogenic stroke, transitional ischemic attack (TIA) and treatment of a migraine. AIM: Our goal was to present our experience in the interventional treatment of PFO, as well as to evaluate the short and mid-term results in patients with closed PFO. MATERIAL AND METHODS: Transcatheter closure of PFO was performed in 52 patients (67.3% women, mean age 40...
December 15, 2016: Open Access Macedonian Journal of Medical Sciences
https://www.readbyqxmd.com/read/28026909/plasma-d-dimer-levels-and-ischaemic-lesions-in-multiple-vascular-regions-can-predict-occult-cancer-in-patients-with-cryptogenic-stroke
#20
Y Gon, M Sakaguchi, J Takasugi, T Kawano, H Kanki, A Watanabe, N Oyama, Y Terasaki, T Sasaki, H Mochizuki
BACKGROUND AND PURPOSE: Cancer patients with cryptogenic stroke often have high plasma D-dimer levels and lesions in multiple vascular regions. Hence, if patients with cryptogenic stroke display such characteristics, occult cancer could be predicted. This study aimed to investigate the clinical characteristics of cryptogenic stroke as the first manifestation of occult cancer and to determine whether plasma D-dimer levels and lesions in multiple vascular regions can predict occult cancer in patients with cryptogenic stroke...
March 2017: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
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