Cryptogenic Stroke

Dhakal, Prajwal; Verma, Vivek; Bhatt, Vijaya Raj

doi:10.1056/nejmc1609156

Cited by 49 publications

(10 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A presumptive diagnosis of such stroke can also be inferred from the absence of conventional stroke risk factors, a history of deep vein thrombosis, recent travel, pulmonary embolus, or the presence of Valsalva maneuver before the stroke event. 14 Our first and fourth case shows this very clearly.…”

Section: Case Reportmentioning

confidence: 51%

Diagnosing and treating Patent Foramen Ovale (PFO) from various manifestations in adults: case series

Silalahi

Suwita²,

Darmawan

et al. 2022

Bali Med J.

View full text Add to dashboard Cite

Background. Patent foramen ovale (PFO) is a part of atrial septal defects (ASD) entities. While mostly asymptomatic, some adults with PFO will develop symptoms, from mild complaints such as migraine or palpitation to more debilitating complications such as syncope or cryptogenic stroke. Therefore, it is highly crucial that PFO be diagnosed and treated promptly. Echocardiography, trans-thoracal and or trans-esophageal, is the main diagnosis modality. For treatment, antiplatelet with or without anticoagulation, trans-catheter closure, and surgery are utilized in accordance with their indications. Case Presentation. We present four adult patients referred with various symptoms: vertigo, migraine, palpitation, and cryptogenic stroke. Three of them had no explicit risk factors for the cerebrovascular event, with one patient having a co-existing hypercoagulable state. Echocardiography revealed a positive bubble test, which meant that PFO was the primary etiology of those cases. We then treated each of them with transcatheter device closure, which improved their symptoms, before adding antiplatelet for six months. Conclusion. Proper diagnosis and prompt treatment of PFO are imperative in reducing complications. Echocardiography, mainly TEE, is the main diagnostic tool for PFO. Antithrombotic (with or without anticoagulant), minimally invasive procedure and surgery in some cases are the modalities available.

show abstract

Section: Case Reportmentioning

confidence: 51%

Diagnosing and treating Patent Foramen Ovale (PFO) from various manifestations in adults: case series

Silalahi

Suwita²,

Darmawan

et al. 2022

Bali Med J.

View full text Add to dashboard Cite

show abstract

“…Posteriormente se realizó una angiotomografía cerebral mayor predisposición a enfermedades cerebrovasculares: de tipo isquémico agudo, trombosis del seno venoso, hemorragia cerebral, encefalopatía hemorrágica necrotizante aguda y hemorragia subaracnoidea que fue lo que finalmente dió un desenlace fatal a nuestro enfermo [11][12][13][14][15] . La arritmia en el COVID-19, es relativamente frecuente con una incidencia de 16,7% de forma general y de 44% en pacientes críticamente enfermos de forma particular 16 ; la respuesta inflamatoria excesiva desencadena injuria miocárdica y miocarditis, además de otras posibles noxas cardíacas como la ruptura de placas ateromatosas y trombosis coronaria 17 .…”

Section: Discussionunclassified

Coexistencia de hemorragia subaracnoidea aneurismática accidentada y tromboembolia pulmonar en paciente con COVID-19. Reporte de un caso.

Páez¹,

Moscoso²,

Coello

et al. 2020

View full text Add to dashboard Cite

El COVID-19 es causado por el SARS-CoV2, un coronavirus beta, que actualmente es responsable de una pandemia con alta tasa de contagiosidad y mortalidad a nivel mundial. Este virus, a más de su impacto a nivel pulmonar, puede desencadenar una tormenta de citocinas proinflamatorias que dañan el endotelio vascular generando endotelitis, disfunción endotelial y alta prevalencia de eventos trombóticos. Clínica y analíticamente la expresión de este fenómeno se evidencia con niveles elevados de dímero D, trombosis venosa y/o arterial, embolia pulmonar, enfermedades cerebrovasculares y cardiovasculares y trombosis microvascular difusa. Dado que el endotelio es un órgano vital en la regulación del tono vascular y la homeostasis, su afectación conduce a vasoconstricción, isquemia, infarto e inflamación y esto posiblemente cause debilitamiento de su estructura. En él siguiente reporte de caso, narramos la historia de un paciente con neumonía por SARS-CoV2, que presentó concomitancia de alteraciones endoteliales hemorrágicas y trombóticas, expresadas por una hemorragia subaracnoidea aneurismática accidentada y una tromboembolia pulmonar submasiva.

show abstract

“…Cryptogenic stroke refers to a subclass of ischemic stroke for which no cause can be identified and comprises 25-33% of all ischemic strokes. [21][22][23][24] The TOAST criteria formalized the classification of cryptogenic stroke, 25 with other causes of stroke including large artery atherosclerosis, cardioembolism, small vessel stroke, and other determined causes. By this classification scheme, the "cryptogenic" group is heterogeneous and comprises any stroke without a defined cause.…”

Section: Pfo and Embolic Stroke Of Undetermined Sourcementioning

confidence: 99%

Advances in the management of cardioembolic stroke associated with patent foramen ovale

Grory

Ohman

Feng

et al. 2022

BMJ

View full text Add to dashboard Cite

Patent foramen ovale (PFO) describes a valve in the interatrial septum that permits shunting of blood or thrombotic material between the atria. PFOs are present in approximately 25% of the healthy population and are not associated with any pathology in the vast majority of cases. However, comparisons between patients with stroke and healthy controls suggest that PFOs may be causative of stroke in certain patients whose stroke is otherwise cryptogenic. Options for the diagnosis of PFO include transthoracic echocardiography, transesophageal echocardiography, and transcranial Doppler ultrasonography. PFOs associated with an interatrial septal aneurysm seem to be more strongly linked to risk of recurrent stroke. Therapeutic options for secondary stroke prevention in the setting of a PFO include antiplatelet therapy, anticoagulation, and percutaneous device closure. Recent randomized clinical trials suggest that percutaneous closure reduces the subsequent risk of stroke in appropriately selected patients, with a large relative benefit but small absolute benefit. Referral for percutaneous PFO closure should therefore be considered in certain patients after a multidisciplinary, patient centered discussion. Areas for future study include structural biomarkers to aid in determining the role of PFO closure in older people with possible PFO associated stroke, the role of direct oral anticoagulants, and very long term outcomes after device closure.

show abstract

Cryptogenic Stroke

Cited by 49 publications

References 8 publications

Diagnosing and treating Patent Foramen Ovale (PFO) from various manifestations in adults: case series

Diagnosing and treating Patent Foramen Ovale (PFO) from various manifestations in adults: case series

Coexistencia de hemorragia subaracnoidea aneurismática accidentada y tromboembolia pulmonar en paciente con COVID-19. Reporte de un caso.

Advances in the management of cardioembolic stroke associated with patent foramen ovale

Contact Info

Product

Resources

About