Cryptogenic Stroke: Research and Practice.
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. The heterogeneity of these mechanisms leads to differences in stroke prevention strategies among cryptogenic stroke patients.


CONCLUSIONS
A thorough diagnostic evaluation is essential to determine the pathogenesis in cryptogenic stroke. This approach, in addition to risk factor management and lifestyle modifications, will lead to improved stroke prevention strategies in patients with cryptogenic stroke. This will allow for targeted clinical trials to improve stroke prevention strategies in this patient population.
From the Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI (S.Y., K.L.F.); Department of Neurology (R.A.B.) and Department of Internal Medicine, Division of Cardiovascular Medicine (R.P.), The Feinberg School of Medicine, Northwestern University, Chicago, IL; and Department of Internal Medicine, Division of Cardiology, Weill Cornell Medicine, New York, NY (P.M.O.).
Shadi
S
Yaghi
From the Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI (S.Y., K.L.F.); Department of Neurology (R.A.B.) and Department of Internal Medicine, Division of Cardiovascular Medicine (R.P.), The Feinberg School of Medicine, Northwestern University, Chicago, IL; and Department of Internal Medicine, Division of Cardiology, Weill Cornell Medicine, New York, NY (P.M.O.).
Richard A
RA
Bernstein
From the Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI (S.Y., K.L.F.); Department of Neurology (R.A.B.) and Department of Internal Medicine, Division of Cardiovascular Medicine (R.P.), The Feinberg School of Medicine, Northwestern University, Chicago, IL; and Department of Internal Medicine, Division of Cardiology, Weill Cornell Medicine, New York, NY (P.M.O.).
Rod
R
Passman
From the Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI (S.Y., K.L.F.); Department of Neurology (R.A.B.) and Department of Internal Medicine, Division of Cardiovascular Medicine (R.P.), The Feinberg School of Medicine, Northwestern University, Chicago, IL; and Department of Internal Medicine, Division of Cardiology, Weill Cornell Medicine, New York, NY (P.M.O.).
Peter M
PM
Okin
From the Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI (S.Y., K.L.F.); Department of Neurology (R.A.B.) and Department of Internal Medicine, Division of Cardiovascular Medicine (R.P.), The Feinberg School of Medicine, Northwestern University, Chicago, IL; and Department of Internal Medicine, Division of Cardiology, Weill Cornell Medicine, New York, NY (P.M.O.). kfurie@lifespan.org.
Karen L
KL
Furie
D000925:Anticoagulants / Q000008:administration & dosage; D050197:Atherosclerosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000628:therapy; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000628:therapy; D054092:Foramen Ovale, Patent / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000628:therapy; D006331:Heart Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000628:therapy; D006801:Humans; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D012307:Risk Factors; D055502:Secondary Prevention / Q000379:methods; D020521:Stroke / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000628:therapy
D000925:Anticoagulants
cryptogenic stroke; diagnostic testing; embolism; prevention; therapeutic implications