Cryptogenic stroke

## Contents

* 1 Causes
* 1.1 Patent foramen ovale
* 1.2 Atrial fibrillation
* 1.3 Unknown source
* 2 See also
* 3 External links
* 4 References

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In neurology, Cryptogenic stroke is stroke of undetermined source[1].

## Causes

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### Patent foramen ovale

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One cause is paradoxical embolism that may be treated with patent foramen ovale closure[2][3].

### Atrial fibrillation

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One cause is atrial fibrillation which may be detected by prolonged event monitors[4] or prolonged, implantable recorders such as the LINQ[5][6], or even smartphones[7].

The various methods of diagnosis have been compared by a systematic reviews which:

* recommends" sequentially combining cardiac monitoring methods"[8]. An example of a phase 4 (second ambulatory period) consisted of mobile cardiac outpatient telemetry, external loop recording, and implantable loop recording is the http://www.tlcdiagnostics.com/healthcare-professionals/cardiac-monitoring/king-hearts
* "evidence for a potential impact of PCM on secondary stroke prevention"[9]

Clinical practice guidelines address the diagnosis strategy:

* The 2019 AHA/ACC/HRS Focused Update of atrial fibrillation guidelines contain a new section, "7.12. Device Detection of AF and Atrial Flutter," which states "In patients with cryptogenic stroke (ie, stroke of unknown cause) in whom external ambulatory monitoring is inconclusive, implantation of a cardiac monitor (loop recorder) is reasonable to optimize detection of silent AF". However, the guidelines do not address alternative methods to detect atrial fibrillation[10].
* 2016 Guidelines by the ESC state "In stroke patients, additional ECG monitoring by long-term noninvasive ECG monitors or implanted loop recorders should be considered to document silent atrial fibrillation."[11]

The benefit of anticoagulation based on long-term monitoring is uncertain[12].

### Unknown source

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For cryptogenic stroke on unknown source, anticoagulation may not help over aspirin[13].

## See also

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## External links

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## References

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1. ↑ Saver JL (2016). "CLINICAL PRACTICE. Cryptogenic Stroke". N Engl J Med. 374 (21): 2065–74. doi:10.1056/NEJMcp1503946. PMID 27223148.
2. ↑ Mas JL, Derumeaux G, Guillon B, Massardier E, Hosseini H, Mechtouff L; et al. (2017). "Patent Foramen Ovale Closure or Anticoagulation vs. Antiplatelets after Stroke". N Engl J Med. 377 (11): 1011–1021. doi:10.1056/NEJMoa1705915. PMID 28902593.CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link)  Review in: Ann Intern Med. 2018 Jan 16;168(2):JC7
3. ↑ Saver JL, Carroll JD, Thaler DE, Smalling RW, MacDonald LA, Marks DS; et al. (2017). "Long-Term Outcomes of Patent Foramen Ovale Closure or Medical Therapy after Stroke". N Engl J Med. 377 (11): 1022–1032. doi:10.1056/NEJMoa1610057. PMID 28902590.CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link)
4. ↑ Gladstone DJ, Spring M, Dorian P, Panzov V, Thorpe KE, Hall J; et al. (2014). "Atrial fibrillation in patients with cryptogenic stroke". N Engl J Med. 370 (26): 2467–77. doi:10.1056/NEJMoa1311376. PMID 24963566.CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link)  Review in: Evid Based Med. 2014 Dec;19(6):235 Review in: Ann Intern Med. 2014 Nov 18;161(10):JC2 Review in: Ann Intern Med. 2014 Nov 18;161(10):JC3
5. ↑ Sanna T, Diener HC, Passman RS, Di Lazzaro V, Bernstein RA, Morillo CA; et al. (2014). "Cryptogenic stroke and underlying atrial fibrillation". N Engl J Med. 370 (26): 2478–86. doi:10.1056/NEJMoa1313600. PMID 24963567.CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link)
6. ↑ Edwards SJ, Wakefield V, Jhita T, Kew K, Cain P, Marceniuk G (2020). "Implantable cardiac monitors to detect atrial fibrillation after cryptogenic stroke: a systematic review and economic evaluation". Health Technol Assess. 24 (5): 1–184. doi:10.3310/hta24050. PMC 6983910 Check `|pmc=` value (help). PMID 31944175.CS1 maint: Multiple names: authors list (link)
7. ↑ Perez MV, Mahaffey KW, Hedlin H, Rumsfeld JS, Garcia A, Ferris T; et al. (2019). "Large-Scale Assessment of a Smartwatch to Identify Atrial Fibrillation". N Engl J Med. 381 (20): 1909–1917. doi:10.1056/NEJMoa1901183. PMID 31722151.CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link)
8. ↑ Sposato LA, Cipriano LE, Saposnik G, Ruíz Vargas E, Riccio PM, Hachinski V (2015). "Diagnosis of atrial fibrillation after stroke and transient ischaemic attack: a systematic review and meta-analysis". Lancet Neurol. 14 (4): 377–87. doi:10.1016/S1474-4422(15)70027-X. PMID 25748102.CS1 maint: Multiple names: authors list (link)
9. ↑ Tsivgoulis G, Katsanos AH, Grory BM, Köhrmann M, Ricci BA, Tsioufis K; et al. (2019). "Prolonged Cardiac Rhythm Monitoring and Secondary Stroke Prevention in Patients With Cryptogenic Cerebral Ischemia". Stroke. 50 (8): 2175–2180. doi:10.1161/STROKEAHA.119.025169. PMID 31216964.CS1 maint: Multiple names: authors list (link)
10. ↑ January CT, Wann LS, Calkins H, Chen LY, Cigarroa JE, Cleveland JC; et al. (2019). "2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society in Collaboration With the Society of Thoracic Surgeons". Circulation. 140 (2): e125–e151. doi:10.1161/CIR.0000000000000665. PMID 30686041.CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link)
11. ↑ Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B; et al. (2016). "2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS". Eur J Cardiothorac Surg. 50 (5): e1–e88. doi:10.1093/ejcts/ezw313. PMID 27663299.CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link)
12. ↑ Martin DT, Bersohn MM, Waldo AL, Wathen MS, Choucair WK, Lip GY; et al. (2015). "Randomized trial of atrial arrhythmia monitoring to guide anticoagulation in patients with implanted defibrillator and cardiac resynchronization devices". Eur Heart J. 36 (26): 1660–8. doi:10.1093/eurheartj/ehv115. PMID 25908774.CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link)
13. ↑ Diener HC, Sacco RL, Easton JD, Granger CB, Bernstein RA, Uchiyama S; et al. (2019). "Dabigatran for Prevention of Stroke after Embolic Stroke of Undetermined Source". N Engl J Med. 380 (20): 1906–1917. doi:10.1056/NEJMoa1813959. PMID 31091372.CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link)