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Evaluation of the patient with unexplained stroke

Jorge R Kizer1

  • 1Department of Medicine, Weill Medical College of Cornell University, New York 10068, USA. jok2007@med.cornell.edu

Coronary Artery Disease
|October 17, 2008
PubMed

Insights

Many ischemic strokes remain unexplained. Cardiac or aortic embolism, often linked to heart or aortic issues, is a likely cause, particularly in younger and older adults. Early diagnosis is key.

Area of Science:

  • Neurology
  • Cardiology
  • Vascular Medicine

Background:

  • A significant percentage of ischemic strokes are classified as 'cryptogenic' or unexplained, despite advanced diagnostic tools.
  • Potential causes include unrecognized cardiac or aortic embolism, with distinct pathophysiological patterns in different age groups.

Purpose of the Study:

  • To highlight the importance of echocardiography in diagnosing cryptogenic ischemic strokes.
  • To emphasize the bimodal pathophysiology of cryptogenic stroke, involving interatrial septal abnormalities and aortic/arterial atherothrombotic embolism.

Main Methods:

  • Review of diagnostic approaches for cryptogenic ischemic stroke.
  • Emphasis on echocardiography, specifically transesophageal echocardiography, as the preferred imaging modality.
  • Clinical judgment in guiding therapy pending further trial data.

Main Results:

  • Echocardiography is central to evaluating unexplained ischemic stroke.
  • Interatrial septal abnormalities are implicated in younger adults, while subclinical aortic and large-artery atherothrombotic embolism are prominent in older individuals.
  • Timely and comprehensive evaluation can identify the embolic source.

Conclusions:

  • Unrecognized cardiac or aortic embolism is a major contributor to cryptogenic ischemic strokes.
  • Transesophageal echocardiography is the diagnostic modality of choice for unexplained ischemic stroke.
  • Prompt evaluation and tailored therapy based on clinical judgment are crucial for patient management.

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