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Related Concept Videos

Ischemic Stroke l: Introduction01:15

Ischemic Stroke l: Introduction

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Ischemic stroke is an acute cerebrovascular condition in which blood flow to a brain region is suddenly interrupted, leading to tissue infarction. Neurons depend on continuous oxygen and glucose supply, so even brief reductions in perfusion cause energy failure, ionic imbalance, and irreversible injury. Ischemic strokes are classified into thrombotic and embolic types based on their underlying mechanisms.Thrombotic MechanismsThrombotic stroke develops when a clot forms within a cerebral artery.
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Transient Ischemic Attack l: Introduction01:26

Transient Ischemic Attack l: Introduction

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A transient ischemic attack (TIA) is a brief episode of neurological dysfunction caused by a temporary, focal reduction in cerebral blood flow. Although symptoms resemble those of an ischemic stroke, the interruption in perfusion is short-lived and does not cause permanent infarction. TIAs are clinically important because they often serve as early warning events for future stroke.Mechanisms of Transient Cerebral IschemiaTransient cerebral ischemia may arise through several mechanisms. One...
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Hemorrhagic Stroke ll: Pathophysiology01:29

Hemorrhagic Stroke ll: Pathophysiology

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A hemorrhagic stroke develops when a cerebral blood vessel ruptures, allowing blood to escape into the surrounding brain tissue, as in intracerebral hemorrhage (ICH), or into the subarachnoid space, as in subarachnoid hemorrhage (SAH). Because the skull is a rigid compartment, the sudden presence of extravascular blood rapidly increases intracranial pressure and compresses adjacent neural structures, leading to immediate tissue injury and impaired cerebral perfusion.Mass Effect and Primary...
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Hemorrhagic Stroke l: Introduction01:17

Hemorrhagic Stroke l: Introduction

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A hemorrhagic stroke is an acute neurological event that occurs when a weakened cerebral blood vessel ruptures, allowing blood to accumulate within or around the brain. The sudden release of blood forms a focal hematoma that increases intracranial pressure, displaces neural tissue, and can obstruct cerebrospinal fluid pathways. These effects may be compounded by intraventricular extension of the hemorrhage, cerebral edema, or compression of adjacent structures, all of which contribute to...
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Ischemic Stroke ll: Pathophysiology01:15

Ischemic Stroke ll: Pathophysiology

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An ischemic stroke occurs when a cerebral blood vessel becomes obstructed, most often by a thrombus or embolus, interrupting the delivery of oxygen and glucose to brain tissue. Because neurons rely on continuous aerobic metabolism, energy failure begins within minutes of reduced perfusion. The region receiving the least blood flow becomes the infarct core, an area of irreversible cellular death. Surrounding this core lies the penumbra, a zone of hypoperfused but still viable tissue that is...
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Stroke: Introduction and Types01:29

Stroke: Introduction and Types

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A stroke is an acute neurological event caused by the sudden disruption of cerebral blood flow, leading to rapid loss of neuronal function. Neurons depend on continuous oxygen and glucose supply, so even brief interruptions can cause irreversible injury within minutes. Strokes are classified into ischemic and hemorrhagic types.Ischemic StrokeIschemic strokes are most common and occur due to arterial occlusion, depriving brain tissue of oxygen and nutrients. This leads to energy failure, ionic...
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Cryptogenic stroke and underlying atrial fibrillation.

Tommaso Sanna1, Hans-Christoph Diener, Rod S Passman

  • 1From the Catholic University of the Sacred Heart, Institute of Cardiology (T.S.), and Institute of Neurology, Campus Bio-Medico University (V.D.L.) - both in Rome; the Department of Neurology and Stroke Center, University Hospital Essen, Essen (H.-C.D.), and Hospital Klinikum Coburg, Teaching Hospital of the University of Würzburg, Coburg (J.B.) - both in Germany; Bluhm Cardiovascular Institute (R.S.P.) and Davee Department of Neurology (R.A.B.), Northwestern University Feinberg School of Medicine, Chicago; Population Health Research Institute, McMaster University, Hamilton, ON, Canada (C.A.M.); University of Kansas Medical Center, Kansas City (M.M.R.); the KU Leuven Department of Neurosciences, the VIB-Vesalius Research Center, and the Department of Neurology, University Hospitals Leuven - all in Leuven, Belgium (V.T.); Medtronic, Mounds View, MN (T.R., K.L.); and Medtronic, Maastricht, the Netherlands (F.B.).

The New England Journal of Medicine
|June 26, 2014
PubMed
Summary
This summary is machine-generated.

Long-term monitoring with an insertable cardiac monitor (ICM) significantly improved the detection of atrial fibrillation in cryptogenic stroke patients compared to standard follow-up. This finding has important implications for stroke management and prevention strategies.

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Area of Science:

  • Cardiology
  • Neurology
  • Medical Devices

Background:

  • Current guidelines suggest 24-hour ECG monitoring post-ischemic stroke to detect atrial fibrillation (AF).
  • The optimal duration and method for AF detection remain unclear, especially in cryptogenic stroke cases where the cause is often undetermined.
  • Identifying AF in cryptogenic stroke patients is crucial for guiding therapeutic decisions and preventing recurrent events.

Purpose of the Study:

  • To evaluate the efficacy of long-term monitoring using an insertable cardiac monitor (ICM) versus conventional follow-up for detecting atrial fibrillation in patients with cryptogenic stroke.
  • To compare the time to the first detection of atrial fibrillation within 6 and 12 months between the ICM and control groups.

Main Methods:

  • A randomized, controlled trial involving 441 patients aged 40 years or older with cryptogenic stroke and no initial evidence of AF.
  • Patients were randomized to either ICM monitoring or conventional follow-up within 90 days of the index event.
  • The primary endpoint was the detection of atrial fibrillation (lasting >30 seconds) within 6 months, with a secondary endpoint at 12 months. Data analysis followed the intention-to-treat principle.

Main Results:

  • At 6 months, atrial fibrillation was detected in 8.9% of the ICM group versus 1.4% of the control group (HR 6.4; P<0.001).
  • By 12 months, atrial fibrillation detection rates were 12.4% in the ICM group compared to 2.0% in the control group (HR 7.3; P<0.001).
  • The ICM group demonstrated a significantly higher rate of AF detection throughout the study period.

Conclusions:

  • Insertable cardiac monitor (ICM) use is superior to conventional follow-up for detecting atrial fibrillation in patients with cryptogenic stroke.
  • Long-term ICM monitoring offers a more effective strategy for identifying AF, enabling timely therapeutic interventions.
  • The CRYSTAL AF study (NCT00924638) provides robust evidence supporting ICMs in cryptogenic stroke management.