Aetiological diagnosis of middle-aged and elderly cryptogenic ischaemic cerebral vascular disease
Insights
Cryptogenic ischaemic cerebral vascular disease (CICVD) in older adults is challenging to diagnose. Cardiac emboli and aortic plaques are likely causes, similar to younger patients, but more research is needed.
Area of Science:
- Neurology
- Cardiology
- Vascular Medicine
Background:
- Cryptogenic ischaemic cerebral vascular disease (CICVD) presents diagnostic challenges, particularly in middle-aged and elderly populations.
- Existing research predominantly focuses on younger CICVD patients, leaving a gap in understanding aetiologies in older demographics.
Purpose of the Study:
- To review and synthesize current studies on the aetiologies of CICVD in middle-aged and elderly stroke patients.
- To identify the primary and contributing factors responsible for CICVD in these age groups.
Main Methods:
- Systematic review of existing literature on CICVD aetiologies.
- Analysis of studies focusing on stroke patients aged middle-aged and older.
Main Results:
- Cardiac emboli from occult heart sources or transient arrhythmias are identified as potential primary causes of CICVD in older adults.
- Dislodged aortic plaques are a significant contributing factor, with hereditary arteriopathy and thrombophilia playing a role in a smaller subset of cases.
- Identified aetiologies in older patients largely mirror those in younger populations, though further investigation is warranted.
Conclusions:
- Embolic events originating from the heart and aortic plaque dislodgement are key factors in middle-aged and elderly CICVD.
- While causes are similar across age groups, further research is essential to fully elucidate the role of these factors in the elderly CICVD population.
Abstract:
Although tremendous efforts have been made to explore the potential aetiologies of cryptogenic ischaemic cerebral vascular disease (CICVD), it remains a great challenge for neurologists to get a comprehensive picture of CICVD across the world. Part of the reason why is that the vast majority of studies have focussed on CICVD in young stroke patients while the underlying causes of CICVD in middle-aged or elderly stroke population have not been fully investigated. The focus of this paper has been dedicated to review the different studies that explore the aetiologies of CICVD cases in this patient population. While there is a set of heterogeneous causes that can lead to CICVD in middle-aged and elderly patients, our review reveals that emboli originated from or across occult places within the heart or produced by transient arrhythmias could possibly be the main culprit. Dislodged aortic plaques might also account for certain CICVD cases and in fewer cases, hereditary arteriopathy and thrombophilia can also play a role. The aforementioned factors have similar roles in middle-aged and elderly CICVD patients as in their younger counterparts. However, more studies are needed to explore the role of these factors in older patients.
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