[Cryptogenic stroke management : where are we ?]

Area of Science:

• Neurology
• Cardiology
• Stroke Medicine

Background:

• Cryptogenic stroke is an outdated term for ischemic stroke without a clear cause.
• Embolic stroke of undetermined source (ESUS) was introduced for non-lacunar strokes with likely thromboembolic mechanisms.
• The ESUS subgroup is heterogeneous, with multiple potential embolic causes.

Purpose of the Study:

• To explore the heterogeneity of ESUS.
• To contrast the prevalence of covert atrial fibrillation versus intracranial and extracranial atherosclerosis in ESUS.
• To emphasize the role of cardiologists in diagnosing ESUS.

Main Methods:

• Review of existing literature on cryptogenic stroke and ESUS.
• Analysis of potential embolic causes, including atrial fibrillation and atherosclerosis.
• Discussion of diagnostic approaches and the neurologist-cardiologist collaboration.

Main Results:

• Covert atrial fibrillation is less frequently the cause of ESUS than initially anticipated.
• Intracranial and extracranial atherosclerosis are more significant contributors to ESUS.
• The heterogeneity of ESUS necessitates a broad diagnostic approach.

Conclusions:

• ESUS is a complex condition with diverse underlying etiologies.
• Cardiologists play a crucial role in the etiological workup of ischemic stroke.
• Further research is needed to personalize treatments for ESUS patients.