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Cryptogenic Stroke: What You Don't Know CAN Hurt You

"Lucky" is a word that may seem strange to use in the context of stroke, but if you are among those fortunate enough to have had the cause behind your stroke identified, then that word does, to some extent, describe you.

Every year, more than 200,000 strokes in the U.S. are referred to as "cryptogenic strokes," meaning no one is sure why they happened. Why is this a problem? When you consider that the number one risk factor for having a second stroke is having had a previous one, AND that a second stroke is 16 times more likely to be fatal, it becomes clear that prevention is key to survival. Unfortunately, prevention is much more difficult to achieve if etiology of the original…

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Articles of Interest

Cryptogenic Stroke Initiative

In about 1 in 3 Ischemic Strokes, the root cause is still unknown after testing... The American Heart Association/American Stroke Association’s Cryptogenic Stroke Initiative, sponsored by Medtronic, elevates stroke of undetermined cause, “cryptogenic” stroke, as a national healthcare priority. This initiative seeks to improve care for the estimated 200,000 people who suffer a cryptogenic stroke each year, to help prevent disability and death from stroke.

What's at the heart of my cryptogenic stroke?

Having a stroke of unknown cause, or cryptogenic stroke, may be frustrating and overwhelming. In this guide, we will provide you with information and resources that can help you and your loved ones find answers around cryptogenic stroke.

A mystery: Understanding cryptogenic stroke

There are many different causes, including the heart valve infection known as endocarditis, structural abnormalities of the heart, blood clotting disorders, and the abnormal heart rhythm atrial fibrillation.

Cryptogenic stroke

Cryptogenic, or unexplained, stroke is present in about 30%–40% of ischemic stroke patients. Pursuing a stroke mechanism is important in such patients to better choose therapy to reduce the stroke recurrence risk. Intracranial vessel imaging and cardiac evaluation with transesophageal echocardiogram and outpatient cardiac monitoring may help identify the stroke mechanism.

Cryptogenic Stroke & Atrial Fibrillation: Establishing the Link Through Team Approaches to Care

It is estimated that 87 percent of strokes are ischemic, and 25 to 40 percent of these occurrences are deemed cryptogenic, or a stroke of unknown cause. A large portion of these cryptogenic patients may have asymptomatic or undiagnosed atrial fibrillation (AF), and yet many patients do not receive additional cardiac monitoring following their initial stroke hospitalization. It is important to determine stroke etiology so that these patients are not at risk for additional strokes or even death.

Cryptogenic Stroke (CS) Stories

Cryptogenic stroke is an ischemic stroke for which no probable cause is found despite a thorough diagnostic evaluation.

Cryptogenic Stroke and Significance of the Patent Foramen Ovale: A Case Series

Cryptogenic stroke is a diagnosis of exclusion and can only be diagnosed after workup for other causes such as large artery atherosclerosis, small artery disease, cardioembolic and structural cardiac abnormalities, has been ruled out. Cryptogenic strokes account for approximately 25% of strokes, which is a significant number of cases without an identifiable cause, thus, treating patients for secondary prevention is essential. Hence, the term cryptogenic stroke is used to describe the absence of any other known cause of stroke except patent foramen ovale (PFO).

Diagnosis of atrial fibrillation in patients with cryptogenic stroke

In patients, and in particular the elderly, who present with a cerebrovascular accident of no known cause, referred to as a “cryptogenic stroke”, the most likely diagnosis is asymptomatic atrial fibrillation or flutter. How then do we diagnose this arrhythmia?

Embolic Stroke of Unknown Source: What Are the Next Steps?

Embolic stroke of unknown source (ESUS) and cryptogenic stroke are not the same, but both have soft definitions. Most patients with ESUS or cryptogenic strokes do not have a recurrence.

Embolic Strokes of Unknown Source and Cryptogenic Stroke: Implications in Clinical Practice

Up to a third of strokes are rendered cryptogenic or of undetermined etiology. This number is specifically higher in younger patients. At times, inadequate diagnostic workups, multiple causes, or an under-recognized etiology contributes to this statistic. Embolic stroke of undetermined source, a new clinical entity particularly refers to patients with embolic stroke for whom the etiology of embolism remains unidentified despite through investigations ruling out established cardiac and vascular sources.

Evaluation of Cryptogenic Stroke

In summary, cryptogenic stroke is a diagnosis of exclusion — it is an ischemic stroke with no identifiable etiology. A schematic regarding the approach to evaluation of cryptogenic stroke is outlined...

Introducing Joe, A Tough-as-Nails Stroke Survivor

In most cases, a stroke is caused by a blood clot that blocks blood flow to the brain. But in some instances, despite testing, the cause can't be determined. Strokes without a known cause are called cryptogenic1 and this is what Joe experienced.

Management of cryptogenic stroke

CS is more frequent in younger than older patients and most frequently due to cardiac embolism, followed by vasculopathy, and coagulopathy. The most frequent causes of cardiac embolism include paradoxical embolism from upstream veins via a patent foramen ovale (PFO), paroxysmal atrial-fibrillation, valvular heart-disease, and atrial septal aneurysm.

Optimising care after cryptogenic stroke, an expert’s perspective

In 75 percent of stroke cases, consultants can identify the origin of the condition. However, in 25 to 40 percent of cases, despite blood tests and further investigations, the source remains unknown. These strokes, without a clear cause are labelled as cryptogenic strokes. 25 percent of cryptogenic strokes are the result of atrial fibrillation (AF) which refers to an irregular, and often very fast heart rate. Those with AF are five to seven times more likely to form blood clots and suffer a stroke.

Prognosis of Cryptogenic Stroke With Patent Foramen Ovale at Older Ages and Implications for Trials

The findings of this study suggest that a higher risk of stroke recurrence at older ages in patients with patent foramen ovale warrants trials of patent foramen ovale closure in older patients.

Role of Hypercoagulable Studies in Cryptogenic Stroke: A Retrospective Study

Hypercoagulable states are recognized, although uncommon, etiology of ischemic stroke especially in young adults under the age of 40 and children. Currently, there are no specific guidelines related to screening patients for inherited thrombophilia who are diagnosed with ischemic stroke without any identifiable risk factors. Typically, patients to be screened for thrombophilia will have prior unexplained thromboembolic events.

Stroke Spotlight: Cryptogenic Stroke & Embolic Stroke of Undetermined Score

Despite improvements over the last decade, stroke remains the fifth leading cause of death and the leading cause of long-term disability in the US. Approximately 30% of strokes remain cryptogenic upon hospital discharge, despite extensive workup. A significant portion of people with cryptogenic strokes are eventually diagnosed with atrial fibrillation (AFib). Several classification systems have been developed to describe the etiology of stroke...