Cryptogenic Stroke: An Approach Towards Discovery of its Possible Hidden Causes

Abstract

Cryptogenic stroke is defined as brain infarction that is not attributable to a source of definite cardioembolism, large artery atherosclerosis, or small artery disease despite a thorough vascular, cardiac, and serologic evaluation. Embolic stroke of undetermined source (ESUS) is defined as a nonlacunar brain infarct without proximal arterial stenosis or cardioembolic sources. ESUS represents a subset of cryptogenic stroke. The pathophysiology of cryptogenic stroke is likely heterogeneous. Proposed mechanisms include cardiac embolism secondary to occult paroxysmal atrial fibrillation, aortic atheromatous disease or other cardiac sources, paradoxical embolism from atrial septal abnormalities such as patent foramen ovale, hypercoagulable states, and preclinical or subclinical cerebrovascular disease. In our study, 55 CS patients,out of 482 patients, were included representing 11.4% of total ischemic stroke patients included during the study time and Laboratory investigations were done including routine lab (complete blood picture, liver functions, kidney functions, electrolytes), ESR, CRP, ANA, Anti DNA, anticardiolipin antibody, lupus anticoagulant, ANCA P and ANCA C, Protein C, protein S, antithrombin ш. A panel of investigations were done including 48 hours Holter ECG, TEE and TCD for detection of RLS.