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. 2014 Oct;4(5):386-393.
doi: 10.1212/CPJ.0000000000000086.

Cryptogenic stroke: A diagnostic challenge

Shadi Yaghi  1 , Mitchell S V Elkind  1
Affiliations

Cryptogenic stroke: A diagnostic challenge

Shadi Yaghi et al. Neurol Clin Pract. 2014 Oct.

Abstract

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. This article highlights the diagnostic yield of various tests in identifying a stroke mechanism in stroke patients whose initial diagnostic evaluation is negative, and the implications for treatment.

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Figures

Figure 1
Figure 1. MRI
Diffusion-weighted imaging (b1000) (left) shows a hyperintense lesion along the right motor cortex (hand knob) that is hypointense on apparent diffusion coefficient map sequence (right) consistent with an acute infarct.
Figure 2
Figure 2. Suggested approach to the identification and further evaluation of cryptogenic stroke
ASD = atrial septal defect; PFO = patent foramen ovale; TTE = transthoracic echocardiography.
Figure 3
Figure 3. MRI
Arterial wall imaging study demonstrates enhancement consistent with atherosclerosis (arrow) in the proximal left middle cerebral artery territory in a patient with recurrent infarction in the territory of the deep white matter and basal ganglia of the left hemisphere.
See this image and copyright information in PMC

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