Current approaches to diagnosis and prevention of ishemic stroke.

Abstract

Etiology ofembolic stroke is very heterogeneous. It could be related to large vessel disease, small vessel disease, thromboembolism of cardiac origin. Clarification of etiology of stroke is important prerequisite for adequate selection of its secondary prevention measures. Standard work-up allows identification of its etiology in 60-90% of cases. 1n the rest 10-40% of cases stroke is considered cryptogenic. The majority of cryptogenic strokes are embolic. In keeping with this, a concept of embolic stroke of undetermined source (ESUS) was suggested. 1n the paper authors review most sigificant causes of ESUS. Occult atrial fibrillation is one of the common cause of ESUS. 1t could be detected only by means of long term ECG monitoring. Standard 24-hour ECG monitoring after stroke detects around 5% of cases ofpreviously unknown paroxysmal atrial fibrillation, while long-term monitoring of ECG allows detection ofparoxysmal atrial fibrillation in 15% of cases. Patent foramen ovale could lead to stroke in patients with deep vein thrombosis in the legs and pelvis due to paradoxical embolism. Atherosclerosis of aortic arch is observed in the half ofpeople older than 45 years. Large, ulcerated, non-calcified or floating atheromas could cause a stroke. Malignant tumors could lead to cerebral embolism through non-bacterial thrombotic endocarditis. Tumor embolism into cerebral arteries could also be seen in rare cases. The rate of cerebral embolism is high in mixomas. Approaches to diagnosis and secondary prevention of ESUS are discussed in the paper.