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Cerebrovascular disease and risk of stroke
Submitted by Dr. Yasser
Mokhtar, MD. Dept. of internal medicine. School of
medicine, University of South Dakota.
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Stroke is a loss of cerebral
function with symptoms lasting >24 hrs or death due to vascular
disease |
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Cryptogenic stroke
Approximately forty per cent of cerebral infarction can not be classified as
strokes of determined cause despite a complete diagnostic work-up and referred
to as cryptogenic strokes (Sacco et al., 1989).
Despite efforts to arrive at a diagnosis, the cause of infarction in a
discouragingly number of cases remains undetermined. Some cases may be
unexplained because no appropriate laboratory studies are performed, whereas
others remain undetermined because of improper timing of the appropriate
laboratory studies. Results from the stroke data bank indicated that large
artery atherosclerotic occlusive disease was a less frequent cause of stroke,
that small vessel disease or lacunar and cardioembolic infarction were
relatively frequent and that the cause for most cases of infarction could not be
classified into these traditional diagnostic categories (Timsit et al., 1992).
This conclusion forced the creation of a separate diagnostic category for
cases whose mechanisms of infarction remained unproven, known as infarct of
undetermined cause or cryptogenic infarction (Sacco et al., 1992).
Emerging technologies have led to suggestions that some cryptogenic
infarction may be explained by hematologic disorders causing hypercoagulable
states from protein C, free protein S, lupus anticoagulant or anticardiolipin
antibody abnormalities.
Ample evidence exists for many occult sources of emboli, the difficulty is in
proving their existence and their role in the first or succeeding ischemic
strokes. Clinical studies implicated aortic atherosclerosis and paradoxical
emboli through a PFO (Kittner and Gorelick 1992 and Sacco et al., 1993).
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