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(Stroke. 2009;40:e530.)
© 2009 American Heart Association, Inc.

Letters to the Editor

Cryptogenic Stroke: Cryptic Definition?

Marta Altieri, MD, PhD; Pina Troisi, MD; Ilaria Maestrini, MD Gian Luigi Lenzi, MD

Clinica Neurologica A, Sapienza Università di Roma, Viale dell’Università 30, Rome, Italy

An extract of the first 250 words of the full text is provided, because this article has no abstract.

To the Editor:

We have read with great interest the article entitled "May-Turner Syndrome in patients with cryptogenic stroke and patent foramen ovale" which appeared in Stroke.¹

The article is innovative, being the first large-scale analysis of the association between May-Turner Syndrome, cryptogenic stroke, and patent foramen ovale (PFO). Nonetheless, it arises some uncertainties concerning the definition of "cryptogenic stroke". In the present study, cryptogenic stroke was defined as "a sudden focal neurological event in the absence of an identifiable cause such as uncontrolled hypertension, intracranial hemorrhage, ipsilateral carotid lesion, atrial fibrillation, intracardiac thrombus, degenerative neurological disorder or neoplasm."¹

In literature, the term cryptogenic stroke usually refers to strokes with no clearly definable cause even after extensive workup.² Approximately 30% to 40% of ischemic strokes are cryptogenic.³ This means that in a large part of our patients we are unable to identify stroke etiology because: (1) the cause is reversible, and the workout is not performed at the appropriate time; (2) the causes of stroke are not fully investigated; and (3) some causes of stroke remain unknown.³ In the TOAST classification, the stroke is of undetermined etiology when the presence of multiple, concomitant risk factors force the physician to be unable to determine a final diagnosis.⁴

Paradoxical embolism via PFO has been documented as a stroke mechanism. Nevertheless, data are still conflicting, and PFO remains associated with cryptogenic stroke. In the present study all patients had undergone PFO closure, but a comprehensive workout was also performed to rule out . . . [Full Text of this Article]