Evaluation of Cryptogenic Stroke With Advanced Diagnostic Techniques
Despite efforts to arrive at a diagnosis, the cause of stroke remains undetermined in 25% to 40% of patients. Factors contributing to undetermined causes of stroke include inadequate information about the underlying vascular pathology, ill-timed diagnostic workup, and incomplete evaluation. Fortunately, mounting evidence suggest that advanced diagnostic techniques may have great use in reducing the proportions of strokes of undetermined cause. For instance, long-term monitoring to document paroxysmal atrial fibrillation, high-resolution MRI technique to visualize wall pathology (ie, plaque, dissection, or vasculitis), coronary computed tomographic angiography to better establish potential sources of aortocardiac embolism, and laboratory tests for cancer-related coagulopathy can all assist with prompt identification of underlying stroke mechanisms and guide early specific treatments to improve stroke outcomes. Still, conducting many of the aforementioned advanced diagnostic techniques can be time-consuming and expensive, and so careful selection and judicious use of the most appropriate diagnostic modalities, guided by patients’ characteristics at the time of presentation, are crucial. This review article provides an overview of the promising role of various advanced diagnostic techniques in the approach to deciphering the so-called cryptogenic strokes. It details sophisticated tools that have the potential to better inform clinicians caring for patients with stroke about the causative mechanisms at play (and, therefore, distinctive treatments that may be required) and presents pragmatic strategies for using these procedures in routine practice although the effectiveness of such strategies need to be tested in future longitudinal studies.
- Received October 1, 2013.
- Revision received December 28, 2013.
- Accepted December 31, 2013.
- © 2014 American Heart Association, Inc.