Embolic Stroke of Undetermined Source: A Systematic Review and Clinical Update

@article{Hart2017EmbolicSO,
  title={Embolic Stroke of Undetermined Source: A Systematic Review and Clinical Update},
  author={Robert G. Hart and Luciana Catanese and Kanjana S Perera and George Ntaios and Stuart J. Connolly},
  journal={Stroke},
  year={2017},
  volume={48},
  pages={867–872}
}
Background and Purpose— Embolic stroke of undetermined source (ESUS) designates patients with nonlacunar cryptogenic ischemic strokes in whom embolism is the likely stroke mechanism. It has been hypothesized that anticoagulation is more efficacious than antiplatelet therapy for secondary stroke prevention in ESUS patients. We review available information about ESUS. Methods— Systematic literature review to assess the frequency of ESUS, patient features, and prognosis using PubMed from 2014 to… 

Tables from this paper

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Embolic strokes of undetermined source in a cohort of Polish stroke patients
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Compared to all types of stroke but for those with small vessel disease, ESUS patients were most often independent before stroke and had the least severe neurological deficit at admission and the best outcome at discharge.
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TLDR
Because of the complexity of the evaluation and the uncertainty associated with an unknown cause of stroke, neuroscience nurses caring for ESUS patients should be familiar with ESUS and educate the patient about the condition and the importance of complying with all prescribed treatments, tests, and subsequent follow-up appointments after discharge.
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Embolic stroke of undetermined source (ESUS) cohort of Brazilian patients in a university hospital.
TLDR
Although a small cohort, this study suggests that the ESUS population is similar in countries with different health financing when compared with European and North American cohorts.
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TLDR
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Different Clinical Phenotypes of Embolic Stroke of Undetermined Source: A Subgroup Analysis of 86 Patients.
  • S. Piffer, V. Bignamini, D. Bonifati
  • Medicine, Psychology
    Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
  • 2018
Characterization of Patients with Embolic Strokes of Undetermined Source in the NAVIGATE ESUS Randomized Trial.
  • S. Kasner, P. Lavados, R. Hart
  • Medicine
    Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
  • 2018
Prevalence and Overlap of Potential Embolic Sources in Patients With Embolic Stroke of Undetermined Source
TLDR
There is major overlap of PES in patients with embolic stroke of undetermined source and this may possibly explain the negative results of the recent large randomized controlled trials of secondary prevention in Patients with ESUS and offer a rationale for a randomized controlled trial of combination of anticoagulation and aspirin for the prevention of stroke recurrence.
Age-related burden and characteristics of embolic stroke of undetermined source in the real world clinical practice
TLDR
A thorough diagnostic work-up, with an age-specific approach, is necessary and of the utmost importance for the identification of stroke etiology, in order to optimize secondary stroke prevention strategies.
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