隐源性卒中：研究与实践。
Cryptogenic Stroke: Research and Practice.
机构信息
From the Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI (S.Y., K.L.F.); Department of Neurology (R.A.B.) and Department of Internal Medicine, Division of Cardiovascular Medicine (R.P.), The Feinberg School of Medicine, Northwestern University, Chicago, IL; and Department of Internal Medicine, Division of Cardiology, Weill Cornell Medicine, New York, NY (P.M.O.).
出版信息
Circ Res. 2017 Feb 3;120(3):527-540. doi: 10.1161/CIRCRESAHA.116.308447.
BACKGROUND
Cryptogenic stroke accounts for 30% to 40% of ischemic stroke. It is essential to determine the possible culprit because this will improve secondary stroke prevention strategies.
METHODS
We performed a narrative nonsystematic review of the literature that included randomized trials, exploratory comparative studies, and case series on cryptogenic stroke.
RESULTS
There are several possible mechanisms implicated in cryptogenic stroke, including occult paroxysmal atrial fibrillation, patent foramen ovale, aortic arch atherosclerosis, atrial cardiopathy, and substenotic atherosclerosis. The heterogeneity of these mechanisms leads to differences in stroke prevention strategies among cryptogenic stroke patients.
CONCLUSIONS
A thorough diagnostic evaluation is essential to determine the pathogenesis in cryptogenic stroke. This approach, in addition to risk factor management and lifestyle modifications, will lead to improved stroke prevention strategies in patients with cryptogenic stroke. This will allow for targeted clinical trials to improve stroke prevention strategies in this patient population.
背景
不明原因的中风占缺血性中风的 30%至 40%。确定可能的病因至关重要，因为这将改善二级中风预防策略。
方法
我们对包括随机试验、探索性比较研究和不明原因中风病例系列的文献进行了叙述性非系统性综述。
结果
不明原因中风可能涉及多种机制，包括隐匿性阵发性心房颤动、卵圆孔未闭、主动脉弓粥样硬化、心房心肌病和狭窄前粥样硬化。这些机制的异质性导致不明原因中风患者的中风预防策略存在差异。
结论
彻底的诊断评估对于确定不明原因中风的发病机制至关重要。这种方法除了危险因素管理和生活方式改变外，还将导致不明原因中风患者的中风预防策略得到改善。这将有助于针对该患者人群进行临床试验，以改善中风预防策略。
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