Ferri Claudio, Baldini Gianluca, Ferri Livia
MeSVA Department-Chair and School of Internal Medicine, University of L'Aquila, L'Aquila, Italy.
Eur Heart J Suppl. 2025 Apr 16;27(Suppl 3):iii93-iii97. doi: 10.1093/eurheartjsupp/suaf023. eCollection 2025 Mar.
A cerebral stroke is a heterogeneous entity and-in the context of this heterogeneity-a cryptogenic stroke, that is, of unknown origin at the time of diagnosis, finds a worthy position. Cryptogenic strokes are ∼25% of ischaemic strokes and in hindsight, they often appear to be of obvious or highly presumptive origin. Knowledge of the causes of a cerebral stroke that are not immediately evident is, therefore, fundamental for the purposes of correct secondary and, hopefully, primary prevention. Certainly, in fact, a cryptogenic stroke may require appropriate treatment, which is similar to a stroke whose origin is immediately evident. Equally certainly, however, cryptogenic stroke can benefit from specific treatments, which the lack of diagnosis of origin is destined to nullify. Therefore, it must unfortunately be accepted that a minority of cryptogenic strokes remain without a culprit and, therefore, without a specific corrective treatment. However, the insistent deepening of the diagnostic process in 'obscure' cases must also be pursued. Only the unyielding examination of these cases, in fact, is destined to identify a covert vasculitis, Fabry disease, occult atrial fibrillation, or one of the many pathologies, often far from rare, which require a therapy as specific as it is life-saving. In this brief review, therefore, we will try to fully expand on the identifiable causes of cryptogenic stroke.
脑卒是一种异质性疾病，在这种异质性背景下，隐源性卒中（即在诊断时病因不明）占有重要地位。隐源性卒中约占缺血性卒中的25%，事后看来，其病因往往看似明显或高度可疑。因此，了解那些并非即刻明了的脑卒病因，对于正确的二级预防乃至有望实现的一级预防至关重要。事实上，隐源性卒中确实可能需要与病因明确的卒中相似的适当治疗。然而同样确定的是，隐源性卒中可受益于特定治疗，而病因不明注定会使这些治疗无法发挥作用。因此，不幸的是，必须承认少数隐源性卒中仍找不到病因，因而没有特定的纠正性治疗方法。然而，对于“不明原因”病例，仍必须持续深入诊断过程。事实上，只有对这些病例进行坚持不懈的检查，才有可能识别出隐匿性血管炎、法布里病、隐匿性心房颤动或众多虽不罕见但需要特定且能挽救生命治疗的疾病之一。因此，在这篇简短的综述中，我们将尽力全面阐述隐源性卒中的可识别病因。
