Embolic stroke of undetermined source

Vinogradov O.I.; Jablonskij M.A.; Kuznecov A.N.

doi:https://doi.org/10.17116/jnevro202012012242

Vinogradov O.I.

Pirogov National Medical and Surgical Center

ORCID: 0000-0002-3847-9366

Jablonskij M.A.

City polyclinic No. 4 of the Balashikha Regional Hospital

Kuznecov A.N.

Pirogov National Medical and Surgical Center

Scopus AuthorID: 57213759918
ORCID: 0000-0002-7125-9840

Embolic stroke of undetermined source

Authors:

Vinogradov O.I., Jablonskij M.A., Kuznecov A.N.

More about the authors

Journal: S.S. Korsakov Journal of Neurology and Psychiatry. 2020;120(12‑2): 42‑48

DOI: 10.17116/jnevro202012012242

Read: 9069 times

Download PDF (RU)

Contact the author

Table of contents

To cite this article:

Vinogradov OI, Jablonskij MA, Kuznecov AN. Embolic stroke of undetermined source. S.S. Korsakov Journal of Neurology and Psychiatry. 2020;120(12‑2):42‑48. (In Russ.)
https://doi.org/10.17116/jnevro202012012242

Подписка 2026 Журнал неврологии и психиатрии им. С.С. Корсакова. Спецвыпуски (S.S. Korsakov Journal of Neurology and Psychiatry (special issues))

Использование инфографики авторами научных работ

Close metadata

Recommended articles:

Sequential use of botulinum toxin A and bovhyaluronidase azoximer in the correction of post-stroke spasticity. S.S. Korsakov Journal of Neurology and Psychiatry. 2025;(2):80-85

Central nervous system involvement in systemic lupus erythematosus. S.S. Korsakov Journal of Neurology and Psychiatry. 2025;(2):124-129

Results of application of modified technique of esophageal varices ligation in patients with liver cirrhosis combined with hepatocellular carcinoma. Endoscopic Surgery. 2025;(2):17-25

Adjuvant pharmacological modulation with Cytoflavin in rehabilitation at stages 2—3 in patients with acute cerebral insufficiency and post-intensive care syndrome. S.S. Korsakov Journal of Neurology and Psychiatry. 2025;(3):78-85

Anesthetic management of endovascular procedures in patients with ischemic stroke. Russian Journal of Anesthesiology and Reanimatology. 2025;(2):20-25

Comparison of fluoroscopy and intracardiac echocardiography for control of endovascular closure of patent foramen ovale. Russian Cardiology Bulletin. 2025;(1):64-69

Analysis of the possibilities of secondary prevention of chronic non-communicable diseases based on a survey of hospital doctors in the Russian cities. Russian Journal of Preventive Medicine. 2025;(5):49-55

Mathematical modeling of outcomes in patients with clinical combination of ischemic stroke and COVID-19 complicated by multiple organ failure. Russian Journal of Anesthesiology and Reanimatology. 2025;(3):42-49

Socio-economic damage caused by elevated low-density lipoprotein cholesterol levels. Medical Technologies. Assessment and Choice. 2025;(2):88-98

Cerebrolysin with reperfusion therapy in ischemic stroke: a prospective analysis of multimodal brain imaging data from the CEREHETIS trial. S.S. Korsakov Journal of Neurology and Psychiatry. 2025;(6):84-98

Abstract:

About 20—40% of ischemic stroke survivors cannot be attributed to a particular pathogenetic subtype despite a thorough diagnostic evaluation (cryptogenic stroke). Most cryptogenic strokes are likely embolic. This understanding is captured by a related concept, termed embolic stroke of undetermined source (ESUS), which is defined as a nonlacunar brain infarct without proximal arterial stenosis or cardioembolic sources. These patients are generally younger, has less disabilities and more favourable prognosis. It is assumed that in this group of patients, anticoagulants may have an advantage over antiplatelet drugs as a means of secondary prevention. Specific methods of treatment and secondary prevention of ESUS has not yet been developed.

Keywords:

ischemic stroke

embolic stroke of undetermined source

secondary prevention

Authors:

Vinogradov O.I.

Pirogov National Medical and Surgical Center

ORCID: 0000-0002-3847-9366

Jablonskij M.A.

City polyclinic No. 4 of the Balashikha Regional Hospital

Kuznecov A.N.

Pirogov National Medical and Surgical Center

Scopus AuthorID: 57213759918
ORCID: 0000-0002-7125-9840

Received:

03.12.2019

Accepted:

23.07.2020

Close metadata

References:

Kiyuna F, Sato N, Matsuo R, Kamouchi M, Hata J, Wakisaka Y, Kuroda J, Ago T, Kitazono T, Investigators FSR. Association of Embolic Sources With Cause-Specific Functional Outcomes Among Adults With Cryptogenic Stroke. JAMA Network Open. 2018;1(5):182953-182953. https://doi.org/10.1001/jamanetworkopen.2018.2953
Bembenek JP, Karlinski MA, Kurkowska-Jastrzebska I, Czlonkowska A. Embolic strokes of undetermined source in a cohort of Polish stroke patients. Neurological Sciences: Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology. 2018;39(6):1041-1047. https://doi.org/10.1007/s10072-018-3322-5
Ay H, Furie KL, Singhal A, Smith WS, Sorensen AG, Koroshetz WJ. An evidence-based causative classification system for acute ischemic stroke. Annals of Neurology. 2005;58(5):688-697. https://doi.org/10.1002/ana.20617
Ay H, Benner T, Arsava EM, Furie KL, Singhal AB, Jensen MB, Ayata C, Towfighi A, Smith EE, Chong JY, Koroshetz WJ, Sorensen AG. A computerized algorithm for etiologic classification of ischemic stroke: the Causative Classification of Stroke System. Stroke. 2007;38(11):2979-2984. https://doi.org/10.1161/STROKEAHA.107.490896
Hao Q, Tampi M, O’Donnell M, Foroutan F, Siemieniuk RA, Guyatt G. Clopidogrel plus aspirin versus aspirin alone for acute minor ischaemic stroke or high risk transient ischaemic attack: systematic review and meta-analysis. BMJ. 2018;363:k5108. https://doi.org/10.1136/bmj.k5108
Prasad K, Siemieniuk R, Hao Q, Guyatt G, O’Donnell M, Lytvyn L, Heen AF, Agoritsas T, Vandvik PO, Gorthi SP, Fisch L, Jusufovic M, Muller J, Booth B, Horton E, Fraiz A, Siemieniuk J, Fobuzi AC, Katragunta N, Rochwerg B. Dual antiplatelet therapy with aspirin and clopidogrel for acute high risk transient ischaemic attack and minor ischaemic stroke: a clinical practice guideline. BMJ. 2018;363:k5130. https://doi.org/10.1136/bmj.k5130
Hart RG, Catanese L, Perera KS, Ntaios G, Connolly SJ. Embolic stroke of undetermined source: a systematic review and clinical update. Stroke. 2017;48(4):867-872. https://doi.org/10.1161/strokeaha.116.016414
Ricci B, Chang AD. A Simple Score That Predicts Paroxysmal Atrial Fibrillation on Outpatient Cardiac Monitoring after Embolic Stroke of Unknown Source. J Stroke Cerebrovasc Dis. 2018;27(6):1692-1696. https://doi.org/10.1016/j.jstrokecerebrovasdis.2018.01.028
Fan Y, Liao X, Pan Y, Dong K, Wang Y, Wang Y. Intravenous Thrombolysis Is Safe and Effective for the Cryptogenic Stroke in China: Data From the Thrombolysis Implementation and Monitor of Acute Ischemic Stroke in China (TIMS-China). Journal of Stroke and Cerebrovascular Diseases: The Official Journal of National Stroke Association. 2019;28(1):220-226. https://doi.org/10.1016/j.jstrokecerebrovasdis.2018.09.041
Gladstone DJ, Spring M, Dorian P, Panzov V, Thorpe KE, Hall J, Vaid H, O’Donnell M, Laupacis A, Côté R, Sharma M, Blakely JA, Shuaib A, Hachinski V, Coutts SB, Sahlas DJ, Teal P, Yip S, Spence JD, Buck B, Verreault S, Casaubon LK, Penn A, Selchen D, Jin A, Howse D, Mehdiratta M, Boyle K, Aviv R, Kapral MK, Mamdani M; EMBRACE Investigators and Coordinators. Atrial fibrillation in patients with cryptogenic stroke. N Engl J Med. 2014;370:2467-2477. https://doi.org/10.1056/nejmoa1311376
Sanna T, Diener H-C, Passman RS, Di Lazzaro V, Bernstein RA, Morillo CA, Rymer MM, Thijs V, Rogers T, Beckers F, Lindborg K, Brachmann J. Cryptogenic Stroke and Underlying Atrial Fibrillation. New England Journal of Medicine. 2014;370(26):2478-2486. https://doi.org/10.1056/NEJMoa1313600
Sebasigari D, Merkler A, Guo Y, Gialdini G, Kummer B, Hemendinger M, Song C, Chu A, Cutting S, Silver B, Elkind MSV, Kamel H, Furie KL, Yaghi S. Biomarkers of Atrial Cardiopathy and Atrial Fibrillation Detection on Mobile Outpatient Continuous Telemetry After Embolic Stroke of Undetermined Source. Journal of Stroke and Cerebrovascular Diseases: The Official Journal of National Stroke Association. 2017;26(6):1249-1253. https://doi.org/10.1016/j.jstrokecerebrovasdis.2017.01.016
Bembenek JP, Karlinski MA, Kurkowska-Jastrzebska I, Czlonkowska A. Embolic strokes of undetermined source in a cohort of Polish stroke patients. Neurological Sciences: Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology. 2018;39(6):1041-1047. https://doi.org/10.1007/s10072-018-3322-5
Powers WJ, Rabinstein AA, Ackerson T. 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association Originally published1 Mar 2018. https://doi.org/10.1161/STR.0000000000000158
Causative Classification System for Ischemic Stroke (CCS). https://ccs.mgh.harvard.edu/ccs_intro.php
Kent DM, Dahabreh IJ, Ruthazer R, Furlan AJ, Weimar C, Serena J, Meier B, Mattle HP, Di Angelantonio E, Paciaroni M, Schuchlenz H, Homma S, Lutz JS, Thaler DE. Anticoagulant vs. antiplatelet therapy in patients with cryptogenic stroke and patent foramen ovale: an individual participant data meta-analysis. Eur Heart J. 2015;36(35):2381-2389. https://doi.org/10.1093/eurheartj/ehv252
Amarenco P, Albers G, Denison H, Easton D, Evans S, Held P, Hil, M, Jonasson J, Kasner S, Minematsu K, Molina C, Wang Y, Wong L, Johnston SC, Rivas R, Klapp C. Efficacy and safety of ticagrelor versus aspirin in acute stroke or transient ischaemic attack of atherosclerotic origin: a subgroup analysis of SOCRATES, a randomised, double-blind, controlled trial. The Lancet Neurology. 2017;16:301-310.
Ntaios G, Papavasileiou V, Milionis H, Makaritsis K, Vemmou A, Koroboki E, Manios E, Spengos K, Michel P, Vemmos K. Embolic strokes of undetermined source in the Athens Stroke Registry: an outcome analysis. Stroke. 2015;46(8):2087-2093. https://doi.org/10.1161/STROKEAHA.115.009334