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      Evaluating Rates of Recurrent Ischemic Stroke Among Young Adults With Embolic Stroke of Undetermined Source : The Young ESUS Longitudinal Cohort Study

      Author(s): 1 , 2 , 1 , 2 , 1 , 3 , 2 , 2 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 2 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , 21 , Young ESUS Investigators
      Publication date (Electronic):
      Journal: JAMA Neurology
      Publisher: American Medical Association (AMA)

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          Most cited references23

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          Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment

          B Love, D L Gordon, J. Biller … (1993)
          Article 0 comments Cited 863 times – based on 0 reviews     Review now
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            An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American Heart Association/American Stroke Association.

            Ralph Sacco, Scott E Kasner, Joseph P Broderick … (2013)
            Despite the global impact and advances in understanding the pathophysiology of cerebrovascular diseases, the term "stroke" is not consistently defined in clinical practice, in clinical research, or in assessments of the public health. The classic definition is mainly clinical and does not account for advances in science and technology. The Stroke Council of the American Heart Association/American Stroke Association convened a writing group to develop an expert consensus document for an updated definition of stroke for the 21st century. Central nervous system infarction is defined as brain, spinal cord, or retinal cell death attributable to ischemia, based on neuropathological, neuroimaging, and/or clinical evidence of permanent injury. Central nervous system infarction occurs over a clinical spectrum: Ischemic stroke specifically refers to central nervous system infarction accompanied by overt symptoms, while silent infarction by definition causes no known symptoms. Stroke also broadly includes intracerebral hemorrhage and subarachnoid hemorrhage. The updated definition of stroke incorporates clinical and tissue criteria and can be incorporated into practice, research, and assessments of the public health.
            Article 0 comments Cited 659 times – based on 0 reviews     Review now
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              Embolic strokes of undetermined source: the case for a new clinical construct.

              Robert Hart, Hans-Christoph Diener, Shelagh B. Coutts … (2014)
              Cryptogenic (of unknown cause) ischaemic strokes are now thought to comprise about 25% of all ischaemic strokes. Advances in imaging techniques and improved understanding of stroke pathophysiology have prompted a reassessment of cryptogenic stroke. There is persuasive evidence that most cryptogenic strokes are thromboembolic. The thrombus is thought to originate from any of several well established potential embolic sources, including minor-risk or covert cardiac sources, veins via paradoxical embolism, and non-occlusive atherosclerotic plaques in the aortic arch, cervical, or cerebral arteries. Accordingly, we propose that embolic strokes of undetermined source are a therapeutically relevant entity, which are defined as a non-lacunar brain infarct without proximal arterial stenosis or cardioembolic sources, with a clear indication for anticoagulation. Because emboli consist mainly of thrombus, anticoagulants are likely to reduce recurrent brain ischaemia more effectively than are antiplatelet drugs. Randomised trials testing direct-acting oral anticoagulants for secondary prevention of embolic strokes of undetermined source are warranted.
              Article 0 comments Cited 269 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Title: JAMA Neurology
                Abbreviated Title: JAMA Neurol
                Publisher: American Medical Association (AMA)
                ISSN (Print): 2168-6149
                Publication date (Electronic): March 14 2022
                Affiliations
                [1 ]Department of Medicine, Neurology, McMaster University, Hamilton, Ontario, Canada
                [2 ]Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada
                [3 ]Department of Statistics, Hamilton Health Sciences, Hamilton, Ontario, Canada
                [4 ]Medical School, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia
                [5 ]Department of Neurology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
                [6 ]Department of Neurology & Neurological Sciences, Stanford Stroke Center, Stanford, California
                [7 ]Stanford Children’s Health, Stanford, California
                [8 ]Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
                [9 ]Institute for Neurological Research-FLENI, Buenos Aires, Argentina
                [10 ]Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
                [11 ]National Institute of Neurology, La Fama, Tlalpan, México
                [12 ]Department of Clinical Neurosciences, University of Calgary, Foothills Medical Calgary, Calgary, Alberta, Canada
                [13 ]Department of Neurology, University Hospital Bern, Bern, Switzerland
                [14 ]International Clinical Research Center and Neurology Department, St Anne’s University Hospital, Brno, Czech Republic
                [15 ]Masaryk University, Brno, Czech Republic
                [16 ]Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
                [17 ]Department of Neurosciences, Western University, London, Ontario, Canada
                [18 ]Division of Brain Sciences, Imperial College, The Hammersmith Hospital, London, United Kingdom
                [19 ]Neurology Service, Bichat Hospital, Paris, France
                [20 ]Department of Neurolog, Universitätsklinikum Würzburg, Würzburg, Germany
                [21 ]for the Young ESUS Investigators
                Article
                DOI: 10.1001/jamaneurol.2022.0048
                PubMed ID: 35285869
                SO-VID: 6c934c88-ec0e-4738-9e51-21b25f6611c0
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