This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
Around 25% of ischemic strokes remain “cryptogenic” after a comprehensive workup.1 This led to the concept of Embolic Stroke of Uncertain Source (ESUS), with the underlying implication that many of those patients have undetected atrial fibrillation (AF). However, with the negative results of the randomized clinical trials comparing anticoagulation vs antiplatelet therapy for patients with ESUS,2,3 it is apparent that the link between AF and ischemic stroke is more complex.4 A thrombogenic substrate may occur with or without preceding AF, with the concept of an atrial myopathy well-recognized, albeit not so clearly characterized. Indeed, AF may occur because of the atrial myopathy process (often years after stroke), and the risk factors for the development of both conditions are shared (e.g., hypertension, diabetes, obesity, and alcohol excess). The fact that atrial thrombus can occur without preceding AF might explain the potentially futile process of extended periods of ECG monitoring in patients with ESUS to capture so-called sub-clinical AF.
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the editorial.
See page 600
- Received June 7, 2022.
- Accepted in final form June 24, 2022.
- © 2022 American Academy of Neurology
AAN Members
We have changed the login procedure to improve access between AAN.com and the Neurology journals. If you are experiencing issues, please log out of AAN.com and clear history and cookies. (For instructions by browser, please click the instruction pages below). After clearing, choose preferred Journal and select login for AAN Members. You will be redirected to a login page where you can log in with your AAN ID number and password. When you are returned to the Journal, your name should appear at the top right of the page.
AAN Non-Member Subscribers
Purchase access
Letters: Rapid online correspondence
REQUIREMENTS
You must ensure that your Disclosures have been updated within the previous six months. Please go to our Submission Site to add or update your Disclosure information.
Your co-authors must send a completed Publishing Agreement Form to Neurology Staff (not necessary for the lead/corresponding author as the form below will suffice) before you upload your comment.
If you are responding to a comment that was written about an article you originally authored:
You (and co-authors) do not need to fill out forms or check disclosures as author forms are still valid
and apply to letter.
Submission specifications:
- Submissions must be < 200 words with < 5 references. Reference 1 must be the article on which you are commenting.
- Submissions should not have more than 5 authors. (Exception: original author replies can include all original authors of the article)
- Submit only on articles published within 6 months of issue date.
- Do not be redundant. Read any comments already posted on the article prior to submission.
- Submitted comments are subject to editing and editor review prior to posting.
