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Traditionally, one-fourth of the patients with ischemic stroke have no identified etiologic cause despite intensive investigation and have been deemed to have cryptogenic stroke. In an effort to understand this group of patients better, a subset of these patients with cryptogenic stroke has been studied: those with nonlacunar cryptogenic stroke suspected of having embolism. This group can be viewed as a new category of patients with embolic stroke of unknown source (ESUS).1 The frequency of ESUS ranges from 9% to 25% among the cases of ischemic stroke, with an annual stroke recurrence of 4.5% despite antiplatelet therapy.2 The most probable occult embolic sources include paroxysmal atrial fibrillation (AF), nonstenosing cervical or intracranial plaques, and patent foramen ovale. Because the treatments for these causes are completely different, identifying the culprit mechanism has fundamental importance.
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- © 2019 American Academy of Neurology
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