ESUS (neurology)

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In neurology, ESUS (embolic stroke of undetermined source, for example: embolic stroke with an undetermined embolic source) describes a special form of ischemic , i.e., stroke caused by reduced blood flow . This is a subclass of the cryptogenic cerebral infarcts defined according to the TOAST classification (cerebral infarcts of unclear cause (= etiology )). This results in treatment-relevant differences to other entities.

criteria

The following criteria have been defined for the diagnosis of ESUS, which require a complete diagnosis:

  • Presence of a morphologically detectable infarct area in the brain with a non-lacunar distribution pattern
  • Lack of evidence of> 50 percent stenosis of an intra- or extracranial vessel that also supplies the infarct area
  • Lack of evidence of a major risk factor for a cardiac source of embolism (e.g. atrial fibrillation )
  • Lack of evidence of another stroke etiology (e.g. dissections , arteritis )

Diagnostics and therapy

In the past, studies were carried out in which the superiority of DOAKS in the secondary prophylaxis of ESUS over ASA was to be proven. All previous studies had a negative result. Therefore, the treatment recommendation is currently the same as for other strokes of unexplained etiology (English: cryptogenic stroke ) and if there is no indication for oral anticoagulation, secondary prophylaxis using ASA should take place. However, cardiac diagnostics play a special role in the clarification of a possibly unnoticed cardiac infarct etiology, including the possibility of a prolonged heart rhythm analysis over one to three years.

Individual evidence

  1. ^ A b Robert G Hart, Hans-Christoph Diener, Shelagh B Coutts, J Donald Easton, Christopher B Granger: Embolic strokes of undetermined source: the case for a new clinical construct . In: The Lancet Neurology . tape 13 , no. 4 , April 2014, ISSN  1474-4422 , p. 429-438 , doi : 10.1016 / s1474-4422 (13) 70310-7 .
  2. ↑ LL 030142 Cryptogenic Stroke and Open Foramen ovale 2018. Retrieved November 27, 2018 .
  3. ^ Robert G. Hart, Mukul Sharma, Hardi Mundl, Scott E. Kasner, Shrikant I. Bangdiwala: Rivaroxaban for Stroke Prevention after Embolic Stroke of Undetermined Source . In: New England Journal of Medicine . tape 378 , no. 23 , June 7, 2018, ISSN  0028-4793 , p. 2191–2201 , doi : 10.1056 / nejmoa1802686 ( nejm.org [accessed November 27, 2018]).
  4. ↑ LL-23-ll-Secondary prophylaxis of ischemic stroke and transient ischemic attack. Retrieved November 27, 2018 .
  5. ↑ Aristeidis H. Katsanos, Rohini Bhole, Alexandra Frogoudaki, Sotirios Giannopoulos, Nitin Goyal: The value of transesophageal echocardiography for embolic strokes of undetermined source . In: Neurology . tape 87 , no. 10 , September 6, 2016, ISSN  0028-3878 , p. 988-995 , doi : 10.1212 / WNL.0000000000003063 , PMID 27488602 , PMC 27488602 (free full text) - ( neurology.org [accessed November 27, 2018]).
  6. ↑ Jeffrey L. Saver: Cryptogenic Stroke . In: New England Journal of Medicine . tape 374 , no. 21 , May 26, 2016, ISSN  0028-4793 , p. 2065-2074 , doi : 10.1056 / nejmcp1503946 ( nejm.org [accessed November 27, 2018]).