ESUS (Embolic Stroke of Undetermined Source)
Definition
1st description 2014
-Specific subset of cryptogenic stroke
>No major CE factors
>Embolic Stroke of Undetermined Source
>17% of IS
Diagnostic
Basic
-bMRI & vessel (CTA/ MRA)
Advanced
Vascular
-Vessel wall MRI (black-blood sequence)
>Eval of high-risk A-A, although no significant stenosis
-T1-fat suppression
>if c/f dissection
-DSA
>highly c/f vasculitis
Cardiac
≠TTE, TEE, Cardiac CT, and Cardiac MRI
If PFO→ LE and UE dopplers; pelvic MR venography
-TCD-HIT
MCOT/ ILR
Labs
Hypercogulable panel
>repeat in 3mo for confirmation
Autommine work-up
Others
CAP CT scan w/ IV contrast
PET CT scan
Age-appropriate cancer screening, fu w/ PCP
>CEA
>CA19-9
Therapy
-ASA
>DOAC not superior to ASA
>NAVIGATE ESUS and RE-SPECT ESUS