We would like to thank Simona Lattanzi and Mauro Silvestrini for the interest in our article.1 We agree with the different points that were raised by the authors. There is increasing evidence that there is much more in cryptogenic stroke beyond paroxysmal atrial fibrillation.2 The designation of embolic strokes of undetermined source3 (ESUS) used in recent clinical trials may be too simplistic to characterize the different mechanism/causes that may be associated with cryptogenic stroke.
Namely, like we showed in our article, some of the causes/mechanism behind cryptogenic stroke may not be identifiable by the routine exams that are currently done to study stroke etiology. Cardiac MRI identified cardiomyopathies not previously seen by echocardiography.1 Cardiac MRI may also be useful in evaluating atrial fibrosis that may have an important role in stroke pathogenesis.4
As suggested by the authors, the recognition of specific patterns related to patients’ demographics or imaging may be useful to further expand our knowledge regarding cryptogenic stroke. Specifically, because it is not viable in a global health care perspective to perform advance imaging to all patients, the identification of specific patterns could help to select which patients need a more thorough investigation.
Disclosure
The authors report no relevant disclosures. Contact journal@neurology.org for full disclosures.
References
Fonseca AC, Marto JP, Pimenta D, et al. Undetermined stroke genesis and hidden cardiomyopathies determined by cardiac magnetic resonance. Neurology 2020;94;e107–e113.
Fonseca AC, Ferro JM. Cryptogenic stroke. Eur J Neurol 2015;22:618–623.
Hart RG, Diener HC, Coutts SB, et al. Embolic strokes of undetermined source: the case for a new clinical construct. Lancet Neurol 2014;13:429–438.
Fonseca AC, Alves P, Inácio N, et al. Patients With Undetermined Stroke Have Increased Atrial Fibrosis: A Cardiac Magnetic Resonance Imaging Study. Stroke 2018;49:734–737.
We would like to thank Simona Lattanzi and Mauro Silvestrini for the interest in our article.1 We agree with the different points that were raised by the authors. There is increasing evidence that there is much more in cryptogenic stroke beyond paroxysmal atrial fibrillation.2 The designation of embolic strokes of undetermined source3 (ESUS) used in recent clinical trials may be too simplistic to characterize the different mechanism/causes that may be associated with cryptogenic stroke.
Namely, like we showed in our article, some of the causes/mechanism behind cryptogenic stroke may not be identifiable by the routine exams that are currently done to study stroke etiology. Cardiac MRI identified cardiomyopathies not previously seen by echocardiography.1 Cardiac MRI may also be useful in evaluating atrial fibrosis that may have an important role in stroke pathogenesis.4
As suggested by the authors, the recognition of specific patterns related to patients’ demographics or imaging may be useful to further expand our knowledge regarding cryptogenic stroke. Specifically, because it is not viable in a global health care perspective to perform advance imaging to all patients, the identification of specific patterns could help to select which patients need a more thorough investigation.
Disclosure
The authors report no relevant disclosures. Contact journal@neurology.org for full disclosures.
References