Péter Pál Böjti, MD1, Noémi Eszter Bartha, MD2, Szilvia Fülöp, MD2, Zoltán Szakács MD, Ph.D2, Géza Szilágyi, MD, Ph.D2
1 Department of Neurology, Semmelweis University, Budapest, Hungary; János Szentágothai Doctoral School of Neurosciences, Semmelweis University, Budapest, Hungary
2 Department of Neurology, Medical Centre Hungarian Defence Forces, Budapest, Hungary
Introduction: After routine diagnostic procedures, 23-25% of ischemic strokes etiology are considered cryptogenic, which means etiology remains unknown. However, in 25% of these cases extensive workup reveals a pathogenic patent foramen ovale (PFO).
Aims: The aim of our retrospective study was to emphasize the substantial etiological role of PFO-related stroke (PFO-RS) in cryptogenic strokes (CS), and to identify age related differences in stroke etiology.
Method: All new ischemic strokes registered in the Department of Neurology of Medical Centre Hungarian Defence Forces in a two-year period (2014-2015) were classified by ASCOD (Atherosclerosis, Small-vessel disease, Cardiac pathology, Other, Dissection) phenotyping. CS was defined when the etiology was unknown. With the help of special ultrasound techniques and RoPE (Risk of Paradoxical Embolism) score the portion of PFO-RS were determined in the examined CS population. Moreover, etiological distribution and differences between age groups (<40, 40-60, >60 years) were described.
Results: During the examined period, 8.12% (80) of 985 new ischemic strokes were categorized as CS. 41,38% of the examined CS were found to be PFO-related. PFO-RS were substantially more frequent in the younger age groups than in the older age groups. The probability of appearance of PFO-RS were significantly higher in younger age than in case of age independency. Age related differences in stroke etiology were found to be statistically significant (p=0,000, df=14), in which small-vessel disease, cardiac pathology, dissection, other pathologies, CS and PFO-RS were contributed significantly.
Conclusion: Our results verify the substantial etiological role of PFO-RS in CS, and confirm the essential role of contrast enhanced functional transcranial Doppler in the routine diagnostic workup. Based on our results, till in young age rare etiologies are typical, while in older age classical etiologies are mainly characteristic.
Doctoral School: János Szentágothai Doctoral School of Neurosciences, Semmelweis University, Budapest, Hungary
Program: Clinical Neurosciences
Supervisor: Géza Szilágyi
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