Embolic Stroke of Undetermined Source in Latin America A Review

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dc.contributor.authorCantu-Brito, Carlos
dc.contributor.authorSilva, Gisele Sampaio [UNIFESP]
dc.contributor.authorAmeriso, Sebastian F.
dc.date.accessioned2019-08-19T11:48:43Z
dc.date.available2019-08-19T11:48:43Z
dc.date.issued2017
dc.description.abstractBackground: Stroke is a major health concern throughout Latin America. As elsewhere, no precise cause can be determined for a substantial portion of strokes. In 6 studies since 2010 in the region, 16% to 43% of ischemic strokes were identified as cryptogenic. The term embolic stroke of undetermined source (ESUS) has been proposed as more clinically useful and positively defined than the vague term cryptogenic. The epidemiology of ESUS in Latin America is largely unknown. Review Summary: This article aims to provide a description of the epidemiology of ESUS in Latin America and practical information regarding available diagnostic procedures and current guidelines. Atrial fibrillation (AF) is a significant risk factor for stroke, observed in approximately 10% of Mexican and Brazilian stroke patients. Previously unknown AF has been detected through extended monitoring in numerous studies of stroke patients, including 8% of patients in an Argentinian study, and is a possible contributing cause of ESUS. External or implantable outpatient cardiac monitoring has shown increased diagnostic yield for the detection of intermittent AF versus standard cardiac monitoring, but is infrequently used in Latin America. Conclusions: Undiagnosed AF is likely to contribute significantly to cryptogenic stroke and ESUS. Research is needed to continue evaluation of the optimum means of identifying clinically relevant occult AF. In view of the thromboembolic mechanism of ESUS, anticoagulant therapy may prove useful in prevention of recurrence. Ongoing trials are evaluating use of dabigatran, rivaroxaban, or apixaban versus aspirin for reducing the risk of recurrent stroke in patients with previous ESUS.en
dc.description.affiliationSalvador Zubiran Natl Inst Med Sci & Nutr, Dept Neurol, Mexico City, DF, Mexico
dc.description.affiliationUniv Fed São Paulo, Fed Univ São Paulo, Hosp Albert Einstein, UNIFESP, São Paulo, Brazil
dc.description.affiliationFLENI, Inst Neurol Res, Buenos Aires, DF, Argentina
dc.description.affiliationUnifespUniv Fed São Paulo, Fed Univ São Paulo, Hosp Albert Einstein, UNIFESP, São Paulo, Brazil
dc.description.sourceWeb of Science
dc.description.sponsorshipBoehringer Ingelheim
dc.description.sponsorshipBayer
dc.description.sponsorshipPfizer
dc.description.sponsorshipServier
dc.description.sponsorshipBristol-Myers Squibb
dc.description.sponsorshipAstraZeneca
dc.description.sponsorshipSanofi
dc.description.sponsorshipMerck
dc.description.sponsorshipBristol-Myers Squibb Company
dc.description.sponsorshipPfizer Inc
dc.format.extent171-181
dc.identifierhttp://dx.doi.org/10.1097/NRL.0000000000000128
dc.identifier.citationNeurologist. Philadelphia, v. 22, n. 5, p. 171-181, 2017.
dc.identifier.doi10.1097/NRL.0000000000000128
dc.identifier.issn1074-7931
dc.identifier.urihttp://repositorio.unifesp.br/handle/11600/51330
dc.identifier.wosWOS:000408834800003
dc.language.isoeng
dc.publisherLippincott Williams & Wilkins
dc.rightsinfo:eu-repo/semantics/restrictedAccess
dc.subjectLatin Americaen
dc.subjectcryptogenic strokeen
dc.subjectatrial fibrillationen
dc.titleEmbolic Stroke of Undetermined Source in Latin America A Reviewen
dc.typeinfo:eu-repo/semantics/review
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