[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-detail-152603-en":3,"doc-seo-152603-105":30,"detail-sidebar-cat-0-en-105":92},{"code":4,"msg":5,"data":6},0,"success",{"doc_id":7,"user_id":8,"nickname":9,"user_avatar":10,"doc_module":4,"category_id":11,"category_name":12,"doc_title":13,"doc_description":14,"doc_content":15,"file_id":16,"file_url":17,"file_type":18,"file_size":19,"view_count":20,"is_deleted":4,"is_public":20,"is_downloadable":20,"audit_status":20,"page_count":21,"language":22,"language_code":23,"site_id":24,"html_lang":23,"table_of_contents":25,"faqs":26,"seo_title":27,"seo_description":14,"update_tm":28,"read_time":29},152603,1099513958607,"Jiven","https://ap-avatar.wpscdn.com/avatar/100002390cf8733938c?x-image-process=image/resize,m_fixed,w_180,h_180&k=1778829742770036399",7,"Healthcare","Diagnostic Evaluation of Stroke Etiology - Evidence-Based Approach","Objective-focused diagnostic evaluation of stroke etiology supports precise, mechanism-targeted therapies. An evidence-based approach is presented to confirm ischemic stroke diagnosis, characterize comorbidities that inform pathophysiologic mechanisms, and identify treatment targets that improve prevention of recurrent events. Latest developments incorporate routine detection of patent foramen ovale, intermittent atrial fibrillation, and unstable plaque, while clinical trials support selected patent foramen ovale closure and advanced monitoring and MRI techniques to refine risk.","REVIEW ARTICLE  \n􀀁  \nCONTINUUM AUDIO INTERVIEW AVAILABLE ONLINE  \nCITE AS:  \nCONTINUUM (MIN NEA P M INN) 2023;29(2, CEREBROVASCULAR DISEASE):412–424.  \nAddress correspondence to Dr James F. Meschia, Division of Cerebrovascular Disease, Department of Neurology, Mayo Clinic, Jacksonville, FL 32224, [meschia.james@mayo.edu](meschia.james@mayo.edu).  \nRELATIONSHIP DISCLOSURE: The institution of Dr Meschia has received research support from the National Institute of Neurological Disorders and Stroke.  \nUNLABELED USE OF PRODUCTS/INVESTIGATIONAL USE DISCLOSURE:  \nDr Meschia reports no disclosure.  \n© 2023 American Academy of Neurology.  \nDiagnostic Evaluation of Stroke Etiology  \nBy James F. Meschia, MD, FAAN  \nABSTRACT  \nOBJECTIVE: Precise therapies require precise diagnoses. This article providesan evidence-based approach to confirming the diagnosis of ischemic stroke, characterizing comorbidities that provide insights into the pathophysiologic mechanisms of stroke, and identifying targets for treatment to optimize the prevention of recurrent stroke.  \nLATEST DEVELOPMENTS: Identifying the presence of patent foramen ovale, intermittent atrial fibrillation, and unstable plaque is now routinely included in an increasingly nuanced workup in patients with stroke, even as ongoing trials seek to clarify the best approaches for treating these and other comorbidities. Multicenter trials have demonstrated the therapeutic utility of patent foramen ovale closure in select patients younger than age 60 years. Insertable cardiac monitors detect atrial fibrillation lasting more than 30 seconds in about one in ten patients monitored for 12 months following a stroke. MRI of carotid plaque can detect unstable plaque at risk of being a source of cerebral embolism.  \nESSENTIAL POINTS: To optimize the prevention of recurrent stroke, it is important to consider pathologies of intracranial and extracranial blood vessels and of cardiac structure and rhythm as well as other inherited or systemic causes of stroke. Some aspects of the stroke workup should be done routinely, while other components will depend on the clinical circumstances and preliminary testing results.  \nINTRODUCTION  \nW  \nith the advent of evidence-based mechanical thrombectomy, it is tempting to view all ischemic strokes as falling into two broad categories: strokes caused by an accessible clot (large vessel occlusion) and everything else. This perspective, while pragmatic when presented in the emergency department with  \na patient with acute stroke, is woefully inadequate when attempting to optimize prevention of recurrent stroke. To optimize prevention, a more nuanced characterization of stroke is required. While trying to identify stroke etiology is customary, usually etiology can only be inferred through identifying, or not identifying, various comorbidities. Often we cannot be certain that a specific comorbidity truly was on the causal pathway to the presenting stroke, in part because multiple comorbidities frequently coexist in the same patient. For some comorbidities, such as carotid atherosclerotic stenosis, whether a specific  \n412 APRIL 2023  \nCopyright © American Academy of Neurology. Unauthorized reproduction of this article is prohibited.  \ntreatment (eg, endarterectomy) is indicated depends on whether the comorbidity is believed to be mechanistically related to stroke by perfusion zone (eg, symptomatic versus asymptomatic stenosis) . For other comorbidities, such as atrial fibrillation, the indicated treatment is influenced by the increased risk associated with a history of stroke. For example, stroke increases the CHA2DS2-VASc risk estimation score (consisting of congestive heart failure, hypertension, age 75 years or older, diabetes mellitus, previous stroke, vascular disease, age 65 to 74 years, and sex category) by two points.1 Reference to a“stroke workup”(ie, a set of diagnostic tests performed because a patient has hada recent stroke) can be found in the medical litera","cbCaibaB0sZ8A2tw","https://ap.wps.com/l/cbCaibaB0sZ8A2tw","pdf",2926843,1,13,"English","en",105,"# Abstract\n# Introduction\n# Clinical Assessment\n# Diagnostic Workup Strategy\n## Routine vs Conditional Testing","[{\"question\":\"Why is precise diagnosis important in stroke treatment?\",\"answer\":\"Accurate therapies require accurate diagnoses. The article emphasizes confirming ischemic stroke, linking comorbidities to underlying mechanisms, and targeting treatment to prevent recurrent stroke.\"},{\"question\":\"What newer comorbidities are increasingly included in routine stroke workups?\",\"answer\":\"Workups increasingly assess patent foramen ovale, intermittent atrial fibrillation, and unstable plaque. These additions aim to refine etiology and treatment decisions.\"},{\"question\":\"How should clinicians approach stroke workup testing rather than applying one fixed set of tests?\",\"answer\":\"Some components should be done routinely in nearly all cases, while other elements depend on clinical circumstances and preliminary results. The goal is to evaluate relevant intracranial/extracranial vascular and cardiac structural and rhythm causes.\"}]","Diagnostic Evaluation of Stroke Etiology - Evidence-Based Approach | PDF",1787864528,33,{"code":4,"msg":31,"data":32},"ok",{"site_id":24,"language":23,"slug":33,"title":13,"keywords":34,"description":14,"schema_data":35,"social_meta":87,"head_meta":89,"extra_data":91,"updated_unix":28},"diagnostic-evaluation-of-stroke-etiology-evidence-based-approach","",{"@graph":36,"@context":86},[37,54,69],{"@type":38,"itemListElement":39},"BreadcrumbList",[40,44,48,51],{"item":41,"name":42,"@type":43,"position":20},"https://docshare.wps.com","Home","ListItem",{"item":45,"name":46,"@type":43,"position":47},"https://docshare.wps.com/document/","Document",2,{"item":49,"name":12,"@type":43,"position":50},"https://docshare.wps.com/document/healthcare/",3,{"item":52,"name":13,"@type":43,"position":53},"https://docshare.wps.com/document/diagnostic-evaluation-of-stroke-etiology-evidence-based-approach/152603/",4,{"url":52,"name":13,"@type":55,"author":56,"headline":13,"publisher":58,"fileFormat":61,"inLanguage":23,"description":14,"dateModified":62,"datePublished":63,"encodingFormat":61,"isAccessibleForFree":64,"interactionStatistic":65},"DigitalDocument",{"name":9,"@type":57},"Person",{"url":41,"name":59,"@type":60},"DocShare","Organization","application/pdf","2026-09-05","2026-08-27",true,{"@type":66,"interactionType":67,"userInteractionCount":20},"InteractionCounter",{"@type":68},"ViewAction",{"@type":70,"mainEntity":71},"FAQPage",[72,78,82],{"name":73,"@type":74,"acceptedAnswer":75},"Why is precise diagnosis important in stroke treatment?","Question",{"text":76,"@type":77},"Accurate therapies require accurate diagnoses. The article emphasizes confirming ischemic stroke, linking comorbidities to underlying mechanisms, and targeting treatment to prevent recurrent stroke.","Answer",{"name":79,"@type":74,"acceptedAnswer":80},"What newer comorbidities are increasingly included in routine stroke workups?",{"text":81,"@type":77},"Workups increasingly assess patent foramen ovale, intermittent atrial fibrillation, and unstable plaque. These additions aim to refine etiology and treatment decisions.",{"name":83,"@type":74,"acceptedAnswer":84},"How should clinicians approach stroke workup testing rather than applying one fixed set of tests?",{"text":85,"@type":77},"Some components should be done routinely in nearly all cases, while other elements depend on clinical circumstances and preliminary results. 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