A Scoping review of the Underlying Aetiology of Cryptogenic Stroke: resulting in changes to secondary prevention, management and outcome

Introduction: Over a quarter of people who have experienced a stroke, have recurrent events and cross-sectional surveys indicate that some 1/3 of the burden of severe long-term disability due to cerebrovascular disease can be attributed to recurrent stroke. A third of transient ischaemic attacks (TIAs) and ischaemic strokes are of undetermined cause (ie, cryptogenic), potentially undermining secondary prevention. The last few decades have seen a quiet revolution in our appreciation of the potential for preventing recurrent events in stroke survivors, which, if put into practice, could have an enormous impact on the overall burden of stroke disease. Reducing the increasing number classified as cryptogenic stroke by finding the underlying aetiology, determines the choice of therapy and the most effective secondary preventive measures to take, highlighting the role thorough investigation plays. Available diagnostic protocols either fail to identify the aetiology after thorough or incomplete evaluation. Other factors contributing to this include variation in clinical practice as per preference of individual stroke physicians/ treating clinicians and variable availability of the diagnostic tools. Purpose: In this scoping review, studies focusing on discovering the underlying aetiology, the changes to management if any because of this discovery and outcome are reviewed. The extent to which the exists consensus, disagreement and gaps in clinical practice recommendations on aetiologic in acute ischaemic stroke. Method: Articles included were selected using a pre-determined inclusion and exclusion criteria to assess for eligibility. Searching of 4 electronic databases and handsearching of websites/reference lists was done, with data reporting aetiologic workup, outcome and changes (if any) of cryptogenic stroke was extracted. Quality was assessed using the Cochrane Collaboration’s tool for assessing the risk of bias. Results: Out of 1103 studies selected, 81 full-texted were fully reviewed out of which 36 were selected for yielding underlying aetiology of CS after advanced screening. Conclusion: There exists some acceptance about the Standard diagnostic workup needed after stroke but very little on more advanced investigations for the thorough or rarer underlying aetiology of cryptogenic stroke. This demonstrates missed opportunities to manage and institute the correct secondary prevention. Recommendations Further research is needed to effect policy changes that will ensure the existing knowledge on the where and when standard advanced diagnostic techniques are used in discovering the underlying aetiology of cryptogenic stroke.

Citation

Gyimah-Kessie, N. (2025). A Scoping review of the Underlying Aetiology of Cryptogenic Stroke: resulting in changes to secondary prevention, management and outcome [Unpublished doctoral thesis]. University of Chester.

Publisher

University of Chester

URI

https://chesterrep.openrepository.com/handle/10034/629921

Type

Thesis or dissertation

Language

en