Cecilia A. Cordova Vallejos
Montefiore Medical Center / Albert Einstein School of Medicine
Bronx, New York, United States
55 years-old right-handed woman without past medical history presented to Emergency Department for right-sided weakness and slurred speech. Last known well at 11pm, woke up at 7am with formerly mentioned symptoms. She denied difficulty swallowing, vertigo or blurry/double vision. NIH Stroke score of 4 on admission.
CT head negative for acute hemorrhage/demarcated infarct. No t-PA nor thrombectomy, given onset of symptoms and absence of large vessel obstruction. She was started on DAPT for 21 days and statin for secondary stroke prevention. MRI brain revealed Left CR/IC infarct and subacute Right temporoparietal infarct thought to be cardioembolic in nature due to distribution. MRA brain showed mild focal stenosis in M2 of L MCA, poor flow in distal PCA compared to right. Workup, including TTE, Holter monitor and ILR, and vasculitis and inflammatory disease labs, negative.
Discussions: There is no universally accepted definition for cryptogenic stroke (those that do not have a determined etiology), thought to account for 15-40% of strokes.
Prognosis varies and secondary stroke prevention follows the most probable cause, including anticoagulation decision, with a high probability of recurrence.
Rehabilitation programs do not distinguish this stroke population, and no systematic review has been made regarding their rehabilitation process, barriers for discharge, and functional gain in the acute and long term phases.
Conclusions: Cryptogenic stroke has been scarcely reported nor studied in the rehabilitation world. There is no clear knowledge if this patients have a better/worse rehabilitation outcome compared to known-etiology strokes, if present with different complications (from the underlying unknown-etiology), or rehabilitation prognosis, etc. Given the exquisite opportunity of rehabilitation medicine to follow up these patients during their whole rehabilitation process and workup, more research/reports are needed to better understand, treat, and help them regain their functionality and aim for the best health-outcome they can.