Embolic_Stroke_of_Undetermined_Source_ESUS_Criteria_guideline v.1
Defines cryptogenic stroke based on criteria, rather than from the absence of available test results. Outlines sufficient diagnostic workup in ischemic strokes of unclear etiology not previously described.
Diagnoses embolic stroke of undetermined source. Use in patients with ischemic stroke only.
Formula Selection of the appropriate criteria (all 4 must be present): Ischemic stroke detected by CT or MRI that is not lacunar*. Absence of extracranial or intracranial atherosclerosis causing ≥50% luminal stenosis in arteries supplying the area of ischemia. No major risk cardioembolic source of embolism**. No other specific cause of stroke identified (e.g. arteritis, dissection, migraine/vasospasm, drug abuse). Note: diagnosis of ESUS requires a minimum diagnostic evaluation, including cardiac monitoring for >24 hours with automated rhythm detection, in addition to the above criteria. *Lacunar = subcortical infarct ≤1.5 cm (≤2.0 cm on MRI diffusion images) in largest dimension, including on MRI diffusion-weighted images, and in distribution of small, penetrating cerebral arteries of cerebral hemispheres and pons. **Permanent or paroxysmal atrial fibrillation, sustained atrial flutter, intracardiac thrombus, prosthetic cardiac valve, atrial myxoma or other cardiac tumors, mitral stenosis, recent (<4 weeks) MI, left ventricular ejection fraction <30%, valvular vegetations, or infective endocarditis. Interpretation: All criteria present: Diagnistic result will be positive ESUS criteria fulfill. Further evaluation indicated (see Next Steps for details). If all criteria not present : Negative, ESUS criteria not fulfille.
This criteria can not be used in patients with hemorrhagic stroke.
Hart, R. G., Diener, H. C., Coutts, S. B., Easton, J. D., Granger, C. B., O'Donnell, M. J., ... AND Cryptogenic Stroke/ESUS International Working Group. (2014). Embolic strokes of undetermined source: the case for a new clinical construct. The Lancet Neurology, 13(4), 429-438. Hart, R. G., Catanese, L., Perera, K. S., Ntaios, G., AND Connolly, S. J. (2017). Embolic stroke of undetermined source: a systematic review and clinical update. Stroke, 48(4), 867-872.
OBSERVATION.embolic_stroke_of_undetermined_source_esus_criteria.v0, EVALUATION.embolic_stroke_of_undetermined_source_esus_criteria.v0
