Cryptogenic stroke. Part 4: Antiphospholipid syndrome and cancer

Cryptogenic embolic stroke (embolic strokes of undetermined source, ESUS) is an intermediate diagnosis in patients with unknown etiology and implies the absence large sources cardioembolism significant extra- intracranial stenoses probably pathogenesis cerebral infarction. In previous parts article, we discussed issues secondary prevention ESUS underlying potential aortoaortic embolism, paradoxical embolism atrial cardiopathy. This article discusses epidemiology, pathogenesis, ischemic antiphospholipid syndrome (APS) cancer-associated (RAI). Both mechanisms are associated hypercoagulability, often manifest as multifocal cortical brain lesions, respond to anticoagulant therapy. While APS should be suspected primarily young women pathology pregnancy, arterial venous thrombosis, well livedo reticularis (racemosa), RAI does not have a specific clinical picture, but can diffuse infarcts (symptom three pools) combined increased D-dimer level. If suspected, appropriate haematological screening required, followed by use Sydney diagnostic criteria. Possible requires transesophageal echocardiography (ruling out non-bacterial thromboendocarditis) oncological screening. Secondary consists prescribing warfarin target international normalized ratio (INR) 2.0 3.0. treated anticoagulants, choice drug dose determined balance between thrombotic/thromboembolic hemorrhagic risks.