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Clinical phenotypes of embolic strokes of undetermined source

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Abstract

Background and purpose

The embolic stroke of undetermined source (ESUS) represents a heterogeneous clinical entity. The aim of this study was to investigate whether distinct clinical phenotypes may be identified in the ESUS population.

Methods

We retrospectively identified consecutive patients hospitalized for acute ischemic stroke who met the ESUS diagnostic criteria. Baseline characteristics and diagnostic workup findings were collected. Hierarchical cluster analysis was carried out to classify clinical features and identify different groups of ESUS patients.

Results

One hundred twenty-seven patients with a mean age of 68.6 (12.5) years were included. Three main clusters were identified. The first cluster associated young age, male sex, presence of patent foramen ovale, and posterior circulation infarct. The second phenotype linked hypertension, severe stroke, left atrial cardiopathy, diabetes mellitus, and involvement of multiple vascular territories. The third cluster gathered smoking, dyslipidemia, ipsilateral vulnerable sub-stenotic carotid plaque, and infarct of anterior vascular territory.

Conclusions

Distinct clinical phenotypes have been identified within the ESUS population, which may supply clues to the underlying pathogenic mechanisms.

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Authors and Affiliations

  1. Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy

    Simona Lattanzi, Claudia Rinaldi, Alessandra Pulcini, Tommaso Corradetti, Stefania Angelocola & Mauro Silvestrini

  2. Neurology Unit, Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy

    Maria Luisa Zedde

  3. Department of Biomedical Sciences and Public Health, Cardiology and Arrhythmology Clinic, Marche Polytechnic University, Ancona, Italy

    Giuseppe Ciliberti

Authors
  1. Simona Lattanzi
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  2. Claudia Rinaldi
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  3. Alessandra Pulcini
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  4. Tommaso Corradetti
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  5. Stefania Angelocola
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  6. Maria Luisa Zedde
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  7. Giuseppe Ciliberti
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  8. Mauro Silvestrini
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Corresponding author

Correspondence to Simona Lattanzi.

Ethics declarations

The study was approved by the local ethical committee and conducted according to the Declaration of Helsinki. Informed consent was obtained from any patient or legal representative.

Conflict of interest

The authors declare that they have no conflict of interest.

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Lattanzi, S., Rinaldi, C., Pulcini, A. et al. Clinical phenotypes of embolic strokes of undetermined source. Neurol Sci 42, 297–300 (2021). https://doi.org/10.1007/s10072-020-04700-2

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  • DOI: https://doi.org/10.1007/s10072-020-04700-2

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