@article{3121831,
    title = "Clinical and Neuroimaging Characteristics in Embolic Stroke of Undetermined versus Cardioembolic Origin: A Population-Based Study",
    author = "Tsivgoulis, G. and Kargiotis, O. and Katsanos, A.H. and Patousi, A. and Pikilidou, M. and Birbilis, T. and Mantatzis, M. and Palaiodimou, L. and Triantafyllou, S. and Papanas, N. and Skendros, P. and Terzoudi, A. and Georgiadis, G.S. and Maltezos, E. and Piperidou, C. and Serdari, A. and Theodorou, A. and Ikonomidis, I. and Heliopoulos, I. and Vadikolias, K.",
    journal = "Journal of Neuroimaging",
    year = "2019",
    volume = "29",
    number = "6",
    pages = "737-742",
    publisher = "Blackwell Publishing Inc.",
    issn = "1051-2284, 1552-6569",
    doi = "10.1111/jon.12660",
    keywords = "adult;  age;  aged;  all cause mortality;  Article;  brain edema;  brain hemorrhage;  brain ischemia;  cardioembolic stroke;  cerebrovascular accident;  clinical feature;  clinical outcome;  cohort analysis;  comparative study;  disease registry;  embolic strokes of undetermined source;  female;  follow up;  functional status;  hospital admission;  human;  major clinical study;  male;  mortality rate;  National Institutes of Health Stroke Scale;  neuroimaging;  population research;  prevalence;  Rankin scale;  recurrence risk;  recurrent disease;  sex difference;  stroke patient;  atrial fibrillation;  brain;  brain embolism;  cerebrovascular accident;  diagnostic imaging;  middle aged;  register;  risk factor;  very elderly, Aged;  Aged, 80 and over;  Atrial Fibrillation;  Brain;  Brain Edema;  Female;  Humans;  Intracranial Embolism;  Male;  Middle Aged;  Neuroimaging;  Registries;  Risk Factors;  Stroke",
    abstract = "BACKGROUND AND PURPOSE: Evidence suggests that cardioembolism represents the underlying mechanism in the minority of embolic strokes of undetermined source (ESUS). In this population-based study, we sought to compare the clinical and imaging characteristics as well as outcomes in patients with ESUS and cardioembolic stroke (CE). METHODS: We included consecutive patients with first-ever ischemic stroke (IS) from the previously published population-based Evros-Stroke-Registry identified as ESUS or CE according to standardized criteria. Baseline characteristics, admission NIHSS scores, cerebral edema, hemorrhagic transformation, stroke recurrence, functional outcomes (determined by modified Rankin Scale [mRS] scores), and mortality rates were recorded during the 1-year follow-up period. RESULTS: We identified 21 ESUS (3.7% of IS) and 211 CE (37.1% of IS) cases. Patients with ESUS were younger (median age: 68 years [interquartile range [IQR]: 61-75] vs 80 years [IQR: 75-84]; P <.001), had lower median admission NIHSS scores (4 points [IQR: 2-8] vs 10 points [IQR: 5-17]; P <.001), and lower prevalence of cerebral edema on neuroimaging studies (0 vs. 33.3%, P =.002). Functional outcomes were more favorable in ESUS at 28 (median mRS score: 2 [IQR: 1-3] vs 4 [IQR: 4-5]; P <.001), 90 (median mRS score: 1 [IQR: 0-2] vs 4 [IQR: 3-5]; P <.001), and 365 days (median mRS score: 1 [IQR: 0-2] vs 4 [IQR: 2-4]; P < 0.001). At 1-year, the mortality rate was lower in ESUS (0% [95% confidence interval [CI]: 0-13.5%] vs 34.6% [95% CI: 28.2-41.0%]; P <.001); the 1-year recurrent rate was also lower numerically (0% [95% CI: 0-13.5%] vs 9.5% [95% CI: 5.5-13.4%]; P =.140) but this difference failed to reach statistical significance due to the small study population. CONCLUSIONS: The clinical and neuroimaging profiles as well as clinical outcomes vary substantially between ESUS and CE indicating different underlying mechanisms. © 2019 by the American Society of Neuroimaging"
}