About ESUS…

Five subtypes of Ischemic stroke are classified based on therir causes. ESUS (Embolic Stroke of Undetermined Source) stands for a non-lacunar cerebral infarct, in the absence of stenosis of large arteries or causes of cardioembolic stroke. It is estimated that ESUS accounts for about 25% of all ischemic strokes. A multidisciplinary, multistep diagnostic investigation is needed for a correct diagnosis, in order to exclude other possible causes of stroke. At present there are limited indications on how to plan secondary prevention of ischemic stroke in patients with ESUS. In the patient described, cortical ischemia, probably arising following an arterial embolization, represents an index event that could be classified as ESUS: in this case dabigatran was administered off-label, althoughin this type of patient this could be soon supported by the results of the RESPECT-ESUS study, a randomized trial comparing dabigatran and ASA in patients with recent ESUS, to test whether anticoagulant therapy can improve the outcome of patients in this clinical condition (Cardiology).