The Most Common Etiologies in Young Cryptogenic Strokes and Their Relationship with RoPE Score

INTRODUCTION: This study was designed to determine the underlying etiologies and their relationship with the Risk of Paradoxical Embolism (RoPE) score in young cryptogenic stroke patients.
METHODS: In the study, among 1434 patients who were treated with a diagnosis of transient ischemic attack/ischemic stroke in our neurology clinic between May 2021 and May 2023, 121 patients between the ages of 18-50 were evaluated retrospectively. The demographic characteristics of the patients, past medical history, admission and 24-hour National Institutes of Health Stroke Scale (NIHSS) scores, infarct localization, hospital stay, and 90-day modified Rankin score (mRS) were evaluated. RoPE scores were calculated for 48 patients who had no history of chronic disease and were considered to have cryptogenic stroke according to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification. The study protocol was approved by the hospital ethics committee (2023/84). Artificial intelligence was not used in the article.
RESULTS: The average age was 38.90, and 66.7% of the patients were male. The mean baseline NIHSS score was 4.65, and the most common stroke location (64.6%) was the MCA irrigation area. The most common etiology was Patent Foramen Ovale (PFO) with a rate of 37.5%. RoPE score was grouped as >7 and <7, and the relationship between TOAST etiology, NIHSS at admission and 24th hour NIHSS, duration of hospitalization, and Day 90 mRS and PFO closure was evaluated (p=0.381, p=0.509, p=0.447, p=0.591, p=0.884, p=0.500).
DISCUSSION AND CONCLUSION: In our study, the most common cause detected in patients with a RoPE score > 7 was PFO. No significant relationship was found between RoPE score and PFO closure. No significant relationship was found between causes other than PFO and RoPE score. Although it is thought that evaluation with the RoPE score may be effective in cryptogenic strokes, further studies are needed to detect etiologies other than PFO.

Genç Kriptojenik Ýnmelerde En Sýk Görülen Etyolojiler ve RoPE Skoru ile Ýliþkileri

GÝRÝÞ ve AMAÇ: Bu çalýþma, genç kriptojenik inme hastalarýnda altta yatan etyolojileri ve bunlarýn Risk of Paradoxical Embolism (RoPE) skoru ile iliþkisini belirlemek için tasarlandý.
YÖNTEM ve GEREÇLER: Çalýþmada, Mayýs 2021 - Mayýs 2023 tarihleri arasýnda nöroloji kliniðimizde geçici iskemik atak (GÝA) / iskemik inme tanýsý ile tedavi gören 1434 hasta arasýndan, 18-50 yaþ aralýðýndaki 121’i retrospektif olarak gözden geçirildi. Hastalarýn demografik özellikleri, geçmiþ týbbi öyküleri, baþvurudaki ve 24. saat National Institutes of Health Stroke Scale (NIHSS) skorlarý, enfarkt lokalizasyonu, hastanede kalýþ süresi ve 90. gün modifiye Rankin skoru (mRS) deðerlendirildi. Özgeçmiþlerinde kronik hastalýk öyküsü olmayan, Trial of Org 10172 in Acute Stroke Treatment (TOAST) sýnýflamasýna göre kriptojenik inme kabul edilen 48 hasta için RoPE skorlarý hesaplandý.
Çalýþma protokolü hastane etik kurulu (2023/84) tarafýndan onaylandý.
BULGULAR: Yaþ ortalamasý 38.90 olup hastalarýn %66.7’si erkekti. Baþlangýç NIHSS skoru ortalama 4.65, en sýk inme lokalizasyonu (%64.6) MCA sulama alanýydý. Etyolojide en sýk %37.5 oranýnda Patent Foramen Ovale (PFO) saptandý. RoPE skoru >7 ve <7 olarak gruplandýrýlarak TOAST etyolojisi, baþvurudaki NIHSS ve 24. saat NIHSS, hastanede yatýþ süresi ve 90. gün mRS ve PFO kapatýlmasý arasýndaki iliþki deðerlendirildi (p=0.381, p=0.509, p=0.447, p=0.591, p=0.884, p=0.500).
TARTIÞMA ve SONUÇ: Çalýþmamýzda RoPE skoru >7 olan hastalarda en sýk saptanan neden PFO idi. RoPE skoru ile PFO kapatýlma arasýnda anlamlý iliþki bulunmadý. PFO dýþýndaki nedenler ile RoPE skoru arasýnda anlamlý iliþki bulunmadý. Kriptojenik inmelerde RoPE skoru ile deðerlendirmenin etkili olabileceði düþünülmekle birlikte PFO dýþý etyolojileri saptama açýsýndan ileri çalýþmalara ihtiyaç vardýr.