Differential Diagnosis for Embolic Stroke of Uncertain Primary Source
- Single Most Likely Diagnosis
- Atrial Fibrillation: This is often considered the single most likely diagnosis due to its high prevalence and strong association with embolic strokes. Atrial fibrillation can lead to the formation of blood clots in the heart, which can then embolize to the brain, causing a stroke.
- Other Likely Diagnoses
- Carotid Artery Disease: Stenosis or occlusion of the carotid arteries can lead to embolic strokes. The plaque in the carotid arteries can break off and travel to the brain, causing an embolic stroke.
- Patent Foramen Ovale (PFO): A PFO is a hole in the heart that didn't close the way it should after birth. It can allow blood clots to pass from the right side of the heart to the left, potentially causing an embolic stroke.
- Cardiac Valve Disease: Conditions such as mitral stenosis or prosthetic heart valves can increase the risk of blood clot formation, leading to embolic strokes.
- Do Not Miss Diagnoses
- Endocarditis: Infective endocarditis can cause the formation of vegetations on the heart valves, which can break off and embolize to the brain, leading to a stroke. Missing this diagnosis can be fatal.
- Aortic Arch Atheroma: Atheromas in the aortic arch can be a source of emboli, and missing this diagnosis can lead to further strokes or other embolic events.
- Paradoxical Embolism: This occurs when a blood clot passes through a PFO or other right-to-left shunt, potentially causing an embolic stroke. It's crucial not to miss this diagnosis, as it may require specific treatment.
- Rare Diagnoses
- Cholesterol Crystal Embolism: This is a rare condition where cholesterol crystals break off from the walls of the arteries and travel to the brain, causing an embolic stroke.
- Fibrocartilaginous Embolism: This is an extremely rare condition where material from the spine embolizes to the brain, causing a stroke.
- Tumoral Embolism: In rare cases, tumor fragments can break off and embolize to the brain, causing a stroke.