Cryptogenic Stroke

What is a cryptogenic stroke?

A cryptogenic stroke is a stroke that doesn’t have a known cause. It’s a type of ischemic stroke that happens when something blocks a blood vessel in your brain.

People who experience ischemic strokes usually have a health condition that leads to the stroke. But cryptogenic strokes don’t have an obvious cause. “Cryptogenic” is the medical term for something “of unknown origin.”

Like all strokes, cryptogenic strokes are life-threatening medical emergencies and can be fatal. If you think you or someone you’re with is having a stroke, immediately call 911 (or your local emergency services number). The sooner someone is diagnosed and treated, the more likely it is they’ll survive a stroke. Every second counts.

What are cryptogenic stroke symptoms?

Cryptogenic strokes share symptoms with ischemic strokes, including:

• Weakness or paralysis on one side of your face and body
• Aphasia (trouble speaking or a complete loss of speech)
• Slurred or garbled speaking (dysarthria)
• Loss of muscle control on one side of your face
• Sudden worsening or loss of your senses (including your vision, hearing, smell, taste and touch)
• Blurry vision or double vision (diplopia)
• Loss of coordination or clumsiness (ataxia)
• Dizziness or vertigo
• Nausea and vomiting
• Neck stiffness
• Mood swings or sudden personality changes
• Confusion or agitation
• Seizures
• Memory loss (amnesia)
• Headaches (usually sudden and severe)
• Passing out or fainting
• Coma

What are the warning signs of a cryptogenic stroke?

Strokes can cause lots of different symptoms. To recognize the warning signs of a stroke in yourself or a loved one, remember the acronym BE FAST:

• Balance: Watch for a sudden loss of balance.
• Eyes: Look out for sudden vision loss or changes in one or both eyes.
• Face: Smile. Look for a droop on one or both sides of your face.
• Arms: Raise both arms. If you’re having a stroke, one arm will sag or drop in a way that it usually doesn’t.
• Speech: You might slur your speech or have trouble choosing the right words.
• Time: Time is critical — call for help immediately. If possible, look at your watch, phone or a clock to track when symptoms start. Telling a healthcare provider when symptoms began can help them know which treatment options are best for you.

What causes cryptogenic strokes?

Experts don’t know what causes cryptogenic strokes.

Most people who experience an ischemic stroke have a condition that increases their risk, including:

• Clotting disorders
• Atherosclerosis (hardened arteries)
• Atrial fibrillation (having an irregular heartbeat)
• Heart defects like atrial septal defects and ventricular septal defects

These conditions might cause some cryptogenic strokes, but healthcare providers can’t say for sure. Cryptogenic strokes can also happen even if you don’t have any known risk factors.

Cryptogenic transient ischemic attacks

A transient ischemic attack (TIA) — sometimes called a “mini-stroke” — is like a stroke, but the effects are temporary. These are often warning signs that a person has a very high risk of having a true stroke soon. A person who has a TIA needs emergency medical care as soon as possible.

How are cryptogenic strokes diagnosed?

A healthcare provider will diagnose a cryptogenic stroke with a neurological exam and tests. Providers in the emergency room may diagnose it if emergency services transport you to the ER.

Your provider will use some of the following tests to confirm that you’ve had a stroke:

• Blood tests
• CT scan
• Electrocardiogram (EKG)
• Electroencephalogram (EEG)
• MRI
• Prolonged cardiac monitoring (PCM) to check for atrial fibrillation (Afib)

Your providers will be able to see that you’ve had an ischemic stroke. They’ll classify it as cryptogenic if they can’t find a specific issue that caused it.

What are cryptogenic stroke treatments?

Usually, providers treat what causes a stroke. But because we don’t know what causes cryptogenic strokes, there isn’t a specific issue to fix or treat.

Your providers will monitor your health. They may give you anticoagulant medications (blood thinners) to reduce your risk of blood clots, including aspirin. You might need medications to keep your blood pressure at a safe level.

Cryptogenic stroke rehabilitation

Rehab is an important part of recovering after a stroke. You’ll need rehab to help you adjust to changes in your brain and body. You may need to regain abilities you had before or adjust to new or different disabilities. You might need a combination of:

• Physical therapy to strengthen your muscles, improve your balance and regain the use of your arms and legs.
• Occupational therapy to help you safely complete your daily tasks, especially chores or activities that need precise body movements.
• Speech therapy to regain or improve your language and speaking abilities and control the muscles that help you talk, breathe, eat and swallow.
• Cognitive therapy to help improve your memory, concentration and other mental abilities.

How can you prevent a cryptogenic stroke?

Because we don’t know what causes them, the best way to reduce your risk of a cryptogenic stroke is to maintain your overall health. Try to:

• Manage your blood pressure, cholesterol and any health conditions you have.
• Quit smoking.
• Eat plenty of healthy foods and maintain a weight that’s healthy for you.
• Get regular physical activity.

Visit a healthcare provider for a checkup every year (or as often as they suggest). Many health conditions and issues that can raise your stroke risk develop over time. Your provider will help you catch and manage any warning signs before they increase your risk of a stroke later on.

What is the survival rate for a cryptogenic stroke?

Because we don’t know why they happen, it’s hard to come up with an accurate survival rate for cryptogenic strokes. Also, there’s no way to know how your body will respond to a stroke, so there isn’t a way to compare your odds of survival to other people’s.

Cryptogenic strokes can be fatal and cause permanent disabilities. What you can expect (your prognosis) after a stroke depends on a few factors, including:

• Which areas of your brain it affected
• How quickly it was treated
• Your overall health

Experts estimate that around 1 in 4 people who have a cryptogenic stroke have another stroke. Your provider will tell you what to expect. They’ll help you set recovery goals and expectations that fit your unique health and situation.

How do I take care of myself after a cryptogenic stroke?

Recovering and rehabbing after a stroke is hard work. Once you and your provider finalize your treatment plan, follow it as closely as possible. In general, you should:

• Take your medications. Taking your medicine as your provider instructs will help your body heal.
• Go to your rehab and other therapy appointments. Tell your therapists if anything makes you feel unsafe or uncomfortable. Rehab is hard work, but you shouldn’t be in constant pain or discomfort.
• Remember your mental health. Depression and anxiety are extremely common after a stroke. You’re not weak or a quitter for feeling sad or upset. Your emotional health can be just as important as how your physical body is doing. Talk to your provider or a mental health professional if you feel like you need help processing anything during your recovery.
• Schedule follow-up appointments. You’ll need follow-up visits with a neurologist and/or your regular primary care provider. Your providers will tell you how often you’ll need check-ups.

When should I go to the emergency room?

Call 911 (or your local emergency services number) if you think you’re experiencing stroke symptoms again. Another stroke has an even higher risk of being fatal or causing disabilities. Don’t wait to call for help.

People who’ve had a stroke have an increased risk of other potentially serious complications, including:

• Pulmonary embolism
• Heart attack
• Deep vein thrombosis (DVT)

Call emergency services or go to the ER if you think you’re experiencing any symptoms of these complications.

Which questions should I ask my healthcare provider?

• What’s my risk for another stroke?
• Is there any way to know what caused the stroke?
• Which signs or symptoms of another stroke should I watch out for?
• When should I follow up with you?