ECV DE CAUSA INHABITUAL

Ponente: Dr José Gallardo

R1 Medicina Interna
Tutor: Dr Yimber Matos
Médico Neurólogo

San Cristobal, Febrero 2022

Classification of subtype of acute ischemic stroke, Definitions
for use in a multicenter clinical trial. TOAST. Trial of Org 10172
in Acute Stroke Treatment.
 ECV DE CAUSA INHABITUAL (ESUS)

Acrónimo en inglés para embolic stroke of unknown source

• No lacunar

• No cardioembólico

• Sin obstruccion aterotrombótica significativa

Classification of subtype of acute ischemic stroke, Definitions

for use in a multicenter clinical trial. TOAST. Trial of Org 10172
in Acute Stroke Treatment.
ECV DE CAUSA INHABITUAL (ESUS)
ETIOLOGÍA

• Enfermedad valvular

Cardiaco
• Prolapso mitral
• Endocarditis de Libman-Sacks (ELS)
• Defectos de Septum y foramen oval
• Calcificación de anillo valvular aórtico

No • Fibrilación auricular paroxística

• Placas ulceradas no estenosantes en vasos cervicales 

frecuentes • Valvulopatía mixomatosa con prolapso mitral 

Classification of subtype of acute ischemic stroke, Definitions

for use in a multicenter clinical trial. TOAST. Trial of Org 10172
in Acute Stroke Treatment.
 • Chagas
• Toxoplasmosis

ECV Infecciones
DE CAUSA INHABITUAL (ESUS)
• Mucormicosis
• Difteria
• Sífilis
• Hiv
• Tbc
• cisticercosis

• Vasculitis
• Hodgkin
Inflamatorias • Colitis ulcerativa
• Granuloma linfomatoide

• Malformaciones arteriovenosas pulmonares

(MAVP)
Pulmonares • Fistula arteriovenosa pulmonar (ROW)
• Tu pulmonar y mediastínico
Classification of subtype of acute ischemic stroke, Definitions
for use in a multicenter clinical trial. TOAST. Trial of Org 10172
in Acute Stroke Treatment.
ECV DE CAUSA• Purpura
INHABITUAL
trombocitopenica
(ESUS)
Inmunológicas •HEMATOLOGICAS
Anticoagulante lúpico
• Anticuerpos anticardiolipina

• Anemia drepanocítica
• Policitemia vera
Hiperviscosidad • Trombosis primaria
• Talasemia

• CID
Trastornos de • Déficit de AT III, Prot C y S, Factor VII
coagulación •
•
Sx Paraneoplasicos
ACO
Classification of subtype of acute ischemic stroke, Definitions
for use in a multicenter clinical trial. TOAST. Trial of Org 10172
in Acute Stroke Treatment.
ECV DE CAUSA INHABITUAL (ESUS)
• Migraña
Vasoespasmo • Fármacos
• Drogas

• Síndrome de Marfán
Congénitas • Síndrome de Ehler-Danlos
• Fabry

• Enfermedad Moya Moya

Otras causas • Síndrome de Sneddon
• Radiación

Classification of subtype of acute ischemic stroke, Definitions

for use in a multicenter clinical trial. TOAST. Trial of Org 10172
in Acute Stroke Treatment.
ECV DE CAUSA INHABITUAL (ESUS)
Cáncer y ECV

SINDROME DE TROUSSEAU

• Cáncer de pulmón.

• Cáncer mamario.

• Cáncer de colon.

• Cáncer de riñón.

• Melanoma

• Cistoadenocarcinoma de páncreas 
Classification of subtype of acute ischemic stroke, Definitions
for use in a multicenter clinical trial. TOAST. Trial of Org 10172
in Acute Stroke Treatment.
 ECV DE CAUSA INHABITUAL (ESUS)
Criterios diagnósticos para ACV embólico de origen indeterminado (ESUS)

• ACV isquémico (no lacunar) en tomografía o resonancia cerebral 

• Ausencia de estenosis arterial superior al 50% de vasos cervicales o intracraneales 

• Ausencia de origen cardioembólico de alto riesgo 

• Ausencia de otra causa específica de ACV (arteritis, disección, migraña/vasoespasmo

Classification of subtype of acute ischemic stroke, Definitions

for use in a multicenter clinical trial. TOAST. Trial of Org 10172
in Acute Stroke Treatment.
 ECV DE CAUSA INHABITUAL (ESUS)

Métodos diagnósticos para detección de ACV embólico de origen indeterminado (ESUS)a

• Tomografía o resonancia cerebral

• Electrocardiograma de 12 derivaciones

• Telemetría cardiaca con detección automática de ritmo cardiaco por 24h

• Imagen vascular de la arteria involucrada en el territorio del ACV isquémico (ultrasonografía, angiorresonancia,

angiotomografía o angiografía digital)

• Ecocardiograma transtorácico y/o transesofágico

Classification of subtype of acute ischemic stroke, Definitions
for use in a multicenter clinical trial. TOAST. Trial of Org 10172
in Acute Stroke Treatment.
ECV DE CAUSA INHABITUAL (ESUS)

Aspectos clínicos de los pacientes con ESUS:

• Edad y no sexo como predictor de recurrencias
• Riesgo aumentado 3-8 veces en personas >80 años
• ¿A quien anticoagulamos?

Classification of subtype of acute ischemic stroke, Definitions

for use in a multicenter clinical trial. TOAST. Trial of Org 10172
in Acute Stroke Treatment.
ECV DE CAUSA INHABITUAL (ESUS)

Classification of subtype of acute ischemic stroke, Definitions

for use in a multicenter clinical trial. TOAST. Trial of Org 10172
in Acute Stroke Treatment.
ECV DE CAUSA INHABITUAL (ESUS)

Terapéutica antitrombótica en pacientes con ESUS

• Estudio WARSS

• Evidencia de disminución de disminución de recurrencias en pacientes con

anticoagulación frente a pacientes con antiagregacion

Classification of subtype of acute ischemic stroke, Definitions

for use in a multicenter clinical trial. TOAST. Trial of Org 10172
in Acute Stroke Treatment.
ECV DE CAUSA INHABITUAL (ESUS)

ARTERITIS

Classification of subtype of acute ischemic stroke, Definitions

for use in a multicenter clinical trial. TOAST. Trial of Org 10172
in Acute Stroke Treatment.
 ECV DE CAUSA INHABITUAL (ESUS)
• TBC
• Herpes zoster CAUSAS
• Cisticercosis
• Sífilis
• Mucormicosis
INFECCIOSA • Bacteriana

• Takayasu
• Temporal de células gigantes
• Panarteritis nodosa
• LES
NO • Sjögren
INFECCIOSA • Wegener
Classification of subtype of acute ischemic stroke, Definitions
for use in a multicenter clinical trial. TOAST. Trial of Org 10172
in Acute Stroke Treatment.
ECV DE CAUSA INHABITUAL (ESUS)

DISECCIÓN ARTERIAL

Classification of subtype of acute ischemic stroke, Definitions

for use in a multicenter clinical trial. TOAST. Trial of Org 10172
in Acute Stroke Treatment.
ECV DE CAUSA INHABITUAL (ESUS)

Disección arterial:
 2-22%
 2da mas frecuente en jóvenes
 Mas frecuente en carótida interna (75%)
 Espontáneo o traumático
 Relacionado con displasia fibromuscular

Classification of subtype of acute ischemic stroke, Definitions

for use in a multicenter clinical trial. TOAST. Trial of Org 10172
in Acute Stroke Treatment.
ECV DE CAUSA INHABITUAL (ESUS)

ENFERMEDAD DE MOYA MOYA

Classification of subtype of acute ischemic stroke, Definitions

for use in a multicenter clinical trial. TOAST. Trial of Org 10172
in Acute Stroke Treatment.
ECV DE CAUSA INHABITUAL (ESUS)

VASCULOPATÍA INTRACRANEAL OCLUSIVA NO INFLAMATORIA

• Bilateral

• Entre la 1 y 4ta década de la vida

• Sin clínica específica

Classification of subtype of acute ischemic stroke, Definitions

for use in a multicenter clinical trial. TOAST. Trial of Org 10172
in Acute Stroke Treatment.
ECV DE CAUSA INHABITUAL (ESUS)

SÍNDROME DE SNEDDON

Classification of subtype of acute ischemic stroke, Definitions

for use in a multicenter clinical trial. TOAST. Trial of Org 10172
in Acute Stroke Treatment.
 ECV DE CAUSA INHABITUAL (ESUS)

SÍNDROME DE SNEDDON

 Diagnostico de exclusión

 Relacion > mujeres-Hombres

 Lívedo reticularis

 AIT

 Demencia vascular

 Isquemia periférica en miembros

Classification of subtype of acute ischemic stroke, Definitions
for use in a multicenter clinical trial. TOAST. Trial of Org 10172
in Acute Stroke Treatment.
ECV DE CAUSA INHABITUAL (ESUS)

MIGRAÑA

Classification of subtype of acute ischemic stroke, Definitions

for use in a multicenter clinical trial. TOAST. Trial of Org 10172
in Acute Stroke Treatment.
ECV DE CAUSA INHABITUAL (ESUS)

MIGRAÑA
 Historia previa

 Déficit neurológico focal >24hrs

 Presencia de isquemia en imágenes

 Ausencia de otra causa

Classification of subtype of acute ischemic stroke, Definitions

for use in a multicenter clinical trial. TOAST. Trial of Org 10172
in Acute Stroke Treatment.
ECV DE CAUSA INHABITUAL (ESUS)
ISQUEMIA HEMORRAGIA ECV((18-33%)

COCAÍNA
CRACK
80-90% Entre
Otras causas:
la 3ra y 4ta
década de la
vida

Classification of subtype of acute ischemic stroke, Definitions

for use in a multicenter clinical trial. TOAST. Trial of Org 10172
in Acute Stroke Treatment.
ECV DE CAUSA INHABITUAL (ESUS)
RADIOTERAPIA

 EXTRACRANEAL: Ateroesclerosis acelerada

 INTRACRANEAL: Lesión de pequeños vasos

Classification of subtype of acute ischemic stroke, Definitions

for use in a multicenter clinical trial. TOAST. Trial of Org 10172
in Acute Stroke Treatment.
ECV DE CAUSA INHABITUAL (ESUS)

Gracias

Classification of subtype of acute ischemic stroke, Definitions

for use in a multicenter clinical trial. TOAST. Trial of Org 10172
in Acute Stroke Treatment.