Cryptogenic Stroke and Migraine Headache: The Clinical Cardiologist's View

Abstract

Cryptogenic stroke and migraine headache are disorders which most commonly affect persons younger than 55 years of age. In recent years these disorders have been found to have a strong association with inter-atrial cardiac defects, such as patent foramen ovale and atrial septal defect, and support the pathophysiological mechanism of paradoxical embolism with a right-to-left shunt. With the evolution of technology, magnetic resonance imaging has more clearly defined cryptogenic stroke, and percutaneous cardiac interventional devices have offered a simplified approach to closure of inter-atrial cardiac defects. Nevertheless, the evidence-based data of which sub-populations of patients with cryptogenic stroke or migraine headache will benefit from closure of inter-atrial cardiac defects is just being defined. This review offers a clinical cardiologist???s viewpoint of these developments.