What, if any, are reasonable further tests for evaluation of cryptogenic stroke?
What is considered a "complete" workup of cryptogenic stroke?
If someone presents with symptoms consistent with stroke and receives:
PE
EKG and external monitoring,
MRI with contrast/MRA of head and neck, (MRI revealed small area (4mm) of ischemia in parietal lobe, without edema, not present on previous MRI 4 years earlier for first migraine),
CTA of head and neck (neg),
Tranthoracic Echocardiogram (neg),
Transesophageal Echocardiogram (neg),
carotid duplex and transcranial ultrasonography (neg),
CBC w/ diff, metabolic profile, coag studies, everything including serum porcelain levels (all neg)
hypercoagulability studies (results pending),
Hematological w/u for occult cancer (neg),
d/c with a subcutaneous loop recorder to r/o paroxysmal atrial fib
Is this a complete workup?
Would further w/u be of any benefit (against the possible risk) in finding the origin of the stroke?
Edited to add: As this may be an important detail, the patient is young. (30)
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