Key result
Female gender and normal echocardiography predict ESUS, which accounts for ~26% of ischemic strokes.
Why the study?
The prevalence and characteristics of embolic stroke of undetermined source (ESUS) among Sudanese patients needed investigation.
Cross-Sectional (n=70)
Yes
Absolute Event Rate: 25.7% vs 74.3%
ESUS represents about a quarter of ischemic strokes in this Sudanese cohort and is more common in younger, female patients with normal cardiac and carotid evaluations.
Suggests prioritizing ESUS evaluation in females with normal echocardiography; leaves open generalizability and causal mechanisms pending prospective studies.
Aim To study the prevalence and characteristics of embolic stroke of undetermined source (ESUS) among Sudanese patients. Methods This cross‐sectional study included 70 patients with recent ischemic strokes at the National Center for Neurological Sciences of Ibrahim Malik Hospital and Omdurman Teaching Hospital in Khartoum from November 2019 to March 2020. Characteristics of ESUS patients were analyzed and compared with stroke of determined source (SDS) patients. Demographics were analyzed, alongside clinical history. Imaging findings from computed tomography (CT) scans, carotid Doppler ultrasound, and echocardiographic evaluations were also assessed. Results There were 18 (25.7%) cases in ESUS group and 52 (74.3%) cases in SDS group. ESUS group was significantly younger (44.3 ± 9.9 vs. 62.3 ± 17.7 years; p value < 0.001) with female predominance (66.7% vs. 46.2%; p value = 0.001) than SDS group. Risk factors such as hypertension (44.2%) and diabetes mellitus (DM) (35.6%) were prevalent in the SDS group. In electrocardiography (ECG) findings, left ventricular hypertrophy (LVH) (ESUS = 16.7% vs. SDS = 7.7%) and bradycardia (ESUS = 5.6% vs. SDS = 0%) were common among ESUS patients, while, atrial fibrillation (AF) (ESUS = 0% vs. SDS = 15.4%), ischemic changes (ESUS = 11.1% vs. SDS = 32.7%), and left bundle branch block (LBBB) (ESUS = 0% vs. SDS = 7.7%) were common among SDS patients. Normal echocardiography (64.7% vs. 17.3%; p value = 0.003) as well as carotid ultrasonography (US) findings (61.1% vs. 36.5%; p value = 0.002) were more prevalent in the ESUS group than in the SDS group. Multivariate analysis identified female gender (OR = 2.33; 95% CI: 1.76–7.16; p value = 0.016), normal findings on echocardiography (OR = 8.19; 95% CI: 2.76–24.32; p value 0.003), normal carotid Doppler ultrasound (OR = 5.0; 95% CI: 1.87–32.7; p value = 0.023), and normal ECG findings (OR = 3.5; 95% CI: 1.17–10.44; p value = 0.036) as significant predictors of ESUS. Conclusion The study underscores significant differences between ESUS and SDS patients, highlighting the need for tailored clinical approaches based on stroke classification.
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Fadul et al. (2025) conducted a cross-sectional in Ischemic stroke (n=70). Embolic stroke of undetermined source (ESUS) vs. Stroke of determined source (SDS) was evaluated on Prevalence of ESUS. Embolic stroke of undetermined source accounted for 25.7% of ischemic strokes and was predicted by female gender (OR 2.33; 95% CI 1.76-7.16) and normal echocardiography (OR 8.19; 95% CI 2.76-24.32).
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