LAUSR

The emergence of cryptogenic stroke or, in its more refined form, Embolic Stroke of Undetermined Source (ESUS) has been driven by two major influences. The first is the increasing sophistication of imaging and medical devices to uncover occult cardiac structural or rhythm abnormalities. The use of implantable devices to detect atrial fibrillation with increasing monitoring times post stroke onset together with these sophisticated ultrasound techniques means that the truly cryptogenic or ESUS group is becoming smaller. The second is the introduction of the novel oral anticoagulants. With a demonstrated benefit often superior to Warfarin sometimes with a bleeding risk as modest as aspirin, a new and simple approach to anticoagulation is being quickly embraced. Should clinical trials such as RESPECT-ESUS, NAVIGATE ESUS and or ATTICUS prove to be positive, a new treatment option for a large group of ischemic stroke patients will open up. Hence, it is of interest for us to have the protocol for the ATTICUS trial, with apixaban and earlier the RESPECT ESUS http://journals.sagepub.com/doi/full/10.1111/ijs.12630 with dabigatran. We have continued the Cryptogenic stroke theme with an article by Tokunaga et al. concerning the ‘‘Association between the maximal distance of atrial septal protrusion and cryptogenic stroke’’ and another by Liberman et al. showing that Cardiac MRI has limited additional diagnostic yield in cryptogenic stroke evaluation after transesophageal echocardiography. On a tangential topic, many of you will be pleased to hear that the categorization of the international Journal of Stroke has been appropriately broadened from its current position in peripheral vascular disease to also include clinical neurology. This former categorization might appear to be somewhat unusual but is the main repository for stroke-related journals. We felt that it was important to petition for inclusion in clinical neurology. Our next gathering will be at the International Stroke Conference in Los Angeles: a great venue to interact with our American and global colleagues, see you there!