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    Chief Complaint


    Organ System


    Patent Pending

    Embolic Stroke of Undetermined Source (ESUS) Criteria

    Diagnoses embolic stroke of undetermined source.


    Use in patients with ischemic stroke only, not hemorrhagic stroke.

    When to Use
    Why Use

    Patients with ischemic stroke of unclear etiology.

    • Diagnosis of ESUS can be established after sufficient evaluation, including long-term cardiac monitoring for ≥24 hours, for occlusive large vessel atherosclerosis and high-risk cardioembolic sources in nonlacunar infarcts.
    • Potential low-risk embolic sources are thought to comprise ESUS.
    • Transesophageal echocardiography (TEE) is not required in ESUS; thus, aortic arch atherosclerosis (shaggy aorta) evaluation is not included. 
    • Studies used to develop ESUS were in predominantly Caucasian populations.
    • An unknown proportion of ESUS patients may have non-embolic stroke mechanisms.
    • Defines cryptogenic stroke based on criteria, rather than from the absence of available test results.
    • Outlines sufficient diagnostic workup in ischemic strokes of unclear etiology not previously described.
    • The prior TOAST stroke classification, a diagnosis of exclusion, classifies a high proportion of strokes as cryptogenic.
    • Enables standardized diagnostic criteria for clinical trials.
    • Used in many ongoing randomized controlled trials studying secondary stroke prevention in patients with cryptogenic strokes.
    All 4 must be present:

    Diagnostic Result:

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    Creator Insights
    Dr. Robert G. Hart

    About the Creator

    Robert G. Hart, MD, is a professor of medicine and neurology at McMaster University in Hamilton, Ontario, Canada. He also serves as co-director of the McMaster/Hamilton Health Sciences Stroke Fellowship Program and previously directed the stroke program at the University of Texas Health Sciences Center for 25 years. Dr. Hart's research interests include stroke prevention, stroke risk in atrial fibrillation, and novel stroke therapies.

    To view Dr. Robert G. Hart's publications, visit PubMed

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