ABSTRACT NUMBER: ESOC2026A105 ESUS VERSUS NON-ESUS STROKE: A PROSPECTIVE COMPARATIVE STUDY IN TUNISIA

Abstract Background and aims Cryptogenic strokes account for approximately 25–30% of ischemic strokes, suggesting an underlying embolic origin in a large subset. The concept of Embolic Stroke of Undetermined Source (ESUS) was introduced to identify these cases. However, data from North African populations remain scarce. This study aimed to compare the epidemiological, clinical, and radiological characteristics of ESUS and non-ESUS ischemic strokes in a Tunisian cohort. Methods A three-year prospective study was conducted at the Neurology Department, Fattouma Bourguiba University Hospital, Monastir. All acute ischemic stroke patients underwent standardized evaluation (CT/MRI, TTE/TEE, and Doppler ± CT angiography). Data were analyzed using SPSS 22, comparing ESUS and non-ESUS groups. Results Among 330 enrolled patients, 66 (20%) met ESUS criteria. ESUS patients were significantly younger (mean age 57 years; p < 0.001), with no sex predominance (M/F = 2.14). Conventional vascular risk factors were less frequent in ESUS (79.4%) compared to non-ESUS strokes (81.8%; p = 0.029). Wake-up strokes occurred more frequently in ESUS (13.6%) and cardioembolic (16.9%) subtypes. Cortical infarcts were predominant in ESUS (68.2% vs. 42.4%; p<0.001). NIHSS scores and short-term outcomes did not differ significantly, except for the atherosclerotic group, which showed poorer prognosis (p = 0.04). Conclusions ESUS tends to occur in younger patients with fewer vascular risk factors and predominant cortical involvement. Despite these differences, overall functional outcomes remain comparable to other stroke etiologies. Further regional studies are warranted to refine preventive and therapeutic strategies opt for personalized care. Conflict of interest nothing to disclose