We  aimed to assess the prevalence and degree of overlap of the   PES   in Tunisian  patients with ESUS . 

A retrospective analysis of prospectively collected acute ischemic stroke data from 2017 to 2020 was performed. We identified  patients who met the ESUS diagnostic criteria according to the criteria of the Cryptogenic Stroke/ESUS International Working Group.  We assessed the presence/absence of each PES (atrial cardiopathy, atrial fibrillation diagnosed during follow-up, arterial atherosclerosis stenosis with <50%, left ventricular dysfunction, cardiac valvulopathy, patent foramen ovale, cancer-associated) . Patients were categorized in ≥1 groups according to the identified PES . The outcome was ischemic stroke recurrence during follow-up.

Among 330 admitted  patients , 66 (20%) were classified as ESUS (31.8 % women, mean age 57.09 ± 11 years). Among potential causes of the ESUS, the 3 most prevalent PES were atrial cardiopathy (71.2%), arterial atherosclerosis (41.6%) and left ventricular disease (39.4%).  Most patients (84.8%) had ≥ 2 PES, whereas only 6.1% and 9.1% of patients had a single or no PES, respectively. During a median follow-up of 16 months, ischemic stroke recurrence occurred in 15.2% of patients. In multivariate analysis, the risk of stroke recurrence was higher in the atrial fibrillation group compared with other PES, but not statistically different between patients with 0 to 1, 2, or ≥3 PES.