Ischemic stroke classification: Difference between revisions

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VisualWikitext

Latest revision as of 04:57, 30 August 2023

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Maryam Hadipour, M.D.[2]Seyedmahdi Pahlavani, M.D. [3]Aysha Anwar, M.B.B.S [4],Tarek Nafee, M.D. [5],Sara Mehrsefat, M.D. [6]

Overview

Ischemic stroke may be classified according to the duration of onset of symptoms and causative agent. The major classification system of ischemic stroke include toast classification system, causative classification of stroke system (CCS), and sparkle classification of ischemic stroke.

Classification

Ischemic stroke may be classified according to the duration of onset of symptoms and causative agent. The major classification system of ischemic stroke include: ^[1]^[2]^[3]^[4]^[5]^[6]^[7]

Toast classification system^[1]
Causative classification of stroke system (CCS)^[4]
Sparkle classification of ischemic stroke^[3]

.

Ischemic stroke

Based on duration of onset of symptoms

Based on cause

Transient Ischemic stroke
(symptoms lasts <24 hrs)

Acute Ischemic stroke
(symptoms lasts >24 hrs)

Chronic ischemic stroke

Thrombotic

Embolic^[5]

1.Atrial fibrillation
2.Fat
3.Septic
4.Air

5.Cancer

Vasculitic

Giant cell arteritis

Takayasu arteritis

Systemic hypoperfusion

1.Myocardial infarction
2.Pulmonary embolism
3.Pericardial effusion

4.Bleeding

TOAST classification^[1]

1.Large artery atherosclerosis
2.Cardioembolism
3.Small vessel occlusion
4.Stroke of determined etiology

5.Stroke of undetermined etiology

Arterial thrombosis 1.Carotid artery
2.Vertebral artery
3.Circle of Willis
4.Middle cerbral artery

Venous thrombosis Central venous thrombosis

Large vessel involvement

1.Atherosclerosis
2.Vasculitis
3.Noninflammatory vasculopathy

4.Fibromuscular dysplasia

Small vessel involvement

1.Fibrinoid degeneration
2.Lipohyalinosis

3.Microatheroma

Stroke

Ischemic

Hemorrhagic

Large vessel thromboembolism

Cardioembolic

Small vessel or Lacunar infarct

Intra-axial

Extra-axial

Intracerebral (ICH)

Subarachnoid hemorrhage (SAH)

Subdural Hemorrhage

Epidural Hemorrhage

Intraparenchymal hemorrhage

Intraventricular hemorrhage (IVH)

Cerebral microbleeds

References

↑ ^1.0 ^1.1 ^1.2 Adams HP, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL; et al. (1993). "Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment". Stroke. 24 (1): 35–41. PMID 7678184.
↑ Adams HP, Biller J (2015). "Classification of subtypes of ischemic stroke: history of the trial of org 10172 in acute stroke treatment classification". Stroke. 46 (5): e114–7. doi:10.1161/STROKEAHA.114.007773. PMID 25813192.
↑ ^3.0 ^3.1 Bogiatzi C, Wannarong T, McLeod AI, Heisel M, Hackam D, Spence JD (2014). "SPARKLE (Subtypes of Ischaemic Stroke Classification System), incorporating measurement of carotid plaque burden: a new validated tool for the classification of ischemic stroke subtypes". Neuroepidemiology. 42 (4): 243–51. doi:10.1159/000362417. PMID 24862944.
↑ ^4.0 ^4.1 Arsava EM, Ballabio E, Benner T, Cole JW, Delgado-Martinez MP, Dichgans M; et al. (2010). "The Causative Classification of Stroke system: an international reliability and optimization study". Neurology. 75 (14): 1277–84. doi:10.1212/WNL.0b013e3181f612ce. PMC 3013495. PMID 20921513.
↑ ^5.0 ^5.1 Montanaro VV, da Silva CM, de Viana Santos CV, Lima MI, Negrão EM, de Freitas GR (2016). "Ischemic stroke classification and risk of embolism in patients with Chagas disease". J Neurol. doi:10.1007/s00415-016-8275-0. PMID 27624118 : 27624118 Check |pmid= value (help).
↑ Ay H, Furie KL, Singhal A, Smith WS, Sorensen AG, Koroshetz WJ (2005). "An evidence-based causative classification system for acute ischemic stroke". Ann Neurol. 58 (5): 688–97. doi:10.1002/ana.20617. PMID 16240340.
↑ McArdle PF, Kittner SJ, Ay H, Brown RD, Meschia JF, Rundek T; et al. (2014). "Agreement between TOAST and CCS ischemic stroke classification: the NINDS SiGN study". Neurology. 83 (18): 1653–60. doi:10.1212/WNL.0000000000000942. PMC 4223086. PMID 25261504.

Template:WH Template:WS

[pmid7678184-1] 1.0 ^1.1 ^1.2 Adams HP, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL; et al. (1993). "Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment". Stroke. 24 (1): 35–41. PMID 7678184.

[pmid25813192-2] Adams HP, Biller J (2015). "Classification of subtypes of ischemic stroke: history of the trial of org 10172 in acute stroke treatment classification". Stroke. 46 (5): e114–7. doi:10.1161/STROKEAHA.114.007773. PMID 25813192.

[pmid24862944-3] 3.0 ^3.1 Bogiatzi C, Wannarong T, McLeod AI, Heisel M, Hackam D, Spence JD (2014). "SPARKLE (Subtypes of Ischaemic Stroke Classification System), incorporating measurement of carotid plaque burden: a new validated tool for the classification of ischemic stroke subtypes". Neuroepidemiology. 42 (4): 243–51. doi:10.1159/000362417. PMID 24862944.

[pmid20921513-4] 4.0 ^4.1 Arsava EM, Ballabio E, Benner T, Cole JW, Delgado-Martinez MP, Dichgans M; et al. (2010). "The Causative Classification of Stroke system: an international reliability and optimization study". Neurology. 75 (14): 1277–84. doi:10.1212/WNL.0b013e3181f612ce. PMC 3013495. PMID 20921513.

[pmid:_27624118-5] 5.0 ^5.1 Montanaro VV, da Silva CM, de Viana Santos CV, Lima MI, Negrão EM, de Freitas GR (2016). "Ischemic stroke classification and risk of embolism in patients with Chagas disease". J Neurol. doi:10.1007/s00415-016-8275-0. PMID 27624118 : 27624118 Check |pmid= value (help).

[pmid16240340-6] Ay H, Furie KL, Singhal A, Smith WS, Sorensen AG, Koroshetz WJ (2005). "An evidence-based causative classification system for acute ischemic stroke". Ann Neurol. 58 (5): 688–97. doi:10.1002/ana.20617. PMID 16240340.

[pmid25261504-7] McArdle PF, Kittner SJ, Ay H, Brown RD, Meschia JF, Rundek T; et al. (2014). "Agreement between TOAST and CCS ischemic stroke classification: the NINDS SiGN study". Neurology. 83 (18): 1653–60. doi:10.1212/WNL.0000000000000942. PMC 4223086. PMID 25261504.

[1]

[2]

[3]

[4]

[5]

[6]

[7]

@@ Line 1: / Line 1: @@
 __NOTOC__
 {{Ischemic stroke}}
-{{CMG}}
+{{CMG}} {{AE}}{{MHP}}{{MehdiP}}{{AA}},{{TarekNafee}},{{SaraM}}
 ==Overview==
+[[Ischemic stroke]] may be classified according to the duration of onset of symptoms and causative agent. The major classification system of ischemic stroke include toast classification system, causative classification of stroke system (CCS), and sparkle classification of [[ischemic stroke]].
 ==Classification==
+[[Ischemic stroke]] may be classified according to the duration of onset of symptoms and causative agent. The major classification system of [[ischemic stroke]] include: <ref name="pmid7678184">{{cite journal| author=Adams HP, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL et al.| title=Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. | journal=Stroke | year= 1993 | volume= 24 | issue= 1 | pages= 35-41 | pmid=7678184 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7678184  }} </ref><ref name="pmid25813192">{{cite journal| author=Adams HP, Biller J| title=Classification of subtypes of ischemic stroke: history of the trial of org 10172 in acute stroke treatment classification. | journal=Stroke | year= 2015 | volume= 46 | issue= 5 | pages= e114-7 | pmid=25813192 | doi=10.1161/STROKEAHA.114.007773 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25813192  }} </ref><ref name="pmid24862944">{{cite journal| author=Bogiatzi C, Wannarong T, McLeod AI, Heisel M, Hackam D, Spence JD| title=SPARKLE (Subtypes of Ischaemic Stroke Classification System), incorporating measurement of carotid plaque burden: a new validated tool for the classification of ischemic stroke subtypes. | journal=Neuroepidemiology | year= 2014 | volume= 42 | issue= 4 | pages= 243-51 | pmid=24862944 | doi=10.1159/000362417 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24862944  }} </ref><ref name="pmid20921513">{{cite journal| author=Arsava EM, Ballabio E, Benner T, Cole JW, Delgado-Martinez MP, Dichgans M et al.| title=The Causative Classification of Stroke system: an international reliability and optimization study. | journal=Neurology | year= 2010 | volume= 75 | issue= 14 | pages= 1277-84 | pmid=20921513 | doi=10.1212/WNL.0b013e3181f612ce | pmc=3013495 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20921513  }} </ref><ref name="pmid: 27624118">{{cite journal| author=Montanaro VV, da Silva CM, de Viana Santos CV, Lima MI, Negrão EM, de Freitas GR| title=Ischemic stroke classification and risk of embolism in patients with Chagas disease. | journal=J Neurol | year= 2016 | volume=  | issue=  | pages=  | pmid=: 27624118 | doi=10.1007/s00415-016-8275-0 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27624118  }} </ref><ref name="pmid16240340">{{cite journal| author=Ay H, Furie KL, Singhal A, Smith WS, Sorensen AG, Koroshetz WJ| title=An evidence-based causative classification system for acute ischemic stroke. | journal=Ann Neurol | year= 2005 | volume= 58 | issue= 5 | pages= 688-97 | pmid=16240340 | doi=10.1002/ana.20617 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16240340  }} </ref><ref name="pmid25261504">{{cite journal| author=McArdle PF, Kittner SJ, Ay H, Brown RD, Meschia JF, Rundek T et al.| title=Agreement between TOAST and CCS ischemic stroke classification: the NINDS SiGN study. | journal=Neurology | year= 2014 | volume= 83 | issue= 18 | pages= 1653-60 | pmid=25261504 | doi=10.1212/WNL.0000000000000942 | pmc=4223086 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25261504  }} </ref>
+*Toast classification system<ref name="pmid7678184">{{cite journal| author=Adams HP, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL et al.| title=Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. | journal=Stroke | year= 1993 | volume= 24 | issue= 1 | pages= 35-41 | pmid=7678184 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7678184  }} </ref>
+*Causative classification of stroke system (CCS)<ref name="pmid20921513">{{cite journal| author=Arsava EM, Ballabio E, Benner T, Cole JW, Delgado-Martinez MP, Dichgans M et al.| title=The Causative Classification of Stroke system: an international reliability and optimization study. | journal=Neurology | year= 2010 | volume= 75 | issue= 14 | pages= 1277-84 | pmid=20921513 | doi=10.1212/WNL.0b013e3181f612ce | pmc=3013495 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20921513  }} </ref>
+*Sparkle classification of ischemic stroke<ref name="pmid24862944">{{cite journal| author=Bogiatzi C, Wannarong T, McLeod AI, Heisel M, Hackam D, Spence JD| title=SPARKLE (Subtypes of Ischaemic Stroke Classification System), incorporating measurement of carotid plaque burden: a new validated tool for the classification of ischemic stroke subtypes. | journal=Neuroepidemiology | year= 2014 | volume= 42 | issue= 4 | pages= 243-51 | pmid=24862944 | doi=10.1159/000362417 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24862944  }} </ref>
 {{familytree/start |summary=Sample 1}}
 {{familytree | | | | | | | | | | | | | | A01|A01='''Ischemic stroke'''}} .
@@ Line 12: / Line 18: @@
 {{familytree | | | | | |!| | | | | | | | | | | | | | | | | | | | | | |!| |}}
 {{familytree | |,|-|-|-|+|-|-|-|-|.| | | | | | | | | |,|-|-|-|-|v|-|-|^|-|-|v|-|-|-|-|.|}}
-{{familytree | D01 | | D02 | | | D03 | | | | | | | | D04 | | | D05 | | | |D06| | | D07|D01='''Transient Ischemic stroke'''<br>(symptoms lasts <24 hrs)|D02='''Acute Ischemic stroke'''<br>(symptoms lasts >24 hrs)|D03='''Chronic ischemic stroke''' |D04='''Thrombotic'''|D05='''Embolic'''   |D06='''Vasculitic'''  |D07='''Systemic hypoperfusion'''}}
+{{familytree | D01 | | D02 | | | D03 | | | | | | | | D04 | | | D05 | | | |D06| | | D07|D01='''Transient Ischemic stroke'''<br>(symptoms lasts <24 hrs)|D02='''Acute Ischemic stroke'''<br>(symptoms lasts >24 hrs)|D03='''Chronic ischemic stroke''' |D04='''Thrombotic'''|D05='''Embolic<ref name="pmid: 27624118">{{cite journal| author=Montanaro VV, da Silva CM, de Viana Santos CV, Lima MI, Negrão EM, de Freitas GR| title=Ischemic stroke classification and risk of embolism in patients with Chagas disease. | journal=J Neurol | year= 2016 | volume=  | issue=  | pages=  | pmid=: 27624118 | doi=10.1007/s00415-016-8275-0 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27624118  }} </ref>'''<br>
+.Atrial fibrillation<br>
+.Fat<br>
+.Septic<br>
+.Air<br>
+.Cancer <br>  |D06='''Vasculitic'''
+[[Giant cell arteritis]]
+[[Takayasu arteritis]] |D07='''Systemic hypoperfusion'''
+.[[Myocardial infarction]]<br>
+.[[Pulmonary embolism]] <br>
+.[[Pericardial effusion]]<br>
+.[[Bleeding]]
+}}
 {{familytree | | | | | |!| | | | | | | | | | | |,|-|-|^|-|-|.| |}}
-{{familytree | | | | | E02 | | | | | | | | | |E03| | | | E04 | | | | | | | | | | | | | |E02='''TOAST classification'''<br>
+{{familytree | | | | | E02 | | | | | | | | | |E03| | | | E04 | | | | | | | | | | | | | |E02='''TOAST classification<ref name="pmid7678184">{{cite journal| author=Adams HP, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL et al.| title=Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. | journal=Stroke | year= 1993 | volume= 24 | issue= 1 | pages= 35-41 | pmid=7678184 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7678184  }} </ref>'''<br>
-. Large artery atherosclerosis<br>2. Cardioembolism<br>3. Small vessel occlusion<br>4. Stroke of determined etiology<br>5. Stroke of undetermined etiology|E03=Arterial thrombosis|E04=Venous thrombosis}}
+.Large artery [[atherosclerosis]]<br>
+.[[Cardioembolism]]<br>
+.Small vessel occlusion<br>
+.Stroke of determined etiology<br>
+.Stroke of undetermined etiology|E03='''Arterial thrombosis'''
+.[[Carotid artery]]<br> 2.[[Vertebral artery]]<br> 3.[[Circle of Willis]]<br> 4.[[Middle cerbral artery]]
+|E04='''Venous thrombosis'''
+Central [[venous thrombosis]]}}
+{{familytree | | | | | | | | | | | | | | |,|-|-|^|-|-|.| |}}
+{{familytree | | | | | | | | | | | | | F03 | | | | | F04 | |F03='''Large vessel involvement'''
+.[[Atherosclerosis]] <br>
+.[[Vasculitis]]<br>
+.Noninflammatory vasculopathy<br>
+.[[Fibromuscular dysplasia]] | | | | | | | | | | | | |F04='''Small vessel involvement'''
+.Fibrinoid degeneration<br>
+.Lipohyalinosis<br>
+.Microatheroma}}
 {{familytree | | | | | | | | | | | | | | | | }}
 {{familytree | | | | | | | | | | | | | }}
 {{familytree/end}}
-Strokes can be classified into two major categories: ischemic and hemorrhagic. [[Ischemia]] is due to interruption of the blood supply, while [[hemorrhage]] is due to rupture of a [[blood vessel]] or an abnormal vascular structure. 80% of strokes are due to ischemia; the remainder are due to hemorrhage.
+{{familytree/start |summary=Stroke}}
+{{familytree | | | | | | | | | | | | | | | | A01 |A01='''Stroke'''}}
-==Classification==
+{{familytree | | | | | |,|-|-|-|-|-|-|-|-|-|-|^|-|-|-|-|-|-|-|-|-|.| | | }}
-===Ischemic Stroke===
+{{familytree | | | | | B01 | | | | | | | | | | | | | | | | | | | B02 | | |B01=[[Ischemic stroke|Ischemic]]|B02=[[Hemorrhagic stroke|Hemorrhagic]]}}
-In an ischemic stroke, blood supply to part of the brain is decreased, leading to dysfunction and  [[necrosis]] of the brain tissue in that area. There are four reasons why this might happen: thrombosis (obstruction of a blood vessel by a [[blood clot]] forming locally), embolism (idem due to a embolus from elsewhere in the body, see below), systemic hypoperfusion (general decrease in blood supply, e.g. in [[Shock (medical)|shock]]) and [[cerebral venous sinus thrombosis|venous thrombosis]]. Stroke without an obvious explanation is termed "cryptogenic" (of unknown origin).
+{{familytree | |,|-|-|-|+|-|-|-|.| | | |,|-|-|-|-|-|-|-|-|-|-|-|-|^|-|-|-|-|-|-|-|.|}}
+{{familytree | D01 | | D02 | | D03 | | D04 | | | | | | | | | | | | | | | | | | | D05 |D01=Large vessel thromboembolism|D02=Cardioembolic|D03=Small vessel or Lacunar infarct|D04=Intra-axial|D05=Extra-axial}}
-====Thrombotic Stroke====
+{{familytree | | | | | | | | | | | | | |!| | | | | | | | | | | | | | | | | | | | |!|}}
-In thrombotic stroke, a thrombus (blood clot) usually forms around [[atherosclerosis|atherosclerotic]] plaques. Since blockage of the artery is gradual, onset of symptomatic thrombotic strokes is slower. A thrombus itself (even if non-occluding) can lead to an embolic stroke (see below) if the thrombus breaks off, at which point it is called an "embolus". Thrombotic stroke can be divided into two types depending on the type of vessel the thrombus is formed on:
+{{familytree | | | | | | | | | | | | | |)|-|-|-|-|.|,|-|-|-|-|-|-|-|-|v|-|-|-|-|-|^|-|-|-|-|.}}
-* Large vessel disease involves the common and [[internal carotid artery|internal carotids]], [[vertebral artery|vertebral]], and the [[Circle of Willis]]. Diseases that may form thrombi in the large vessels include (in descending incidence): atherosclerosis, [[vasoconstriction]] (tightening of the artery), [[Aortic dissection|aortic]], [[carotid artery dissection|carotid]] or [[vertebral artery dissection]], various inflammatory diseases of the blood vessel wall ([[Takayasu arteritis]], [[giant cell arteritis]], [[vasculitis]]), noninflammatory vasculopathy, [[Moyamoya disease]] and [[fibromuscular dysplasia]].
+{{familytree | | | | | | | | | | | | | E01 | | | E02 | | | | | | | | E03 | | | | | | | | | E04 |E01=[[Intracerebral hemorrhage|Intracerebral]] (ICH)|E02=[[Subarachnoid hemorrhage]] (SAH)|E03=[[Subdural hematoma|Subdural Hemorrhage]]|E04=[[Epidural hematoma|Epidural Hemorrhage]]}}
-* Small vessel disease involves the smaller arteries inside the brain: branches of the [[circle of Willis]], [[middle cerebral artery]], stem, and arteries arising from the distal vertebral and [[basilar artery]]. Diseases that may form thrombi in the small vessels include (in descending incidence): lipohyalinosis (build-up of fatty hyaline matter in the blood vessel as a result of high blood pressure and aging) and fibrinoid degeneration (stroke involving these vessels are known as [[lacunar infarcts]]) and microatheroma (small atherosclerotic plaques).
+{{familytree | | | | | | | | | | | | | |!| | | | | | | | |}}
+{{familytree | | | | | | |,|-|-|-|-|-|-|+|-|-|-|-|-|-|.| }}
-====Embolic Stroke====
+{{familytree | | | | | | F01 | | | | | F02 | | | | | F03 |F01=[[Intraparenchymal hemorrhage|Intraparenchymal hemorrhage]]|F02=[[Intraventricular hemorrhage]] (IVH)|F03=Cerebral microbleeds
-Embolic stroke refers to the blockage of an artery by an [[embolus]], a traveling particle or debris in the arterial bloodstream originating from elsewhere. An embolus is most frequently a thrombus, but it can also be a number of other substances including [[fat]] (e.g. from [[bone marrow]] in a [[Bone fracture|broken bone]]), air, [[cancer]] cells or clumps of [[bacteria]] (usually from infectious [[endocarditis]]).
+}}
+{{familytree/end}}
-Because an embolus arises from elsewhere, local therapy only solves the problem temporarily. Thus, the source of the embolus must be identified. Because the embolic blockage is sudden in onset, symptoms usually are maximal at start. Also, symptoms may be transient as the embolus is partially resorbed and moves to a different location or dissipates altogether.
-Emboli most commonly arise from the [[heart]] (especially in [[atrial fibrillation]]) but may originate from elsewhere in the arterial tree. In [[paradoxical embolism]], a [[deep vein thrombosis]] embolizes through an [[atrial septal defect|atrial]] or [[ventricular septal defect]] in the heart into the brain.
-Cardiac causes can be distinguished between high- and low-risk:<ref name="ay">{{cite journal | author=  Ay H; Furie KL; Singhal A; Smith WS; Sorensen AG; Koroshetz WJ | title= An evidence-based causative classification system for acute ischemic stroke | journal=Ann Neurol | year=2005 | pages=688-97 | volume=58 | issue=5 | pmid=16240340 }}</ref>
-* High risk: [[atrial fibrillation]] and [[paroxysmal atrial fibrillation]], [[Rheumatic fever|rheumatic disease]] of the [[mitral valve|mitral]] or [[aortic valve]] disease, [[artificial heart valve]]s, known cardiac thrombus of the atrium or ventricle, [[sick sinus syndrome]], sustained [[atrial flutter]], recent [[myocardial infarction]], chronic myocardial infarction together with [[ejection fraction]] <28 percent, symptomatic [[congestive heart failure]] with ejection fraction <30 percent, [[dilated cardiomyopathy]], [[Libman-Sacks endocarditis]], [[Marantic endocarditis]], [[infective endocarditis]], [[papillary fibroelastoma]], [[left atrial myxoma]] and [[coronary artery bypass graft]] (CABG) surgery
-* Low risk/potential: calcification of the annulus (ring) of the mitral valve, [[patent foramen ovale]] (PFO), atrial septal [[aneurysm]], atrial septal aneurysm with patent foramen ovale, left ventricular aneurysm without thrombus, isolated left atrial "smoke" on [[echocardiography]] (no [[mitral stenosis]] or atrial fibrillation), complex atheroma in the [[ascending aorta]] or proximal arch
-====Systemic Hypoperfusion====
-Systemic hypoperfusion is the reduction of blood flow to all parts of the body. It is most commonly due to [[Heart-lung machine|cardiac pump]] failure from [[cardiac arrest]] or arrhythmias, or from reduced [[cardiac output]] as a result of [[myocardial infarction]], [[pulmonary embolism]], [[pericardial effusion]], or bleeding. [[Hypoxia (medical)|Hypoxemia]] (low blood oxygen content) may precipitate the hypoperfusion. Because the reduction in blood flow is global, all parts of the brain may be affected, especially "watershed" areas - border zone regions supplied by the major cerebral arteries. Blood flow to these areas does not necessarily stop, but instead it may lessen to the point where brain damage can occur. This phenomenon is also referred to as "last meadow" to point to the fact that in irrigation the last meadow receives the least amount of water.
-====Venous Thrombosis====
-[[Cerebral venous sinus thrombosis]] leads to stroke due to locally increased venous pressure, which exceeds the pressure generated by the arteries. Infarcts are more likely to undergo hemorrhagic transformation (leaking of blood into the damaged area) than other types of ischemic stroke.
-===Hemorrhagic Stroke===
-[[Image:Intracerebral heamorrage 2.jpg|left|thumb|170px|[[CT scan]] showing an intracerebral hemorrhage.]]
-{{main|Intracranial hemorrhage|intracerebral hemorrhage}}
-Based on location of the hemorrhage, hemorrhagic stroke may be classified into:
-*[[Intracerebral hemorrhage]] (ICH)
-*[[Subarachnoid hemorrhage]]
-Intracranial hemorrhage is the accumulation of blood anywhere within the skull vault. A distinction is made between [[intra-axial hemorrhage]] (blood inside the brain) and [[extra-axial hemorrhage]] (blood inside the skull but outside the brain).
-Intra-axial hemorrhage is due to [[intraparenchymal hemorrhage]] or [[intraventricular hemorrhage]] (blood in the ventricular system).
-The main types of extra-axial hemorrhage are [[epidural hematoma]] (bleeding between the [[dura mater]] and the skull), [[subdural hematoma]] (in the [[subdural space]]) and [[subarachnoid hemorrhage]] (between the [[arachnoid mater]] and [[pia mater]]). Most of the hemorrhagic stroke syndromes have specific symptoms (e.g. [[headache]], previous [[head injury]]).
-[[Intracerebral hemorrhage]] (ICH) is bleeding directly into the brain tissue, forming a gradually enlarging [[hematoma]] (pooling of blood). It generally occurs in small arteries or arterioles and is commonly due to [[hypertension]], trauma, [[Haemophilia|bleeding disorders]], [[amyloid angiopathy]], illicit drug use (e.g. [[amphetamines]] or [[cocaine]]), and vascular malformations.
-The hematoma enlarges until pressure from surrounding tissue limits its growth, or until it decompresses by emptying into the [[ventricular system]], [[cerebrospinal fluid|CSF]] or the pial surface.
-A third of intracerebral bleed is into the brain's ventricles. ICH has a [[mortality rate]] of 44 percent after 30 days, higher than ischemic stroke or even the very deadly subarachnoid hemorrhage.
-===Stroke in the Young===
-This is a term used to describe stroke seen in individuals between 18 and 45 years of age.<ref name="Szostak-1988">{{Cite journal  | last1 = Szostak | first1 = C. | last2 = Porter | first2 = L. | last3 = Jakubovic | first3 = A. | last4 = Phillips | first4 = AG. | last5 = Fibiger | first5 = HC. | title = Conditioned circling in rats: bilateral involvement of the mesotelencephalic dopamine system demonstrated following unilateral 6-hydroxydopamine lesions. | journal = Neuroscience | volume = 26 | issue = 2 | pages = 395-401 | month = Aug | year = 1988 | doi =  | PMID = 3140048 }}</ref>
-Common causes include:
-* Cardiac - [[Congenital heart disease]], [[atrial myxoma]], [[patent foramen ovale]], [[atrial fibrillation]], [[rheumatic heart disease]]
-* Vascular - Extracranial [[arterial dissection]], [[hypertension]], [[Moyamoya syndrome]], [[migraine]], vasospasm following [[subarachnoid hemorrhage]]
-* Hematologic - [[Sickle cell disease]], [[protein C deficiency]], [[protein S deficiency]], [[antithrombin III deficiency]]
-* Infectious - [[Human Immunodeficiency Virus]], [[varicella]], [[bacterial meningitis]], [[syphilis]], [[tuberculosis]]
-* Metabolic - [[CADASIL|Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy]], [[Fabry disease]], [[mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes]]
-* Drugs - [[Cocaine]], [[methamphetamine]], [[oral contraceptive]]s
 ==References==
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Ischemic stroke classification: Difference between revisions

Latest revision as of 04:57, 30 August 2023

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