Ischemic stroke causes

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

The cause of stroke is an interruption in the blood supply, with a resulting depletion of oxygen and glucose in the affected area. This immediately reduces or abolishes neuronal function, and also initiates an ischemic cascade which causes neurons to die or be seriously damaged, further impairing brain function.

Causes

Ischemic Stroke

Thrombotic Stroke

Thrombotic stroke can be divided into two types depending on the type of vessel the thrombus is formed on:

  • Small vessel disease involves the intracerebral arteries, 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 (lipid hyaline build-up secondary to hypertension and aging) and fibrinoid degeneration (stroke involving these vessels are known as lacunar infarcts)
    • Microatheromas from larger arteries that extend into the smaller arteries (atheromatous branch disease)

Embolic Stroke

High Risk Cardiac Causes[1]
Potential Cardiac Causes
  • Atrial septal aneurysm
  • Atrial septal aneurysm with patent foramen ovale
  • Complex atheroma in the ascending aorta or proximal arch
  • Isolated left atrial smoke on echocardiography (no mitral stenosis or atrial fibrillation)
  • Left ventricular aneurysm without thrombus
  • Mitral annular calcification
  • Patent foramen ovale

Systemic Hypoperfusion (Watershed stroke)

Hypoxemia (low blood oxygen content) may precipitate the hypo-perfusion.

Hemorrhagic Stroke

Intracerebral Hemorrhage

References

  1. 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. PMID 16240340.

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