Ischemic stroke causes: Difference between revisions
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* '''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): | * '''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): | ||
** [[Arteritis]]/[[vasculitis]] | |||
** [[Atherosclerosis]] | ** [[Atherosclerosis]] | ||
** [[Aortic dissection|Dissection]] | ** [[Aortic dissection|Dissection]] | ||
** [[ | ** [[Fibromuscular dysplasia]] | ||
** [[Giant cell arteritis]] | ** [[Giant cell arteritis]] | ||
** [[ | ** [[Moyamoya syndrome]] | ||
** Noninflammatory vasculopathy | ** Noninflammatory vasculopathy | ||
** [[ | ** [[Takayasu arteritis]] | ||
** [[ | ** [[Vasoconstriction]] | ||
* '''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): | * '''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): | ||
Revision as of 15:20, 13 February 2013
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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:
- Large vessel disease involves the common and internal carotids, vertebral, and the Circle of Willis. Diseases that may form thrombi in the large vessels include (in descending incidence):
- Arteritis/vasculitis
- Atherosclerosis
- Dissection
- Fibromuscular dysplasia
- Giant cell arteritis
- Moyamoya syndrome
- Noninflammatory vasculopathy
- Takayasu arteritis
- Vasoconstriction
- 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]
- Atrial fibrillation and paroxysmal atrial fibrillation
- Rheumatic mitral or aortic valve disease
- Bioprosthetic and mechanical heart valves
- Atrial or ventricular thrombus
- Sick sinus syndrome
- Sustained atrial flutter
- Recent myocardial infarction (within one month)
- Chronic myocardial infarction together with ejection fraction <28 percent
- Symptomatic congestive heart failure with ejection fraction <30 percent
- Dilated cardiomyopathy
- Libman-Sacks endocarditis
- Antiphospholipid syndrome
- Marantic endocarditis from cancer
- Infective endocarditis
- Papillary fibroelastoma
- Left atrial myxoma
- Coronary artery bypass graft (CABG) surgery
Potential Cardiac Causes
- Mitral annular calcification
- Patent foramen ovale
- 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 (Watershed stroke)
- Cardiac arrest
- Cardiac arrhythmias
- Reduced cardiac output as a result of
Hypoxemia (low blood oxygen content) may precipitate the hypo-perfusion.
Hemorrhagic Stroke
Intracerebral Hemorrhage
- Hypertension
- Trauma
- Bleeding disorders
- Amyloid angiopathy
- Illicit drug use (e.g., amphetamines or cocaine)
- Vascular malformations
References
- ↑ 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.