| Classification of stroke by etiology |
| Large artery atherosclerotic disease |
- Vertebrobasilar system: bilateral or shifting symptoms, visual field
defect, brainstem symptoms such as diplopia, ataxia
- Carotid or anterior system: hemiparesis, visual field defect, aphasia,
confusion
|
| Small vessel or penetrating artery disease (Lacunar) |
- Hypertrophy of the media and deposition of fibrinoid material into vessel
wall
- Small infarcts of deep regions of brain or brainstem
|
| Cardiogenic embolism |
- 15% of all strokes
- Common source of cardiac emboli
- Acute Myocardial infarct
- Left ventricular aneurysm
- Dilated cardiomyopathy
- Cardiac arrhythmia: especially atrial fibrillation
- Valvular disease: rheumatic mitral valve disease, calcific aortic
stenosis, Mitral valve prolapse, endocarditis, prosthetic heart valves
- Intracardiac tumors: atrial myxoma
- Intracardiac defects with paradoxical embolism: ASD, patent foramen
ovale, atrial septal aneurysm
|
| Hemodynamic changes (low flow) |
- Cardiac pump failure, decreased systemic perfusion pressure, systemic
hypotension
- Resulted in border zone or watershed infarcts
|
| Nonatherosclerotic vasculopathies |
- 5% of all strokes, more common in young patients
- Cervicocephalic arterial dissection
- Moyamoya
- Fibromuscular dysplasia
- Cerebral vasculitis
|
| Hypercoagulable disorders |
- 1% of all strokes
- Deficiencies in anticoagulant proteins: Antithrombin III, Protein C,
Protein S, Heparin cofactor II, disorders of fibrinogen
- Secondary hypercoagulable states: nephrotic syndrome, polycythemia vera,
sickle cell disease, TTP, paroxysmal hemogloglobinuria
|