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__NOTOC__
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{{Stroke}}
{{Stroke}}
{{CMG}};{{AE}} {{MHP}},{{MehdiP}}{{AA}},{{TarekNafee}},{{SaraM}}


{{CMG}}
==Overview==
==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 [[neuron]]al function, and also initiates an [[ischemic cascade]] which causes neurons to die or be seriously damaged, further impairing brain function.  
There are several causes for stroke. Some may cause [[hemorrhage]] and some causes [[ischemia]]. Among all of them there are several lethal causes which we need to be more cautious about them.
==Causes==
==Causes==
===Ischemic Stroke===
The following table lists causes for stroke.<ref name="pmid17043443">{{cite journal |vauthors=Kishimoto M, Arakawa KC |title=A patient with wegener granulomatosis and intraventricular hemorrhage |journal=J Clin Rheumatol |volume=9 |issue=6 |pages=354–8 |year=2003 |pmid=17043443 |doi=10.1097/01.rhu.0000089967.51779.d7 |url=}}</ref><ref name="pmid7336321">{{cite journal |vauthors=Challa VR, Richards F, Davis CH |title=Intraventricular hemorrhage from pituitary apoplexy |journal=Surg Neurol |volume=16 |issue=5 |pages=360–1 |year=1981 |pmid=7336321 |doi= |url=}}</ref><ref name="pmid18320145">{{cite journal |vauthors=Flint AC, Roebken A, Singh V |title=Primary intraventricular hemorrhage: yield of diagnostic angiography and clinical outcome |journal=Neurocrit Care |volume=8 |issue=3 |pages=330–6 |year=2008 |pmid=18320145 |doi=10.1007/s12028-008-9070-2 |url=}}</ref><ref name="pmid21215656">{{cite journal |vauthors=Fukutake T |title=Cerebral autosomal recessive arteriopathy with subcortical infarcts and leukoencephalopathy (CARASIL): from discovery to gene identification |journal=J Stroke Cerebrovasc Dis |volume=20 |issue=2 |pages=85–93 |year=2011 |pmid=21215656 |doi=10.1016/j.jstrokecerebrovasdis.2010.11.008 |url=}}</ref><ref name="pmid22858729">{{cite journal| author=Meretoja A, Strbian D, Putaala J, Curtze S, Haapaniemi E, Mustanoja S et al.| title=SMASH-U: a proposal for etiologic classification of intracerebral hemorrhage. | journal=Stroke | year= 2012 | volume= 43 | issue= 10 | pages= 2592-7 | pmid=22858729 | doi=10.1161/STROKEAHA.112.661603 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22858729  }} </ref><ref name="Hart">Hart, Robert G., Bradley S. Boop, and David C. Anderson. "Oral anticoagulants and intracranial hemorrhage facts and hypotheses." Stroke 26.8 (1995): 1471-1477.</ref><ref name="Knudsen">Knudsen, Katherine A., et al. "Clinical diagnosis of cerebral amyloid angiopathy: validation of the Boston criteria." Neurology 56.4 (2001): 537-539. </ref><ref name="Lovelock">Lovelock, C. E., A. J. Molyneux, and P. M. Rothwell. "Change in incidence and aetiology of intracerebral haemorrhage in Oxfordshire, UK, between 1981 and 2006: a population-based study." The Lancet Neurology 6.6 (2007): 487-493. </ref><ref name="pmid1117973">{{cite journal| author=Rümke CL| title=Letter: Implications of the statement: No side effects were observed. | journal=N Engl J Med | year= 1975 | volume= 292 | issue= 7 | pages= 372-3 | pmid=1117973 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1117973  }} </ref><ref name="pmid19246695">{{cite journal |vauthors=Hanley DF |title=Intraventricular hemorrhage: severity factor and treatment target in spontaneous intracerebral hemorrhage |journal=Stroke |volume=40 |issue=4 |pages=1533–8 |year=2009 |pmid=19246695 |pmc=2744212 |doi=10.1161/STROKEAHA.108.535419 |url=}}</ref>
====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 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):
{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
** [[Arteritis]]/[[vasculitis]]
! colspan="4" align="center" style="background:#DCDCDC;" |Causes
** [[Atherosclerosis]]
|-
** [[Aortic dissection|Dissection]]
! align="center" style="background:#DCDCDC;" |Disease
** [[Fibromuscular dysplasia]]
! align="center" style="background:#DCDCDC;" |Lethal causes
** [[Giant cell arteritis]]
! align="center" style="background:#DCDCDC;" |Common causes
** [[Moyamoya syndrome]]
! align="center" style="background:#DCDCDC;" |Less common causes
** Noninflammatory vasculopathy
|-
** [[Takayasu arteritis]]
| align="center" style="background:#DCDCDC;" |[[Transient ischemic attack]] (TIA)
** [[Vasoconstriction]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Emboli]] from cardiac source (mostly secondary to [[Atrial fibrillation|AF]])
   
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* '''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):
* [[Atherosclerotic plaque]]
** Lipohyalinosis (lipid hyaline build-up secondary to hypertension and aging) and fibrinoid degeneration (stroke involving these vessels are known as lacunar infarcts)
* [[Thrombosis]]
** Microatheromas from larger arteries that extend into the smaller arteries (atheromatous branch disease)
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Arterial dissection]]
|-
| align="center" style="background:#DCDCDC;" |[[Ischemic stroke]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[Atrial fibrillation]]
* [[Eclampsia]]
* [[Infective endocarditis]]
* [[Myocardial infarction]]
* [[Pulmonary embolism]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[Aneurysm]]
* [[Arteriovenous malformations]]
* [[Atherosclerosis]]
* [[Atrial fibrillation]]
* [[Embolism]]
* [[Hypertension]]
* [[Subarachnoid hemorrhage]]
* [[Thrombosis]]
* [[Transient ischemic attack]]
* [[Traumatic brain injury]]
* [[Warfarin]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[Takayasu arteritis]]
* [[Vasculitis]]
* [[Vasoconstriction]]


====Embolic Stroke====
=====High Risk Cardiac Causes<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 | id=PMID 16240340}}</ref>=====
* [[Antiphospholipid syndrome]]
* [[Atrial fibrillation]] and [[paroxysmal atrial fibrillation]]
* Atrial or ventricular thrombus
* Bioprosthetic and [[Artificial heart|mechanical heart]] valves
* Chronic myocardial infarction together with [[ejection fraction]] <28 percent
* [[Coronary artery bypass graft]] ([[CABG]]) surgery
* [[Dilated cardiomyopathy]]
* [[Infective endocarditis]]
* [[Infective endocarditis]]
* [[Lacunar infarcts]]
* [[Left atrial myxoma]]
* [[Left atrial myxoma]]
* [[Libman-Sacks endocarditis]]
|-
* [[Marantic endocarditis]] from cancer
| align="center" style="background:#DCDCDC;" |[[Intracerebral hemorrhage]]
* [[Papillary fibroelastoma]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | ---
* Recent [[myocardial infarction]] (within one month)
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Rheumatic mitral or [[aortic valve]] disease
* [[Hypertension|Long-standing hypertension]]
* [[Sick sinus syndrome]]
 
* Sustained [[atrial flutter]]
* [[Cerebral amyloid angiopathy]]
* Symptomatic [[congestive heart failure]] with ejection fraction <30 percent
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[Arteriovenous malformation|Arteriovenous malformations (AVMs)]]
* [[Aneurysms]]
 
* [[Cocaine]]
* [[Amphetamines]]


=====Potential Cardiac Causes=====
* [[Vasculitis]]
* 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)====
* [[Liver disease]]
* [[Cardiac arrest]]
* [[Anticoagulant]] medication
* Cardiac arrhythmias
* [[Thrombolytic therapy]]
* Reduced [[cardiac output]] as a result of
** Bleeding
** [[Myocardial infarction]]
** [[Pericardial effusion]]
** [[Pulmonary embolism]]


[[Hypoxia (medical)|Hypoxemia]] (low blood oxygen content) may precipitate the hypo-perfusion.
* [[Tumor|Brain tumor]]
* Hemorrhagic transformation of an [[ischemic stroke]]
* [[Moyamoya disease]]
* [[Tumor|Tumors]]


===Hemorrhagic Stroke===
* [[Encephalitis]]
====Intracerebral Hemorrhage====
|-
| align="center" style="background:#DCDCDC;" |[[Subarachnoid hemorrhage]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
Rupture of an aneurysm
* [[Aneurysm|Saccular aneurysms]] (most common cause)
* Fusiform [[Aneurysm|aneurysms]]
* Mycotic [[Aneurysm|aneurysms]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
Rupture of an aneurysm
* [[Aneurysm|Saccular aneurysms]] (most common cause)
* Fusiform [[Aneurysm|aneurysms]]
* Mycotic [[Aneurysm|aneurysms]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[Arteriovenous malformation]]
* [[Dural arteriovenous fistula]]
* [[Perimesencephalic nonaneurysmal subarachnoid hemorrhage|Perimesencephalic]]
* [[Arterial dissection|Intracranial arterial dissection]]
* [[Amyloid angiopathy]]
* [[Amyloid angiopathy]]
* [[Haemophilia|Bleeding disorders]]
* Cerebral [[venous thrombosis]]
* [[Hypertension]]
* Cerebral [[vasculitis]]
* [[Drug use|Illicit drug use]] (e.g., [[amphetamines]] or [[cocaine]])
* Reversible vasoconstriction syndrome
* Trauma
* Vascular malformations


* Cerebral hyperperfusion syndrome after [[carotid endarterectomy]]
* Reversible posterior leukoencephalopathy syndrome
* Brain or cervical [[Tumor|tumors]]
* Illicit drug use ([[cocaine]], [[amphetamines]])
|-
| align="center" style="background:#DCDCDC;" |[[Subdural hematoma|Subdural hemorrhage]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Rupture of bridging vessels
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Trauma (motor vehicle accidents, falls, and assaults)
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Aneurysmal [[subarachnoid hemorrhage]]
* [[Arteriovenous malformation]]
* [[Meningioma]]
* Dural metastases
* [[Coagulopathy]]
* Neurosurgical procedures
* [[Cocaine abuse]]
|-
| align="center" style="background:#DCDCDC;" |[[Epidural hemorrhage]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Rupture of middle meningeal arteries
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Trauma (motor vehicle accidents, falls, and assaults)
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|-
| align="center" style="background:#DCDCDC;" |[[Intraparenchymal hemorrhage]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | ---
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Trauma (motor vehicle accidents, falls, and assaults)
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | Rupture of an aneurysm
* [[Aneurysm|Saccular aneurysms]] (most common cause)
* Fusiform [[Aneurysm|aneurysms]]
* Mycotic [[Aneurysm|aneurysms]]
[[Arteriovenous malformation]]
|-
| align="center" style="background:#DCDCDC;" |[[Intraventricular hemorrhage]] (IVH)
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | ---
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Secondary to [[intracerebral hemorrhage]]
* Trauma (motor vehicle accidents, falls, and assaults)
* Vascular malformations (usually [[Arteriovenous malformation|arteriovenous malformations]] or [[Arteriovenous fistula|arteriovenous fistulae]])
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Intraventricular tumors ([[papilloma]], neurocytoma, [[meningioma]], metastases, [[astrocytoma]], [[ependymoma]])
* Intraventricular aneurysms
* [[Moyamoya disease]]
* [[Pituitary apoplexy]]
* [[Vasculitis]]
|}
==References==
==References==
{{Reflist|2}}
{{reflist|2}}
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Latest revision as of 05:00, 30 August 2023

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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

There are several causes for stroke. Some may cause hemorrhage and some causes ischemia. Among all of them there are several lethal causes which we need to be more cautious about them.

Causes

The following table lists causes for stroke.[1][2][3][4][5][6][7][8][9][10]

Causes
Disease Lethal causes Common causes Less common causes
Transient ischemic attack (TIA) Emboli from cardiac source (mostly secondary to AF) Arterial dissection
Ischemic stroke
Intracerebral hemorrhage ---
Subarachnoid hemorrhage

Rupture of an aneurysm

Rupture of an aneurysm

Subdural hemorrhage Rupture of bridging vessels Trauma (motor vehicle accidents, falls, and assaults)
Epidural hemorrhage Rupture of middle meningeal arteries Trauma (motor vehicle accidents, falls, and assaults)
Intraparenchymal hemorrhage --- Trauma (motor vehicle accidents, falls, and assaults) Rupture of an aneurysm

Arteriovenous malformation

Intraventricular hemorrhage (IVH) ---

References

  1. ↑ Kishimoto M, Arakawa KC (2003). "A patient with wegener granulomatosis and intraventricular hemorrhage". J Clin Rheumatol. 9 (6): 354–8. doi:10.1097/01.rhu.0000089967.51779.d7. PMID 17043443.
  2. ↑ Challa VR, Richards F, Davis CH (1981). "Intraventricular hemorrhage from pituitary apoplexy". Surg Neurol. 16 (5): 360–1. PMID 7336321.
  3. ↑ Flint AC, Roebken A, Singh V (2008). "Primary intraventricular hemorrhage: yield of diagnostic angiography and clinical outcome". Neurocrit Care. 8 (3): 330–6. doi:10.1007/s12028-008-9070-2. PMID 18320145.
  4. ↑ Fukutake T (2011). "Cerebral autosomal recessive arteriopathy with subcortical infarcts and leukoencephalopathy (CARASIL): from discovery to gene identification". J Stroke Cerebrovasc Dis. 20 (2): 85–93. doi:10.1016/j.jstrokecerebrovasdis.2010.11.008. PMID 21215656.
  5. ↑ Meretoja A, Strbian D, Putaala J, Curtze S, Haapaniemi E, Mustanoja S; et al. (2012). "SMASH-U: a proposal for etiologic classification of intracerebral hemorrhage". Stroke. 43 (10): 2592–7. doi:10.1161/STROKEAHA.112.661603. PMID 22858729.
  6. ↑ Hart, Robert G., Bradley S. Boop, and David C. Anderson. "Oral anticoagulants and intracranial hemorrhage facts and hypotheses." Stroke 26.8 (1995): 1471-1477.
  7. ↑ Knudsen, Katherine A., et al. "Clinical diagnosis of cerebral amyloid angiopathy: validation of the Boston criteria." Neurology 56.4 (2001): 537-539.
  8. ↑ Lovelock, C. E., A. J. Molyneux, and P. M. Rothwell. "Change in incidence and aetiology of intracerebral haemorrhage in Oxfordshire, UK, between 1981 and 2006: a population-based study." The Lancet Neurology 6.6 (2007): 487-493.
  9. ↑ Rümke CL (1975). "Letter: Implications of the statement: No side effects were observed". N Engl J Med. 292 (7): 372–3. PMID 1117973.
  10. ↑ Hanley DF (2009). "Intraventricular hemorrhage: severity factor and treatment target in spontaneous intracerebral hemorrhage". Stroke. 40 (4): 1533–8. doi:10.1161/STROKEAHA.108.535419. PMC 2744212. PMID 19246695.

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