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:
- 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]
- Antiphospholipid syndrome
- Atrial fibrillation and paroxysmal atrial fibrillation
- Atrial or ventricular thrombus
- Bioprosthetic and mechanical heart valves
- Chronic myocardial infarction together with ejection fraction <28 percent
- Coronary artery bypass graft (CABG) surgery
- Dilated cardiomyopathy
- Infective endocarditis
- Left atrial myxoma
- Libman-Sacks endocarditis
- Marantic endocarditis from cancer
- Papillary fibroelastoma
- Recent myocardial infarction (within one month)
- Rheumatic mitral or aortic valve disease
- Sick sinus syndrome
- Sustained atrial flutter
- Symptomatic congestive heart failure with ejection fraction <30 percent
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)
- 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
- Amyloid angiopathy
- Bleeding disorders
- Hypertension
- Illicit drug use (e.g., amphetamines or cocaine)
- Trauma
- 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.