Causes of ischemic stroke
What are the major etiologies of ischemic stroke?
The major etiologies of ischemic stroke are
(1) cardioembolism;
(2) small vessel vasculopathy (arteriolosclerosis, lipohyalinosis) involving the penetrating arteries branching off the middle cerebral artery, anterior cerebral artery, posterior cerebral artery, or basilar arteries; and
(3) large vessel atherosclerosis due to plaque rupture involving the intracranial or extracranial cerebral arteries.
Here is the table lists characteristics of these etiologic stroke subtypes.
Clues to the Most Common Ischemic Stroke Etiologies
| Etiology | Clinical Features |
|---|---|
| Large vessel atherosclerosis | Plaque rupture results in in situ large artery thrombosis or artery-to-artery thromboembolism Often occurs in early morning hours/on waking History of TIAs in same vascular distribution Symptoms may fluctuate |
| Cardioembolism | History or clinical features of heart disease Stroke symptoms are maximal at onset as clot is preformed TIA symptoms are usually different from one another, representing emboli to different vascular distributions Often occurs during waking hours Can be associated with Valsalva Caused by embolism, usually from left atrial appendage (in the setting of atrial fibrillation) or left ventricle (in the case of akinetic segment) May have strokes of different ages in different vascular territories |
| Small vessel vasculopathy | Strong association with hypertension and diabetes Diameter <1.5 cm Occurs in subcortical regions such as basal ganglia, thalamus, or brain stem Never see cortical findings (aphasia, neglect) Symptoms may fluctuate dramatically May have TIAs with similar symptoms Occlusion of small penetrating arteries is not always due to small vessel etiology—alternate etiologies must be evaluated |
TIA , Transient ischemic attack.
