Differentiation of Acute Cortical and Subcortical Ischemic Stroke by Risk Factors and Clinical Examination Findings

Abstract

Background: Differentiation between acute cortical and subcortical ischemic stroke may be problematic when cortical stroke presents without obvious cortical deficits such as aphasia, neglect or hemianopia. This study explores stroke risk factors and clinical variables that may assist in this differentiation. Methods: Records of consecutive patients with acute ischemic stroke, examined within 72 h of symptom onset, were reviewed. Stroke type was verified by clinical course and follow-up imaging. Stroke risk factors and acute examination findings were compared by odds ratios and positive predictive values for cortical and subcortical stroke. Results: For 355 patients studied, 237 had cortical stroke and 118 had subcortical stroke. Odds ratios for cortical stroke were highest for atrial fibrillation by EKG (OR = 4.77, CI = 2.08–10.94), recent hospitalization (OR = 4.51, CI = 2.39–8.53) and nonalert mental status (OR = 4.50, CI = 2.29–8.87). Possible cardioembolic condition, ischemic heart disease and peripheral vascular disease were also significant, but hypertension, age and diabetes mellitus were not significantly different for the stroke subtypes. Cortical deficits were absent in 19.4% of cortical stroke patients on initial examination. Predictive models were generated based on the presence or absence of cortical deficits and the interaction of significant risk factors with degree of motor deficit. Conclusions: There are clinical features that, in addition to initial examination, may help differentiate cortical from subcortical ischemic stroke. These features may be relevant to both diagnostic and therapeutic approaches to acute stroke.

The AGES-Reykjavik Study suggests that change in kidney measures is associated with subclinical brain pathology in older community-dwelling persons

“…Cortical infarcts are usually the result of an embolus from the heart or large arteries (i.e., the aortic arch or carotid artery), whereas subcortical infarcts are caused by blockage of small penetrating arteries, and thus they are categorized as manifestations of cerebral small vessel diseases. 14 This is in line with the literature considering brain–kidney interactions to be based on small vessel disease in both organs. 15 In the present study we showed that larger decline in eGFR was associated with greater progression in white matter hyperintensity volume.…”

Cerebrovascular Reactivity and Subcortical Infarctions

“…29,33 Among risk factors for stroke, age, hypertension, and diabetes mellitus were not found to be significantly different in cortical and subcortical stroke. 34 However, hypertension was shown to be strongly and independently correlated with silent cerebral infarctions. [35][36][37][38] Silent cerebral infarctions are frequently shown by CT and MRI in the subcortical white matter or the basal ganglia in patients who have had a stroke and in elderly subjects.…”

The Motor Recovery Related with Brain Lesion in Patients with Intracranial Hemorrhage

“…In these studies, the size of the lesion in the brain was not related to functional outcome [ 2 , 3 ]. Few studies have reported on the relationships between brain lesions and functional recovery [ 5 – 7 ].…”