Ischemic stroke subtypes: risk factors, functional outcome and recurrence

Abstract

The etiology of ischemic stroke affects its prognosis, outcome and management. Our aims were to determine risk factors, clinical and imaging variables and prognostic differences in acute ischemic stroke subtypes. In this study, we prospectively investigated 264 consecutive patients with acute ischemic stroke between 1996 and 2000. All of the patients were categorized to one of four major ischemic stroke subtype based on TOAST (Trial of Org 10172 in Acute Stroke Treatment) criteria. The mean age was greater in patients with stroke of undetermined etiology (SUE). Prevalence of hypertension was higher in patients with lacunar infarct (LAC) than other subtypes. Smoking was less frequent in patients with cardioembolism (CARD). The mean infarct size was largest in patients with large artery atherosclerosis (LAA) while there were no differences in location or conversion of the infarct into hemorrhage. The proportion of the patients with milder neurological deficits at entry was higher in patients with LAC subtype. The rate of independent patients were different between subtypes: 62% in LAC, 43% in CARD, 38% in SUE, 35% in LAA at discharge ( p=0.01), and 91% in LAC, 69% in CARD, 59% in SUE, 60% in LAA at 6 months ( p<0.001). Recurrence rates were not different between groups. We conclude that risk factors, clinical imaging variables are different among ischemic stroke subtypes and that neurological status on admission and during follow-up strongly favors LAC.

Family History in Ischemic Stroke Before 70 Years of Age

“…Other investigators 15,16 have reported similar results. A novel finding in our study is that family history of stroke was associated with a favorable outcome at 3 months, independent of subtype and vascular risk factors.…”

Atherosclerotic Plaque Ulceration in the Symptomatic Internal Carotid Artery Is Associated With Nonlacunar Ischemic Stroke

“…Previous studies have suggested lacunar strokes to be predominantly associated with hypertension and diabetes mellitus. 15,16 However, in a review by Jackson et al, 3 only a marginal increase was shown in the prevalence of hypertension in patients with lacunar stroke as compared to nonlacunar stroke. In the present study, a risk factor-free stroke subtype classification was used and stroke subtypes were differentiated based on clinical symptoms and MDCT imaging of the brain.…”

Frequency and mechanisms of stroke recurrence after cryptogenic stroke

“…However, these reports did not define the NC group as a separate group in their analysis, and most of them considered this group as one of "ischemic stroke of unknown cause." [2][3][4][5]7 In this study, we compared stroke recurrence and prognosis of patients of the NC group with those of other subtypes. To the best of our knowledge, this is the first prospective study on series of patients with ischemic stroke with no determined cause evaluated according to a protocol that included DWI, echocardiogram, and carotid duplex, in which information concerning hospital course, stroke recurrence, and prognosis follow-up of 1 year was included.…”

“…1 In TOAST classification, the stroke with no determined cause was included as one of subgroups of "ischemic stroke of unknown cause," 1 and, in most studies until recently, stroke prognosis and recurrence and their prognostic factors were analyzed accordingly. [2][3][4][5] Approximately 40% of ischemic strokes have no clearly definable cause after extensive workup and are termed cryptogenic strokes. 6 However, data on long-term follow-up and type of recurrent stroke in patients with cryptogenic stroke have seldom been reported.…”