Classification of ischemia stroke

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Classification of ischemia stroke

• PresentedInt.??? ??
• SupervisorVS ??? ??
• 2008/06/26

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TOAST classification

• Large artery atherosclerosis
• Cardioembolism
• Small vessel occlusion
• Stroke of other determined etiology
• Stroke of undetermined etiology
• Two or more causes identified
• Negative evaluation
• Incomplete evaluation

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Large artery atherosclerosis

• Pathologies affecting large extracranial vessels
  include
• Atherosclerosis, Dissection, Takayasu arteritis,
• Giant cell arteritis, Fibromuscular dysplasia
• Pathologies affecting large intracranial vessels
  include
• Atherosclerosis, Dissection, Arteritis/vasculitis,
  Noninflammatory vasculopathy, Moyamoya syndrome,
  Vasoconstriction

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Cardioembolism
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Small vessel disease

• Lipohyalinosis (a lipid hyaline build-up distally
  secondary to hypertension) and fibrinoid
  degeneration
• Atheroma formation at their origin or in the
  parent large artery

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Anatomy of the cerebral arterial circulation
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Coronal section of cerebral hemisphere
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Stuttering course of thrombotic stroke
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Time course of lacunar infarction
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Time course of embolic stroke
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Stroke of undetermined etiology?

• RiskHeavy smoker (2 ppd)
• MRIMultiple infarction lesion
• Embolism
• Cardiogenic ? ? Cardiac echo,TEE ,24hrs Holtor,s
  EKG
• Artery to artery ?
• Blood disorders?
• C3c, C4 , Antinuclear Ab , Homocysteine
• Protein C , Protein S ,
• Anti-cardiolipin Ab , Anti-phospholipid Ab