Rheumatoid arthritis (RA) is an autoimmune disease that is characterized by an inflammatory, symmetric polyarthritis. The mechanisms by which RA patients are predisposed to stroke are varied. The most common of these causes is atherosclerotic disease, which seems to be accelerated by the underlying RA. The role of systemic inflammation in mediating atherosclerotic disease is becoming clear and may be the underlying link between RA and vascular events. Systemic vasculitis in RA involves the vasa nervorum of the peripheral nervous system. Meningeal and brain biopsy remains the gold standard in confirming a diagnosis of vasculitis in RA patients. Although there is a theoretical risk of mechanical injury to the vertebral artery due to cervical arthritis and atlantoaxial subluxation in RA, this most often results in cervical myelopathy. Stroke due to vertebral dissection has been reported in RA, but the vertebral artery occlusion was sometimes associated with only minimal atlantoaxial subluxation.

Minimal change disease (MCD) is the most common cause of nephrotic syndrome in children, although it is not uncommon among adults. Endothelial cell injury, platelet hyperreactivity and hyperaggregability secondary to increased activity of adenosine biphosphate lead to thrombosis. Microalbuminuria is an index of generalized vascular endothelial dysfunction, especially in hypertension and diabetes and a well-recognized risk factor for stroke in men and women, independent of other vascular risk factors and regardless of stroke mechanism. Hyperlipidemia may also contribute to the increased risk for thrombosis seen in nephrotic syndrome. Cerebral arterial infarction is an uncommon yet treatable cause of stroke in patients with nephrotic syndrome, predominantly in patients with membranous glomerulo nephropathy (MGN) followed by focal segmental glomerulosclerosis and immunoglobulin A (IgA) nephropathy, and rarely minimal change nephropathy. Magnetic resonance angiography and magnetic resonance venography are helpful to confirm the diagnosis, and dye contrast catheter cerebral angiography is rarely necessary.