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  • Print publication year: 2009
  • Online publication date: May 2010

2 - Common causes of ischemic stroke

from Section I - Etiology, pathophysiology and imaging

Summary

Introduction

This chapter focuses on the major causes of ischemic stroke. Common and less common stroke syndromes are described in Chapters 8 and 9.

Ischemic stroke is not a single disease but a heterogeneous condition with several very different pathophysiological mechanisms. Identification of the underlying cause is important for several reasons. It helps to group patients into specific subtypes for the study of different aspects of prognosis, which may be used for planning and information purposes. It also helps for selecting patients for some specific therapies, which are among the most effective secondary preventive measures currently available. Identification of the mechanism of ischemic stroke should therefore be part of the routine diagnostic workup in clinical practice.

Cerebral infarction is generally caused by one of three pathogenic mechanisms:

large artery atherosclerosis in extracranial and large intracranial arteries

embolism from the heart

intracranial small-vessel disease (lacunar infarcts).

These three types account for about 75% of all ischemic strokes (Figure 2.1). In about 20% of patients no clear cause of ischemic stroke can be identified despite appropriate investigations; this is labeled cryptogenic stroke. About 5% of all ischemic strokes result from more uncommon causes. These frequencies relate to ischemic stroke aggregating all age groups: in younger patients with stroke the pathogenic spectrum is much different, with arterial dissection as the most common single cause in patients <45 years of age (Chapter 9, Less common stroke syndromes).

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