Ischemic (85%): Cardioembolic (20%); Atherothrombotic (25-30%); Lacunar/Small Vessel (15-20%); Cryptogenic 25-30%; Other/Uncommon (5-10%) e.g. paradoxic from PFO, ASD, HHT
Hemorrhagic (15%): Bleeding into and/or around the brain
Cerebral venous sinus thrombosis
Risk Factors
Hypertension
Smoking
Diabetes
Past stroke
Hyperlipidemia
COVID 19
Family history vascular disease
Atrial fibrillation
Left ventricular thrombus
Prosthetic valve
Hypercoaguable state
For cerbebral venous sinus thrombosis (CVT): inflammation, hypercoaguable state
Symptoms
Acute loss of an objective neurological function, typically reaching peak severity of symptoms in seconds to minutes
Anterior Circulation - Left Middle Cerebral Artery (dominant hemisphere): Can affect frontal, temporal and parietal lobes - can cause aphasia (Brocas--> expression or Wernickes--> comprehension), left gaze preference, right visual field deficit (homonymous hemianopsia), right hemiparesis (facial droop, drift, plegia), right hemisensory loss
Anterior Circulation - Right Middle Cerebral Artery: Can affect frontal, temporal and parietal lobes; can cause right gaze preference, left visual field defect, left hemiparesis, left hemisensory loss, left neglect (doesn't move left side of body, doesn't feel touching of left side, doesn't see object in left field)
Anterior Circulation (Anterior Cerebral Artery): Frontal lobes - contralateral leg weakness more than arm, disinhibition, loss of executive function
Posterior Circulation (Vertebral-Basilar System - PCA): Can affect occipital, medial temporal lobes and thalamus; can cause cortical blindness, homonymous hemianopsia, behavior changes, contralateral sensory loss, aphasia, impaired executive function, decreased loc, memory impairment
Posterior Circulation (Verebral-Basilar System): Other symptoms include - crossed motor and sensory findings (ie ipsilateral face, contralateral body), nystagmus, ataxia, vertigo, diplopia from eye movement abnormalities, dysarthria, tongue deviation, Horner's syndrome, dysphagia, locked-in syndrome
Posterior Circulation (SCA, AICA, PICA): Cerebellar - ataxia, nystagmus, nausea/vomiting, dysarthria, headache, loss of consciousness
Lacunar (thrombosis of penetrating arteries): pure motor (posterior limb internal capsule) to face, arm, leg; pure sensory (thalamic) w/numbness of face, arm, leg; motor and sensory (juncture between thalamus and internal capsule); unilateral ataxia and weakness (corona radiata); dysarthria, dysphagia, decreased fine motor/clumsy hand