Neurology Book


Stroke Pathophysiology

Aka: Stroke Pathophysiology, CVA Causes, Transient Ischemic Attack Causes, TIA Risk Factors, Cerebrovascular Accident Risk Factors, CVA Risk Factors
  1. See Also
    1. Cerebrovascular Accident
    2. Cerebrovascular Accident Risk in Women
    3. Prevention of Ischemic Stroke
  2. Epidemiology
    1. Modifiable risk factors are responsible for 87% of stroke risk (e.g. Obesity, diabetes, Hypertension, Hyperlipidemia)
    2. Behavioral factors are responsible for 47% of modifiable factors (e.g. smoking, sedentary, unhealthy diet)
  3. Risk Factors
    1. Hypertension (increased systolic Blood Pressure)
      1. Hypertension Management (with Diuretic or ACE Inhibitor) significantly lowers the risk of CVA
      2. (2001) Lancet 358(9287):1033-41 [PubMed]
    2. African American or Hispanic Race
    3. Hypothyroidism
    4. Obesity
    5. Sedentary lifestyle
    6. Family History of CVA or Hyperlipidemia
    7. Age over 65 years
    8. Diabetes Mellitus
    9. Coronary Artery Disease
    10. Increased Apolipoprotein-a
    11. Obstructive Sleep Apnea
      1. Consider Sleep Study in cryptogenic stroke if suspected Sleep Apnea
    12. Migraine Headache with aura
      1. Especially in women over age 35, Tobacco Abuse or Oral Contraceptive use
    13. Cigarette smoking (Tobacco Abuse)
      1. Particularly if Oral Contraceptive use age >35 years
    14. Aortic Arch Plaque
      1. Evaluated by TEE Echocardiogram
      2. Measured aortic arch wall thickness
      3. Risk increased 4 fold with thickness >3 mm
        1. Any vascular event
        2. Recurrent Ischemic CVA
      4. Reference
        1. (1996) N Engl J Med, 334:1216-21 [PubMed]
    15. Hypercholesterolemia or Hypertriglyceridemia
      1. Meta-analysis on Cholesterol and Stroke: No effect
        1. Eleven trials, total N=36,000
        2. Cholesterol reduction: 6 to 23%
        3. No significant reduction in fatal or non-fatal CVA
        4. No decrease CVA for selected high risk CAD patients
      2. Reference
        1. Hebert (1995) Arch Intern Med 155:50-5 [PubMed]
  4. Prevention: Protective factors
    1. Lower CVA risk with moderate Alcohol use
      1. Reynolds (2003) JAMA 289:579-88 [PubMed]
  5. Causes
    1. Vessel wall embolus (most common)
      1. Carotid Artery most often the source
      2. Related to thrombus formation distal to stenosis
    2. Cardiac source (Hemispheric attack >60 minutes)
      1. Atrial Fibrillation
        1. For those with crypogenic CVA, consider insertable cardiac monitor (or non-invasive monitor)
        2. Paroxymsal Atrial Fibrillation episodes >2.5 minutes may be significant CVA risk
      2. Mitral valve stenosis
      3. Mitral Valve Prolapse
      4. Calcified mitral annulus
      5. Ventricular aneurysm or Dyskinesia
      6. Atrial or ventricular clot
      7. Valvular vegetation
      8. Atrial Septal Defect
    3. Other vascular sources
      1. Intracranial artery thrombus (esp. African-Americans)
      2. Aortic arch atherosclerotic Plaque
      3. Transient Hypotension with Carotid Stenosis >75%
    4. Less common etiologies (age <45 years)
      1. Subclavian Steal Syndrome
      2. Hyperviscosity Syndrome (e.g. Polycythemia Vera, Leukemia, Multiple Myeloma)
      3. Hypercoagulable State
      4. Carotid dissection
      5. Vertebral Artery Dissection
      6. Moyamoya Disease
  6. References
    1. Choi (2022) Am Fam Physician 105(6): 616-24 [PubMed]
    2. Sacco (2001) Neurology 57:S31-4 [PubMed]

Transient Ischemic Attack (C0007787)

Definition (CHV) mini stroke which is recoverable
Definition (CHV) mini stroke which is recoverable
Definition (CHV) mini stroke which is recoverable
Definition (CHV) mini stroke which is recoverable
Definition (CHV) mini stroke which is recoverable
Definition (CHV) mini stroke which is recoverable
Definition (CHV) mini stroke which is recoverable
Definition (CHV) mini stroke which is recoverable
Definition (CHV) mini stroke which is recoverable
Definition (CHV) mini stroke which is recoverable
Definition (CHV) mini stroke which is recoverable
Definition (CHV) mini stroke which is recoverable
Definition (MEDLINEPLUS)

A transient ischemic attack (TIA) is a stroke that comes and goes quickly. It happens when the blood supply to part of the brain stops briefly. Symptoms of a TIA are like other stroke symptoms, but do not last as long. They happen suddenly, and include

  • Numbness or weakness, especially on one side of the body
  • Confusion or trouble speaking or understanding speech
  • Trouble seeing in one or both eyes
  • Loss of balance or coordination

Most symptoms of a TIA disappear within an hour, although they may last for up to 24 hours. Because you cannot tell if these symptoms are from a TIA or a stroke, you should get to the hospital quickly.

TIAs are often a warning sign for future strokes. Taking medicine, such as blood thinners, may reduce your risk of a stroke. Your doctor might also recommend surgery.

NIH: National Institute of Neurological Disorders and Stroke

Definition (NCI) A brief attack (from a few minutes to an hour) of cerebral dysfunction of vascular origin, with no persistent neurological deficit.
Definition (NCI_CTCAE) A disorder characterized by a brief attack (less than 24 hours) of cerebral dysfunction of vascular origin, with no persistent neurological deficit.
Definition (NCI_FDA) A brief attack (from a few minutes to an hour) of cerebral dysfunction of vascular origin, with no persistent neurological deficit.
Definition (MSH) Brief reversible episodes of focal, nonconvulsive ischemic dysfunction of the brain having a duration of less than 24 hours, and usually less than one hour, caused by transient thrombotic or embolic blood vessel occlusion or stenosis. Events may be classified by arterial distribution, temporal pattern, or etiology (e.g., embolic vs. thrombotic). (From Adams et al., Principles of Neurology, 6th ed, pp814-6)
Definition (CSP) recurring, transient episodes of neurologic dysfunction caused by cerebral ischemia; onset is usually sudden, often when the patient is active; the attack may last a few seconds to several hours; neurologic symptoms depend on the artery involved.
Concepts Disease or Syndrome (T047)
MSH D002546
ICD10 G45.9
SnomedCT 155404005, 313242003, 266314007, 195196001, 195207009, 38609002, 266257000
LNC MTHU020810, LA14278-8
English Attacks, Transient Ischemic, Ischemic Attack, Transient, Ischemic Attacks, Transient, Transient Ischemic Attack, Transient Ischemic Attacks, Attack, Transient Ischemic, TIA - Transient ischaem attack, TIA - Transient ischemic attack, Transient cerebral ischaemic attack, unspecified, Transient cerebral ischemic attack, unspecified, TRANSIENT ISCHAEMIC ATTACK, transient cerebral ischemic attack, transient ischemic attack (diagnosis), transient ischemic attack (TIA), transient ischemic attack, Transient ischemic attacks, TIA (Transient Ischemic Attack), Brain TIA, TIA, Brain, Ischemic Attack, Transient [Disease/Finding], transient cerebral ischemia, transient ischaemic attacks, brain tia, tia brain, attack ischemic transient, ischemic attack transient, attacks ischemic transient, transient ischemic attacks, TIAs (Transient Ischemic Attack), Transient ischaemic attacks, Transient ischemic attacks (disorder), Transient cerebral ischaemia NOS (disorder), Transient cerebral ischaemia NOS, Transient cerebral ischemia NOS, Transient cerebral ischemia (disorder), ATTACK, TRANSIENT ISCHEMIC, ISCHEMIC ATTACK, TRANSIENT, TRANSIENT ISCHEMIC ATTACK, Transient ischemic attack - TIA, Transient cerebral ischemia, TIA, Transient ischemic attack, Temporary cerebral vascular dysfunction, TIA - Transient ischaemic attack, Transient cerebral ischaemia, Transient ischaemic attack, Transient ischemic attack (disorder), attack; transient, transient; attack, Transient cerebral ischemia, NOS, Transient cerebral ischaemia, NOS, Transient cerebral ischemia (disorder) [Ambiguous], transient ischaemic attack
Dutch transient ischaemic attacks, transient ischemic attack, attack; transient, transient; attack, 'Transient (cerebral) ischaemic attack' [TIA], niet gespecificeerd, transient ischaemic attack, Attack, transient ischaemic (TIA), Ischaemic attack, transient (TIA), TIA, Transient ischaemic attack (TIA)
French AIT, Accidents ischémiques transitoires, Accident ischémique cérébral transitoire, Accident ischémique transitoire, ACCIDENT ISCHEMIQUE TRANSITOIRE, AIT (Accident Ischémique Transitoire), Accidents ischémiques cérébraux transitoires, Accès ischémique transitoire cérébral, Accès ischémiques transitoires cérébraux
German transitorische ischaemische Attacken, Zerebrale transitorische ischaemische Attacke, nicht naeher bezeichnet, Transitorische ischaemische Attacken, Transitorische ischaemische Attacke, transitorische ischaemische Attacke, TIA, Ischämische Attacke, transitorische, Transitorisch-ischämische Attacken
Italian Attacchi ischemici transitori, TIA (Attacco ischemico transitorio), Attacco ischemico transitorio
Portuguese Ataques isquémicos transitórios, AIT, ACIDENTE ISQUEMICO TRANSITORIO, Acidentes isquémicos transitórios, Isquemia do Tronco Encefálico Transitória, TIA, Acidente isquémico transitório, Ataque Isquêmico Transitório
Spanish Accidentes isquémicos transitorios, ataques isquémicos transitorios, isquemia cerebral transitoria, SAI, Transient cerebral ischemia NOS, Transient cerebral ischaemia NOS, accidente isquémico transitorio (trastorno), ataques isquémicos transitorios (trastorno), isquemia cerebral transitoria, SAI (trastorno), TIA, Isquemia del Tronco Encefálico Transitoria, AIT, accidente isquémico transitorio (concepto no activo), accidente isquémico transitorio, ataque isquémico transitorio (trastorno), ataque isquémico transitorio, disfunción vascular cerebral temporal, isquemia cerebral transitoria, Accidente isquémico transitorio, Ataque Isquémico Transitorio
Swedish Hjärnischemi, övergående
Japanese イッカセイノウキョケツホッサ, TIA, TIA, 漸強性一過性脳虚血発作, 脳幹虚血-一過性, 可逆的虚血性神経性欠損, 脳虚血発作-一過性, 回復性虚血性神経脱落徴候, 可逆的虚血性神経障害, 一過性脳虚血, 一過性脳虚血発作, 一過性脳幹虚血, 脳虚血-一過性
Finnish Ohimenevä aivoverenkiertohäiriö
Czech Tranzitorní ischemické ataky, Tranzitorní ischemická ataka, mozek - ischémie tranzitorní, TIA, přechodná mozková ischémie, mozek - ischémie přechodná, uzávěr a zúžení mozkových tepen nekončící mozkovým infarktem, tranzitorní ischemická příhoda, tranzitorní ischemická ataka, transientní ischemická ataka
Korean 상세불명의 일과성 대뇌 허혈성 발작
Polish Miniudar mózgu, Przemijający epizod niedokrwienia mózgu, TIA, Incydent przemijającego niedokrwienia mózgu, Przemijające objawy ubytkowe, Przejściowy atak niedokrwienny, Przemijający napad niedokrwienny mózgu, Niedokrwienie mózgu przejściowe, Przejściowe niedokrwienie mózgu
Hungarian Transiens ischaemiás attack, Átmeneti ischaemiás rohamok, TIA, Átmeneti ischaemiás roham
Norwegian TIA, Drypp, Transitorisk iskemisk atakk
Derived from the NIH UMLS (Unified Medical Language System)

Cerebrovascular accident (C0038454)

Definition (MEDLINEPLUS)

A stroke is a medical emergency. Strokes happen when blood flow to your brain stops. Within minutes, brain cells begin to die. There are two kinds of stroke. The more common kind, called ischemic stroke, is caused by a blood clot that blocks or plugs a blood vessel in the brain. The other kind, called hemorrhagic stroke, is caused by a blood vessel that breaks and bleeds into the brain. "Mini-strokes" or transient ischemic attacks (TIAs), occur when the blood supply to the brain is briefly interrupted.

Symptoms of stroke are

  • Sudden numbness or weakness of the face, arm or leg (especially on one side of the body)
  • Sudden confusion, trouble speaking or understanding speech
  • Sudden trouble seeing in one or both eyes
  • Sudden trouble walking, dizziness, loss of balance or coordination
  • Sudden severe headache with no known cause

If you have any of these symptoms, you must get to a hospital quickly to begin treatment. Acute stroke therapies try to stop a stroke while it is happening by quickly dissolving the blood clot or by stopping the bleeding. Post-stroke rehabilitation helps individuals overcome disabilities that result from stroke damage. Drug therapy with blood thinners is the most common treatment for stroke.

NIH: National Institute of Neurological Disorders and Stroke

Definition (MSHCZE) Cévní mozková příhoda zkr. CMP – postižení určitého okrsku mozkové tkáně na podkladu poruchy cév (srov. cerebrovaskulární nemoci), tj. jejich neprůchodnosti s následnou ischemií (mozkový infarkt) nebo poruchy celistvosti cévní stěny s následným krvácením do mozkové tkáně (mozkové krvácení). Projevy jsou od dočasných poruch hybnosti a řeči až po bezvědomí, ochrnutí a smrt. Kromě strukturního poškození se na příznacích podílí event. vzniklý edém mozku s intrakraniální hypertenzí. Příčinou bývá ateroskleróza mozkových tepen často v kombinaci s hypertenzí. Příčinou krvácení může být ianeurysma některé mozkové tepny srov. subarachnoidální krvácení. Drobnější CMP na ischemickém podkladě se označuje TIA. V diagnostice se uplatňuje zejm. CT, ev. MRI, v některých případech ev. angiografie. Jiné názvy apoplexie, iktus, laicky „mozková mrtvice“. (cit. Velký lékařský slovník online, 2013 )
Definition (NCI) A sudden loss of neurological function secondary to hemorrhage or ischemia in the brain parenchyma due to a vascular event. Infarction or hemorrhage may be demonstrated either directly by imaging, laboratory, or pathologic examination in patients with symptom duration less than 24 hours, or inferred by symptoms lasting greater than or equal to 24 hours (or fatal within 24 hours) that cannot be attributed to another cause. Diagnostic tests include CT scan, MRI, angiography, and EEG to locate and evaluate the extent of the hemorrhagic or ischemic damage in the brain parenchyma, coagulation studies, complete blood count, comprehensive metabolic panel, and urinalysis.
Definition (NCI_NCI-GLOSS) In medicine, a loss of blood flow to part of the brain, which damages brain tissue. Strokes are caused by blood clots and broken blood vessels in the brain. Symptoms include dizziness, numbness, weakness on one side of the body, and problems with talking, writing, or understanding language. The risk of stroke is increased by high blood pressure, older age, smoking, diabetes, high cholesterol, heart disease, atherosclerosis (a build-up of fatty material and plaque inside the coronary arteries), and a family history of stroke.
Definition (NCI_CDISC) An acute episode of focal or global neurological dysfunction caused by presumed brain, spinal cord, or retinal vascular injury as a result of hemorrhage or infarction but with insufficient information to allow categorization as ischemic or hemorrhagic.
Definition (NCI_CTCAE) A disorder characterized by a sudden loss of sensory function due to an intracranial vascular event.
Definition (CSP) sudden neurologic impairment due to a cerebrovascular disorder, either an arterial occlusion or an intracranial hemorrhage.
Definition (MSH) A group of pathological conditions characterized by sudden, non-convulsive loss of neurological function due to BRAIN ISCHEMIA or INTRACRANIAL HEMORRHAGES. Stroke is classified by the type of tissue NECROSIS, such as the anatomic location, vasculature involved, etiology, age of the affected individual, and hemorrhagic vs. non-hemorrhagic nature. (From Adams et al., Principles of Neurology, 6th ed, pp777-810)
Concepts Disease or Syndrome (T047)
MSH D020521
ICD10 I64, I63.9
SnomedCT 270883006, 155405006, 82797006, 155388006, 266315008, 195208004, 313267000, 266312006, 230690007
LNC MTHU020801
English Cerebrovascular accident, CVA, Apoplexy, Stroke Syndrome, Stroke and cerebrovascular accident unspecified, Stroke, not specified as haemorrhage or infarction, Stroke, not specified as hemorrhage or infarction, CEREBROVASCULAR ACCIDENT, Strokes, CEREBRAL INFARCTION, Stroke, Cerebrovascular Accident, CVA (cerebral vascular accident), cerebral vascular accident, Stroke/CVA unspecified, Accident cerebrovascular, Cerebrovascular accident NOS, Brain Vascular Accident, Brain Vascular Accidents, Vascular Accident, Brain, Vascular Accidents, Brain, CVA (Cerebrovascular Accident), Apoplexy, Cerebrovascular, Cerebrovascular Apoplexy, Cerebral Stroke, Cerebral Strokes, Stroke, Cerebral, Strokes, Cerebral, Cerebrovascular Stroke, Cerebrovascular Strokes, Stroke, Cerebrovascular, Strokes, Cerebrovascular, Stroke NOS, Stroke [Disease/Finding], cerebrovascular accidents, stroke cerebral, stroke, strokes, vascular cerebral accident, vascular brain accident, cerebral stroke, cerebrovascular stroke, CVAs (Cerebrovascular Accident), Brain Attack, Brain attack, Cerebrovascular accidents, Stroke and cerebrovascular accident unspecified (disorder), Stroke/CVA - undefined, Accident - cerebrovascular, CVA - Cerebrovascular accident unspecified, Stroke unspecified, CVA - cerebrovascular accident (& unspecified [& stroke]) (disorder), Stroke NOS (disorder), CVA unspecified, CVA - cerebrovascular accident (& unspecified [& stroke]), SYNDROME, STROKE, Undetermined Stroke, CVA, CEREBROVASCULAR ACCIDENT, STROKE SYNDROME, STROKE, CEREBROVASCULAR ACCIDENT, (CVA), CVA - Cerebrovascular accident, Cerebrovascular accident (disorder), Stroke/cerebrovascular accident, cerebrovascular accident, apoplexy, cerebral; accident, cerebral; apoplexy, cerebrovascular; accident, accident; cerebral, accident; cerebrovascular, stroke; apoplectic, apoplexy; cerebral, apoplexy; stroke, Apoplexy, NOS, CVA, NOS, Cerebral apoplexy, NOS, Cerebrovascular accident, NOS, Stroke, NOS, Cerebral apoplexy, Cerebrovascular accident (disorder) [Ambiguous], Cerebrovascular Accidents, Stroke (Cerebrum)
Italian Accidente cerebrovascolare, Accidente cerebrovascolare NAS, Ictus, Apoplessia cerebrale, CVA (Incidente cerebrovascolare), Apoplessia cerebrovascolare, Incidente cerebrovascolare, Incidente vascolare cerebrale, Stroke, Apoplessia, Ictus cerebrale
Dutch accident cerebrovasculair, apoplexie, cerebrovasculair accident NAO, beroerte, Cerebrovasculair accident (CVA), accident; cerebraal, accident; cerebrovasculair, apoplexie; beroerte, apoplexie; cerebraal, beroerte; apoplexie, cerebraal; accident, cerebraal; apoplexie, cerebrovasculair; accident, Beroerte, niet gespecificeerd als bloeding of infarct, cerebrovasculair accident, Accident, cerebrovasculair, Apoplexie, Beroerte, CVA, Cerebrale beroerte, Cerebrovasculair accident, Cerebrovasculaire apoplexie, Vasculair accident van de hersenen
French Accident, cérébrovasculaire, Apoplexie, Accident cérébro-vasculaire SAI, AVC, Ictus, ACCIDENT VASCULAIRE CEREBRAL, Accident cérébrovasculaire, Accident vasculaire cérébral, Accident ischémique cérébral, AVC (Accident Vasculaire Cérébral), Accident cérébro-vasculaire, Apoplexie cérébrale, Attaque d'apoplexie
German CVA, Schlaganfall NNB, SCHLAGANFALL, Schlaganfall, nicht als Blutung oder Infarkt bezeichnet, apoplektischer Insult, Apoplexie, Schlaganfall, Zerebraler Schlaganfall, Vaskulärer Insult des Gehirns, Zerebrovaskuläre Apoplexie, Zerebrovaskulärer Insult
Portuguese Acidente vascular cerebral, Acidente vascular cerebral NE, Acidente Vascular Encefálico, Acidente Cerebrovascular, ACIDENTE VASCULAR CEREBRAL, Apoplexia Cerebrovascular, Acidente Vascular Cerebral, AVC, Apoplexia Cerebral, Icto Cerebral, Acidente Vascular do Cérebro, Acidentes Cerebrovasculares, Ictus Cerebral, AVE, Acidente Cerebral Vascular, Acidentes Vasculares Cerebrais, Acidentes Cerebrais Vasculares, Derrame Cerebral, Acidente cerebrovascular, Apoplexia
Spanish Accidente cerebrovascular NEOM, Accidente cerebral vascular, ICTUS, Apoplejía Cerebrovascular, apoplejía, accidente cerebrovascular, no especificado, apoplejía cerebral, accidente cerebrovascular, SAI (trastorno), accidente cerebrovascular, no especificado (trastorno), stroke, ACV, SAI, accidente cerebrovascular, SAI, Accidente Vascular Cerebral, Ataque, AVE, Apoplejía Cerebral, Ictus, Accidente Vascular del Cerebro, Accidentes Cerebrovasculares, Ictus Cerebral, AVC, Derrame Cerebral, Accidente Cerebral Vascular, ACV, accidente cerebrovascular (concepto no activo), accidente cerebrovascular (trastorno), accidente cerebrovascular, Accidente cerebrovascular, Accidente Cerebrovascular, Accidente Vascular Encefálico, Apoplejía, Ataque Cerebral
Japanese 脳血管発作NOS, ソッチュウ, ノウケッカンホッサNOS, ノウケッカンホッサ, ノウソッチュウ, 脳血管発作, 血管発作-脳血管, ストローク, 卒中, 卒中発作, 発作症候群, 脳クリーゼ, 脳出血発作症候群, 脳卒中, 脳卒中発作, 脳発症
Swedish Slaganfall
Czech cévní mozková příhoda, apoplexie, mozková mrtvice, Apoplexie, Cévní mozková příhoda, Cévní mozková příhoda NOS, Mozková příhoda, ictus, iktus, CMP
Finnish Aivohalvaus
Korean 출혈 또는 경색증으로 명시되지 않은 뇌중풍
Polish Apopleksja, Udar mózgowy, Ostry udar mózgu, Udar mózgu, Incydent naczyniowo-mózgowy
Hungarian Stroke, Cerebrovascularis esemény, Cerebralis insultus k.m.n., Cerebralis insultus, Apoplexia, CVA
Norwegian Hjerneslag, Slag, Apopleksi, Cerebrovaskulær hendelse
Derived from the NIH UMLS (Unified Medical Language System)

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