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Stroke PathophysiologyAka: CVA Causes, Transient Ischemic Attack Causes, TIA Risk Factors, Cerebrovascular Accident Risk Factors

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  1. Risk Factors
    1. Hypertension (increased systolic Blood Pressure)
    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. Cigarette smoking (Tobacco abuse)
      1. Particularly if Oral Contraceptive use age >35 years
    12. 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
    13. 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
  2. Protective factors
    1. Lower CVA risk with moderate Alcohol use
      1. Reynolds (2003) JAMA 289:579
  3. 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
      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 (e.g. Polycythemia Vera)
      3. Hypercoagulable State
      4. Carotid dissection
      5. Vertebral artery dissection
  4. References
    1. Sacco (2001) Neurology 57:S31

Transient Ischemic Attack (C0007787)

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.
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)A brief attack (from a few minutes to an hour) of cerebral dysfunction of vascular origin, with no persistent neurological deficit.
ConceptsDisease or Syndrome (T047)
ICD9435.9
MSHD002546
EnglishBrain TIA, Intermittent cerebral ischemia, Temporary cerebral vascular dysfunction, TIA, TIA - Transient ischaemic attack, Transient cerebral ischaemia, Transient cerebral ischemia, transient cerebral ischemic attack, Transient ischaemic attack, Transient ischaemic attacks, Transient Ischemic Attack, Transient Ischemic Attacks
Spanishaccidente isquemico transitorio, AIT, ataque isquemico transitorio, ataques isquemicos transitorios, disfuncion vascular cerebral temporal, isquemia cerebral transitoria
Parent Conceptscerebral ischemia or hypoxia (C0679443), Cerebral Hypoxia-Ischemia (C0178540), Brain Ischemia (C0007786), Cerebrovascular Disorders (C0007820), Transient Ischemic Attack (C0007787), Ambiguous concept (C1274012), Duplicate concept (C1274013)
SourcesAOD, COSTAR, CSP, CST, DXP, LNC, MEDLINEPLUS, MSH, MTH, MTHICD9, NCI, NDFRT, OMIM, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)


Cerebrovascular accident (C0038454)

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)
Definition (NCI)A sudden, nonconvulsive loss of neurologic function due to an ischemic or hemorrhagic intracranial vascular event. In general, cerebrovascular accidents are classified by anatomic location in the brain, vascular distribution, etiology, age of the affected individual, and hemorrhagic vs. nonhemorrhagic nature. (From Adams et al., Principles of Neurology, 6th ed, pp777-810)
ConceptsDisease or Syndrome (T047)
MSHD020521
BasqueATAKEA/EZBEHAR BASKULAR BURMUINETAKOA
DanishApopleksi/cerebrovaskulaer katastr
EnglishAccident - cerebrovascular, ACCIDENT CEREBROVASCULAR, Apoplexy, Brain Attack, Brain Vascular Accident, Brain Vascular Accidents, Cerebral apoplexy, CEREBRAL INFARCTION, Cerebral Stroke, Cerebral Strokes, cerebral vascular accident, CEREBROVASCULAR ACCIDENT, Cerebrovascular Accidents, Cerebrovascular Apoplexy, Cerebrovascular Stroke, Cerebrovascular Strokes, CVA, CVA - Cerebrovascular accident, CVA - Cerebrovascular accident unspecified, CVA unspecified, Stroke, Stroke and cerebrovascular accident unspecified, Stroke Syndrome, Stroke unspecified, Stroke/cerebrovasc accident, Stroke/cerebrovascular accident, Stroke/CVA - undefined, Strokes
FinnishAIVOHALVAUS/ AIVOVERENKIERRON HAIRIO
FrenchAccident vasculaire cerebral
Hebrewerua moxi
Hungarianagyergorcs/agyverzes
ItalianColpo/accidente cerebrovascolare
NorwegianHJERNESLAG/CEREBROVASK KATASTROFE
PortugueseAcidente/doenca cerebrovascular
SpanishAcc cerebrovascular/apoplejia, accidente cerebrovascular, ACV, apoplejia, apoplejia cerebral, stroke
SwedishHJARNSLAG/CEREBROVASKULAR SKADA
Parent ConceptsCerebrovascular Disorders (C0007820), Brain Diseases (C0006111), Arterial thrombosis (C0151942), Vascular Disorders, General and NEC (C0549519), Arterial vessel disorders (C0549603), CNS GENERAL (C0549638), VASCULAR: INTRACRANIAL (C0549642), circulatory system (C0497231), Diagnosis/Diseases Component (C0497531), Cerebrovascular accident (C0038454), Ambiguous concept (C1274012)
SourcesAOD, COSTAR, CSP, CST, DXP, ICPC, ICPCBAQ, ICPCDAN, ICPCDUT, ICPCFIN, ICPCFRE, ICPCGER, ICPCHEB, ICPCHUN, ICPCITA, ICPCNOR, ICPCPOR, ICPCSPA, ICPCSWE, LNC, MEDLINEPLUS, MSH, MTH, NCI, NDFRT, OMIM, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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