stroke

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Pathophysiologic ischemic stroke classification

Large vessel atherothrombotic stroke

More common

Bifurcation of the common carotid artery

Siphon portion of the common carotid artery

Middle cerebral artery stem

Intracranial vertebral arteries proximal to middle basilar artery

Origin of the vertebral arteries

Less common

Origin of the common carotid artery

Posterior cerebral artery stem

Origin of the major branches of the basilar-vertebral arteries

Origin of the branches of the anterior, middle, and posterior cerebral arteries

Small vessel (lacunar) stroke

Mechanism

Lipohyalinotic occlusion

Less frequently proximal atherothrombotic occlusion

Least likely embolic occlusion

Most common locations

Penetrating branches of the anterior, middle, and posterior cerebral and basilar arteries

Cardioaortic embolic stroke

Cardiac sources definite - antithrombotic therapy generally used

Left atrial thrombus

Left ventricular thrombus

Atrial fibrillation and paroxysmal atrial fibrillation

Sustained atrial flutter

Recent myocardial infarction (within one month)

Rheumatic mitral or aortic valve disease

Bioprosthetic and mechanical heart valve

Chronic myocardial infarction with ejection fraction <28 percent

Symptomatic heart failure with ejection fraction <30 percent

Dilated cardiomyopathy

Cardiac sources definite - anticoagulation hazardous

Bacterial endocarditis (exception nonbacterial)

Atrial myxoma

Cardiac sources possible

Mitral annular calcification

Patent foramen ovale

Atrial septal aneurysm

Atrial septal aneurysm with patent foramen ovale

Left ventricular aneurysm without thrombus

Isolated left atrial smoke (no mitral stenosis or atrial fibrillation)

Mitral valve strands

Ascending aortic atheromatous disease (>4 mm)

True unknown source embolic stroke

Other

Dissection

Moyamoya

Binswanger's disease

Primary thrombosis

Cerebral mass