Ischemic Stroke: Uncommon and Special Situations

2021 ◽  
pp. 399-409
Author(s):  
Catherine E. Arnold Fiebelkorn ◽  
James P. Klaas
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Clinical Laboratory ◽  
Small Vessel Disease ◽  
Sinus Thrombosis ◽  
Cerebral Venous Sinus Thrombosis ◽  
Spinal Cord Infarction ◽  
Venous Sinus Thrombosis ◽  
Vessel Disease ◽  
Common Causes

Most ischemic stroke is caused by atherosclerosis (large- and small-vessel disease) and cardioembolic sources (eg, atrial fibrillation). However, it is important to recognize the clinical, laboratory, and radiologic manifestations of rarer causes of stroke since the treatment may differ from the treatment of more typical causes. This chapter reviews the less common causes of stroke in addition to stroke in special situations: stroke in children, stroke in pregnant women, spinal cord infarction, and cerebral venous sinus thrombosis.

Ischaemic stroke: common causes

2017 ◽  
Author(s):  
Hugh Markus ◽  
Anthony Pereira ◽  
Geoffrey Cloud
Keyword(s):  
Atrial Fibrillation ◽  
Heart Disease ◽  
Ischaemic Stroke ◽  
Small Vessel Disease ◽  
Small Vessel ◽  
Large Artery ◽  
Lacunar Stroke ◽  
Vessel Disease ◽  
Common Causes ◽  
Artery Disease

This chapter on common causes of ischaemic stroke reviews the major pathologies underlying ischaemic stroke, namely large-artery disease, cardioembolism, and small-vessel disease. Large-vessel extra- and intracranial atherosclerotic cerebrovascular disease is covered. Cardioembolic aetiologies of stroke including atrial fibrillation and valvular heart disease are discussed. Small-vessel disease causing lacunar stroke and possible heterogonous pathologies underlying this subtype are covered. Dolichoectasia of arteries as a potential cause of stroke and the newer concept of embolic stroke of undetermined source are also discussed.

Fatal cerebral venous sinus thrombosis as major complication of metastatic cervical mass: computed tomography and magnetic resonance findings

2000 ◽  
Vol 114 (10) ◽  
pp. 798-801 ◽  
Author(s):  
Maria F. López-Peláez ◽  
José M. Millán ◽  
Joaquin de Vergas
Keyword(s):  
Sinus Thrombosis ◽  
Major Complication ◽  
Cerebral Venous Sinus Thrombosis ◽  
Venous Sinus ◽  
Jugular Vein Thrombosis ◽  
Cervical Mass ◽  
Venous Sinus Thrombosis ◽  
Vein Thrombosis ◽  
Sagittal Sinus ◽  
Common Causes

Cerebral venous sinus thrombosis is an uncommon but potentially lethal condition, with mortality between 5.5–30 per cent. It was previously associated with infections of the orbit, mastoid or face, but, after the advent of antibiotics, the most common causes include neoplasms, dehydration, oral contraceptives, coagulopathies, collagen diseases, and pregnancy and the puerperium. We report a case of fatal cerebral venous sinus thrombosis in a 68-year-old patient with a metastatic cervical mass, who developed internal jugular vein thrombosis that progressed cranially to transverse and sagittal sinus thrombosis.

scholarly journals A comparative study of seizures in arterial and venous stroke

2017 ◽  
Vol 04 (01) ◽  
pp. 006-011
Author(s):  
R. Singh ◽  
S. Bhoi ◽  
Jayantee Kalita ◽  
Usha Misra ◽  
D. Gupta
Keyword(s):  
Ischemic Stroke ◽  
Sinus Thrombosis ◽  
Cerebral Venous Sinus Thrombosis ◽  
Modified Rankin Scale ◽  
Mr Venography ◽  
Resonance Imaging ◽  
Venous Sinus Thrombosis ◽  
Magnetic Resonance Imaging Mri ◽  
Venous Stroke ◽  
Early Seizures

Abstract Objective This study was undertaken to compare the frequency, spectrum and predictors of seizures in arterial stroke and cerebral venous sinus thrombosis (CVST). Methods The patients having seizures following arterial stroke or CVST during 2010–2015 were included. Stroke was confirmed by computerized tomography (CT) scan, magnetic resonance imaging (MRI) and or MR Venography (MRV). The seizures were categorized into early seizures (<14 days) and late seizures (≥14 days) of arterial stroke or CVST. Neurological findings, risk factors for stroke and CVST were noted. The severity of stroke was defined by National Institute of Health Stroke Scale (NIHSS). The outcome on discharge was assessed by modified Rankin Scale (mRS) as good (0–2) or poor (>2). Results There were 870 patients with arterial stroke and 128 with CVST. Seizures occurred in 74 (57.8%) of CVST and 119 (13.7%) of arterial stroke. Early seizures were more common in CVST than arterial stroke (98.6% vs. 47.9%, p = 0.001) whereas late seizures were more common after arterial stroke than CVST (52.1% vs. 1.4%, p = 0.001). In the arterial stroke, seizures were predicted by carotid territory ischemic stroke (OR 3.95, 95% CI 1.51–10.32, p = 0.005) and CVST by parenchymal involvement (OR 2.61, 95% CI 1.04–6.55, p = 0.04) Conclusion CVST results in more frequent and early seizures whereas in arterial stroke late seizures are common. Post stroke seizures in ischemic stroke were predicted by carotid territory infarction and venous stroke by parenchymal involvement.

Baseline Characteristics and Readmissions after Cerebral Venous Sinus Thrombosis in a Nationally Representative Database

2018 ◽  
Vol 46 (5-6) ◽  
pp. 249-256 ◽  
Author(s):  
Yaowaree Leavell ◽  
Mian Khalid ◽  
Stanley Tuhrim ◽  
Mandip S. Dhamoon
Keyword(s):  
Ischemic Stroke ◽  
Readmission Rate ◽  
Sinus Thrombosis ◽  
Cerebral Venous Sinus Thrombosis ◽  
Venous Sinus ◽  
Index Admission ◽  
Readmission Rates ◽  
Venous Sinus Thrombosis ◽  
Baseline Characteristics ◽  
Nationally Representative

Background: There are limited epidemiologic data on cerebral venous sinus thrombosis (CVST). We aim to summarize baseline characteristics and outcomes using a large nationally representative administrative database. Methods: Using the 2013 Nationwide Readmissions Database, we used validated International Classification of Disease, Ninth Revision codes to identify baseline characteristics of patients admitted with CVST. We calculated readmission rates (per 100,000 index hospitalizations) for neurological complications. Multivariable Poisson regression yielded rate ratios (RR) of associations between index admission variables and all-cause readmission up to 1 year. Results: Among 2,105 patients with index admission for CVST, mean age was 46.8 (SD 18.4); 65.2% were female, and 6.1% were pregnant. Hemorrhagic stroke (15.6%) was more common than ischemic stroke (10.7%), seizure occurred in 16.3, and 3.7% of patients died during index hospitalization. The 90-day readmission rate (per 100,000 index CVST hospitalizations) was the highest for CVST (1,447) and ischemic stroke (755). Diabetes (RR 1.10, 95% CI 1.002–1.22), cancer (1.23, 1.09–1.39), insurance status (0.92, 0.83–0.97 for Medicare/private insurance vs. others), and discharge home (RR 0.89, 95% CI 0.85–0.99) were associated with increased readmission rate. Conclusions: We provide baseline characteristics and readmission rates after CVST over a 1-year period. In-hospital mortality rate and association with pregnancy were lower than previously observed.

scholarly journals Perinatal ischemic stroke: a five-year retrospective study in a level-III maternity

2015 ◽  
Vol 13 (1) ◽  
pp. 65-71 ◽  
Author(s):  
Virgínia Machado ◽  
Sónia Pimentel ◽  
Filomena Pinto ◽  
José Nona
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Sinus Thrombosis ◽  
Cerebral Venous Sinus Thrombosis ◽  
Venous Sinus ◽  
Cerebral Stroke ◽  
Left Middle Cerebral Artery ◽  
Arterial Ischemic Stroke ◽  
Venous Sinus Thrombosis ◽  
Neonatal Stroke

Objective To study the incidence, clinical presentation, risk factors, imaging diagnosis, and clinical outcome of perinatal stroke. Methods Data was retrospectively collected from full-term newborns admitted to the neonatal unit of a level III maternity in Lisbon with cerebral stroke, from January 2007 to December 2011. Results There were 11 cases of stroke: nine were arterial ischemic stroke and two were cerebral venous sinus thrombosis. We estimated an incidence of arterial ischemic stroke of 1.6/5,000 births and of cerebral venous sinus thrombosis of 7.2/100,000 births. There were two cases of recurrent stroke. Eight patients presented with symptoms while the remaining three were asymptomatic and incidentally diagnosed. The most frequently registered symptoms (8/11) were seizures; in that, generalized clonic (3/8) and focal clonic (5/8). Strokes were more commonly left-sided (9/11), and the most affected artery was the left middle cerebral artery (8/11). Transfontanelle ultrasound was positive in most of the patients (10/11), and stroke was confirmed by cerebral magnetic resonance in all patients. Electroencephalographic recordings were carried out in five patients and were abnormal in three (focal abnormalities n=2, burst-suppression pattern n=1). Eight patients had previously identified risk factors for neonatal stroke which included obstetric and neonatal causes. Ten patients were followed up at outpatients setting; four patients developed motor deficits and one presented with epilepsy. Conclusions Although a modest and heterogeneous sample, this study emphasizes the need for a high level of suspicion when it comes to neonatal stroke, primarily in the presence of risk factors. The prevalence of neurological sequelae in our series supports the need of long-term follow-up and early intervention strategies.

Republished: Reversible changes in diffusion- and perfusion-based imaging in cerebral venous sinus thrombosis

2015 ◽  
Vol 8 (2) ◽  
pp. e6-e6 ◽  
Author(s):  
Ning Lin ◽  
Andrew K Wong ◽  
Lindsay J Lipinski ◽  
Maxim Mokin ◽  
Adnan H Siddiqui
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Prognostic Value ◽  
Ct Perfusion ◽  
Sinus Thrombosis ◽  
Cerebral Venous Sinus Thrombosis ◽  
Venous Sinus ◽  
Imaging Studies ◽  
Venous Sinus Thrombosis ◽  
Systemic Anticoagulation

Diffusion- and perfusion-based imaging studies are regularly used in patients with ischemic stroke. Cerebral venous sinus thrombosis (CVST) is a rare cause of stroke and is primarily treated by systemic anticoagulation. Endovascular intervention can be considered in cases of failed medical therapy, yet the prognostic value of diffusion- and perfusion-based imaging for CVST has not been clearly established. We present a patient with CVST whose abnormal findings on MRI and CT perfusion images were largely reversed after endovascular treatment.

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