Differentiation of acute cortical and subcortical ischemic stroke by risk factors and clinical examination findings.
ABSTRACT Differentiation between acute cortical and subcortical ischemic stroke may be problematic when cortical stroke presents without obvious cortical deficits such as aphasia, neglect or hemianopia. This study explores stroke risk factors and clinical variables that may assist in this differentiation.
Records of consecutive patients with acute ischemic stroke, examined within 72 h of symptom onset, were reviewed. Stroke type was verified by clinical course and follow-up imaging. Stroke risk factors and acute examination findings were compared by odds ratios and positive predictive values for cortical and subcortical stroke.
For 355 patients studied, 237 had cortical stroke and 118 had subcortical stroke. Odds ratios for cortical stroke were highest for atrial fibrillation by EKG (OR = 4.77, CI = 2.08-10.94), recent hospitalization (OR = 4.51, CI = 2.39-8.53) and nonalert mental status (OR = 4.50, CI = 2.29-8.87). Possible cardioembolic condition, ischemic heart disease and peripheral vascular disease were also significant, but hypertension, age and diabetes mellitus were not significantly different for the stroke subtypes. Cortical deficits were absent in 19.4% of cortical stroke patients on initial examination. Predictive models were generated based on the presence or absence of cortical deficits and the interaction of significant risk factors with degree of motor deficit.
There are clinical features that, in addition to initial examination, may help differentiate cortical from subcortical ischemic stroke. These features may be relevant to both diagnostic and therapeutic approaches to acute stroke.
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ABSTRACT: We determined the angiographic presence of extracerebral and intracerebral arterial disease in 122 patients with minor stroke within the carotid territory; we excluded patients with a recognized cardiac source of emboli. Based on clinical features and computed tomographic findings, patients were classified as having lacunar infarcts (n = 61), nonlacunar infarcts (n = 53), and infarcts of indeterminate type (n = 8). Severe carotid bifurcation disease (greater than or equal to 50% stenosis or occlusion) was significantly more common in nonlacunar than in lacunar infarcts, on both the ipsilateral (p less than 0.001) and the contralateral (p less than 0.01) sides; 79% of the patients with nonlacunar infarcts had severe carotid bifurcation and/or middle cerebral artery disease on the ipsilateral side compared with 3.3% of the patients with lacunar infarcts. Our data underscore the need for classification of patients by the underlying mechanisms in future studies of treatment of ischemic stroke.Stroke 02/1989; 20(1):59-64. · 6.16 Impact Factor
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ABSTRACT: A stroke registry was developed to determine the localizing value of various clinical data. Adequate localization was achieved in 98% of 246 patients with infarcts. Among 212 male patients with cerebral infarcts not due to cardiogenic embolism or an unusual etiology, there were 152 with large-vessel and 59 with lacunar infarcts. Logistic regression analysis of factors associated with large vessel and lacunar stroke identified myocardial infarction on ECG as the only statistically significant variable; its presence was associated with an odds ratio for lacunar infarction of 0.19 (95% confidence interval 0.06-0.66) (P = 0.009). Logistic regression analysis of factors associated with anterior and posterior circulation large vessel stroke identified pack years of smoking as the only statistically significant variable; the odds ratio for posterior circulation infarction for a 10-year increment in pack years of smoking was 0.83 (95% confidence interval 0.73-0.94) (P = 0.0035).Journal of the Neurological Sciences 03/1993; 114(2):156-9. · 2.24 Impact Factor
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ABSTRACT: The diagnostic utility of clinical and radiological features for distinguishing penetrating artery disease from other causes of stroke has been questioned. To address this issue, we prospectively evaluated more than 40 features in 85 patients with pure motor, sensorimotor, or pure sensory syndromes. Nonischemic causes were present in 4 patients. The causes of ischemic stroke in the other 81 patients were penetrating artery disease (32 patients), large artery occlusive disease (17), cardioembolism (12), other causes (8), and undetermined (12). Of the features evaluated, frequent transient ischemic attacks (greater than or equal to 1/day), transient ischemic attacks occurring only within 1 week of stroke, pure motor hemiparesis (similar involvement of face, arm, and leg), pure sensory stroke, and round or oval infarction were associated (p less than 0.05) with penetrating artery disease. However, only pure sensory stroke involving two or more regions of the body and pure motor hemiparesis associated with subcortical infarction of less than 1.5 cm had positive predictive values exceeding 90% for penetrating artery disease. Carotid bruit ipsilateral to an anterior circulation infarction, monoparesis, and striatocapsular infarction had positive predictive values exceeding 90% for causes other than penetrating artery disease; however, half of the striatocapsular infarctions were of undetermined cause. These data suggest that certain clinical and radiological features are useful for distinguishing penetrating artery disease from other causes of stroke.Annals of Neurology 11/1991; 30(4):519-25. · 11.19 Impact Factor