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Cerebrovascular disease and risk of stroke
Submitted by Dr. Yasser
Mokhtar, MD. Dept. of internal medicine. School of
medicine, University of South Dakota.
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Stroke is a loss of cerebral
function with symptoms lasting >24 hrs or death due to vascular
disease |
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Causes of stroke
Ic. Hematologic disorders:
A number of quite easily diagnosed hematological disorders, many of which are
common, may occasionally cause cerebral infarction (Hart and Kanter 1990). They
include polycythemia, essential thrombocytosis (Murphy et al., 1983), leukemia
and paraproteinemia (Davies-Jones 1989), sickle cell disease (Feldenzer et al.,
1987), iron deficiency anemia (Shahard and Sadeh 1991), paroxysmal nocturnal
hemoglobinuria (Forman et al., 1984), thrombotic thrombocytopenic purpura (Ridolfi
and Bell 1981), disseminated intravascular coagulation (Schwarzmann and Hill
1982) and hypercoagulability (Schulta et al., 1991).
Id. Miscellaneous rare causes of stroke:
Stroke complicates the last trimester of pregnancy and the puerperium in no
more than 30 per 100000 deliveries in developed countries (Weibers 1985).
Stroke in cancer patients may be a coincidence, but causal possibilities
include embolism of non-infected heart valve vegetations (non-bacterial,
thrombotic or marrantic endocarditis), tumor emboli, hemorrhage into primary
tumors (e.g. malignant astrocytoma), metastases, hemostatic failure,
hyperviscosity syndrome (e.g. myeloma), disseminated intravascular coagulation
and intracranial venous thrombosis (Graus et al., 1985).
The relationship between migraine and stroke is difficult to disentangle.
Stroke is no more frequent in migraineurs than in the normal population (Henrich
1987). Migrainous stroke should be reserved for a persisting focal neurologic
deficit which starts during a typical migrainous aura, clearly mimics the
symptomatology of previously experienced auras, and for which there is no better
or even other explanation (Bousser et al., 1985).
Hypoglycemia, almost always as a result of hypoglycemic drugs rather, is a
well recognized but rare cause of transient focal neurological episodes (Malouf
and Brust 1985).
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II. Spontaneous intracranial hemorrhage:
Spontaneous intracranial hemorrhage occurs into the subarachnoid space (SAH),
within the brain (PICH), sometimes into the ventricles (ventricular hemorrhage)
and rarely into subdural space (subdural hemorrhage).
The causes of intracranial hemorrhage are much the same, whatever the primary
site of bleeding although their relative frequency varies somewhat with the
site.
1. Subarachnoid hemorrhage is usually due to bleeding from a vascular
malformation (Rinkel et al., 1990).
2. Primary intracerebral hemorrhage is most commonly due to
hypertensive vascular disease, vascular malformation, saccular aneurysm and
cerebral amyloid angiopathy (Feldman 1991).
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