Stroke Etiology [Neurosurgery Wiki]

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====== Stroke Etiology ======
[[Cerebral ischemia]] and successive [[reperfusion]] are the prevailing cause of cerebral [[stroke]].
One of the main causes of stroke is [[carotid artery stenosis]]. 

Extra cranial [[carotid artery dissection]] and [[vertebral artery dissection]] is an important cause of [[stroke]], especially in young people. 

[[Stroke]] etiology was classified as cardioembolism in 22 patients (59.4%), large-artery atherosclerosis in 8 (21.6%), and undetermined in 7 (18.9%). The [[clot]]s from cardioembolism had a significantly higher proportion of [[red blood cell]]s (37.8% versus 16.9%, P = .031) and a lower proportion of [[fibrin]] (32.3% versus 48.5%, P = .044) compared with those from large artery [[atherosclerosis]]. The proportion of red blood cells was significantly higher in clots with a susceptibility vessel sign than in those without it (48.0% versus 1.9%, P < .001), whereas the proportions of fibrin (26.4% versus 57.0%, P < .001) and platelets (22.6% versus 36.9%, P = .011) were significantly higher in clots without a susceptibility vessel sign than those with it.

The histologic composition of clots retrieved from cerebral arteries in patients with acute stroke differs between those with cardioembolism and large-artery atherosclerosis. In addition, a susceptibility vessel sign on [[gradient echo sequence]] is strongly associated with a high proportion of red blood cells and a low proportion of fibrin and platelets in retrieved clots
((Kim SK, Yoon W, Kim TS, Kim HS, Heo TW, Park MS. Histologic Analysis of
Retrieved Clots in Acute Ischemic Stroke: Correlation with Stroke Etiology and
Gradient-Echo MRI. AJNR Am J Neuroradiol. 2015 Jul 9. [Epub ahead of print]
PubMed PMID: 26159515.
)).
----
There is conflicting evidence for whether or not the incidence of stroke is influenced by the daily temperature.

The daily temperature had measurable and different associations with the number of strokes and strokes subtypes in [[Seoul]], Korea
((Shin DW, Yoon JE, Hwang HW, Kim JS, Park SQ, Roh H, Ahn MY, Lee KB. Numbers of
Stroke Patients and Stroke Subtypes According to Highest and Lowest Daily
Temperatures in Seoul. J Clin Neurol. 2016 Oct;12(4):476-481. doi:
10.3988/jcn.2016.12.4.476. PubMed PMID: 27819418.
)).
----
[[Bone disease]]s are among the most uncommon causes of [[stroke]], but they should be considered as stroke cause in particular clinical scenarios. On the other hand, [[osteoporosis]]/[[osteopenia]] and increased [[fracture]] risk are well documented post stroke complications. The relationship between stroke and bone health is complex. The current facts suggest that these two conditions share same risk factors, but also are risk factors for each other. However, the [[evidence]] shows more clear effect of stroke on the bone health, than in the opposite direction. A extensive review of Mijajlovic et al. aimed to fill the huge gap of evidence about this topic, and since bone pathology is extremely rare cause of [[stroke]], although a complex connection between these two conditions definitely exists
((Mijajlovic MD, Aleksic V, Stojanovski N, Bornstein NM. Relationship between bone disorders and stroke. Neurol Sci. 2020 Oct 2. doi: 10.1007/s10072-020-04748-0. Epub ahead of print. PMID: 33006058.)).

===== References =====