Cerebrovascular disease

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Cerebrovascular disease
1471-2415-12-28-1Cerebral angiogram.jpg
Cerebral angiogram of a carotid-cavernous fistula
Specialty Neurology
Symptoms Weakness on one side of body [1]
Types Stroke, vascular dementia, TIA, subarachnoid haemorrhage [2]
Diagnostic method Neurological exam, physical exam [3]
Treatment Blood thinners, anti-hypertensives [4]

Cerebrovascular disease includes a variety of medical conditions that affect the blood vessels of the brain and the cerebral circulation. Arteries supplying oxygen and nutrients to the brain are often damaged or deformed in these disorders. [2] The most common presentation of cerebrovascular disease is an ischemic stroke or mini-stroke and sometimes a hemorrhagic stroke. [2] Hypertension (high blood pressure) is the most important contributing risk factor for stroke and cerebrovascular diseases as it can change the structure of blood vessels and result in atherosclerosis. [5] Atherosclerosis narrows blood vessels in the brain, resulting in decreased cerebral perfusion. Other risk factors that contribute to stroke include smoking and diabetes. [6] Narrowed cerebral arteries can lead to ischemic stroke, but continually elevated blood pressure can also cause tearing of vessels, leading to a hemorrhagic stroke. [4]

Contents

A stroke usually presents with an abrupt onset of a neurologic deficit – such as hemiplegia (one-sided weakness), numbness, aphasia (language impairment), or ataxia (loss of coordination) – attributable to a focal vascular lesion. [7] The neurologic symptoms manifest within seconds because neurons need a continual supply of nutrients, including glucose and oxygen, that are provided by the blood. Therefore, if blood supply to the brain is impeded, injury and energy failure is rapid. [8]

Besides hypertension, there are also many less common causes of cerebrovascular disease, including those that are congenital or idiopathic and include CADASIL, aneurysms, amyloid angiopathy, arteriovenous malformations, fistulas, and arterial dissections. [9] Many of these diseases can be asymptomatic until an acute event, such as a stroke, occurs. [9] Cerebrovascular diseases can also present less commonly with headache or seizures. [10] Any of these diseases can result in vascular dementia due to ischemic damage to the brain. [11] [12]

Signs and symptoms

Types of brain herniation Brain herniation types-2.svg
Types of brain herniation

The most common presentation of cerebrovascular diseases is an acute stroke, which occurs when blood supply to the brain is compromised. [13] Symptoms of stroke are usually rapid in onset, and may include weakness of one side of the face or body, numbness on one side of the face or body, inability to produce or understand speech, vision changes, and balance difficulties. [1] Hemorrhagic strokes can present with a very severe, sudden headache associated with vomiting, neck stiffness, and decreased consciousness. [13] Symptoms vary depending on the location and the size of the area of involvement of the stroke. Edema, or swelling, of the brain may occur which increases intracranial pressure and may result in brain herniation. A stroke may result in coma or death if it involves key areas of the brain. [14]

Other symptoms of cerebrovascular disease include migraines, seizures, epilepsy, or cognitive decline. However, cerebrovascular disease may go undetected for years until an acute stroke occurs. In addition, patients with some rare congenital cerebrovascular diseases may begin to have these symptoms in childhood. [15]

Causes

Congenital

Congenital diseases are medical conditions that are present at birth that may be associated with or inherited through genes. [16] Examples of congenital cerebrovascular diseases include arteriovenous malformations, germinal matrix hemorrhage, and CADASIL (cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy). [9] Arteriovenous malformations are abnormal tangles of blood vessels. Usually, a capillary bed separates arteries from veins, which protects the veins from the higher blood pressures that occur in arteries. In arteriovenous malformations, arteries are directly connected to veins, which increases the risk of venous rupture and hemorrhage. Cerebral arteriovenous malformations in the brain have a 2–4% chance of rupture each year. However, many arteriovenous malformations go unnoticed and are asymptomatic throughout a person's lifetime. [17]

A germinal matrix hemorrhage is bleeding into the brain of premature infants caused by the rupture of fragile blood vessels within the germinal matrix of premature babies. [18] The germinal matrix is a highly vascularized area within an unborn infant's brain from which brain cells, including neurons and glial cells, originate. Infants are at most risk to germinal matrix hemorrhages when they are born prematurely, before 32 weeks. [18] The stresses exposed after birth, along with the fragile blood vessels, increase risk of hemorrhage. Signs and symptoms include flaccid weakness, seizures, abnormal posturing, or irregular respiration. [18]

CADASIL is an inherited disorder caused by mutations in the NOTCH3 gene located on chromosome 19. [19] NOTCH3 codes for a transmembrane protein whose function is not well-known. However, the mutation causes accumulation of this protein within small to medium-sized blood vessels. [19] This disease often presents in early adulthood with migraines, stroke, mood disturbances, and cognitive deterioration. MRI shows white matter changes in the brain and also signs of repeated strokes. The diagnosis can be confirmed by gene testing. [20]

Acquired

Acquired cerebrovascular diseases are those that are obtained throughout a person's life that may be preventable by controlling risk factors. The incidence of cerebrovascular disease increases as an individual ages. [21] Causes of acquired cerebrovascular disease include atherosclerosis, embolism, aneurysms, and arterial dissections. [9] Atherosclerosis leads to narrowing of blood vessels and less perfusion to the brain, and it also increases the risk of thrombosis, or a blockage of an artery, within the brain. Major modifiable risk factors for atherosclerosis include: [22]

Illustration of a cerebral aneurysm, demonstrating the bulge in an artery in the brain Cerebral aneurysm NIH.jpg
Illustration of a cerebral aneurysm, demonstrating the bulge in an artery in the brain

Controlling these risk factors can reduce the incidence of atherosclerosis and stroke. [25] Atrial fibrillation is also a major risk factor for strokes. Atrial fibrillation causes blood clots to form within the heart, which may travel to the arteries within the brain and cause an embolism. The embolism prevents blood flow to the brain, which leads to a stroke.[ citation needed ]

An aneurysm is an abnormal bulging of small sections of arteries, which increases the risk of artery rupture. Intracranial aneurysms are a leading cause of subarachnoid hemorrhage, or bleeding around the brain within the subarachnoid space. There are various hereditary disorders associated with intracranial aneurysms, such as Ehlers-Danlos syndrome, autosomal dominant polycystic kidney disease, and familial hyperaldosteronism type I. [26] [27] [28] However, individuals without these disorders may also obtain aneurysms. The American Heart Association and American Stroke Association recommend controlling modifiable risk factors including smoking and hypertension. [29]

Arterial dissections are tears of the internal lining of arteries, often associated with trauma. [30] Dissections within the carotid arteries or vertebral arteries may compromise blood flow to the brain due to thrombosis, and dissections increase the risk of vessel rupture. [31]

Idiopathic

Idiopathic diseases are those that occur spontaneously without a known cause. [32] Moyamoya is an example of an idiopathic cerebrovascular disorder that results in narrowing and occlusion of intracranial blood vessels. [9] The most common presentation is stroke or transient ischemic attack, but cognitive decline within children may also be a presenting symptom. [9] [13] The disease may begin to show symptoms beginning in adolescence, but some may not have symptoms until adulthood. [13]

Pathophysiology

Mechanism of brain cell death

When a reduction in blood flow lasting seconds occurs, the brain tissue suffers ischemia, or inadequate blood supply. [33] [34] If the interruption of blood flow is not restored in minutes, the tissue suffers infarction followed by tissue death. [35] When the low cerebral blood flow persists for a longer duration, this may develop into an infarction in the border zones (areas of poor blood flow between the major cerebral artery distributions). In more severe instances, global hypoxia-ischemia causes widespread brain injury leading to a severe cognitive sequelae called hypoxic-ischemic encephalopathy . [36]

An ischemic cascade occurs where an energetic molecular problem arises due to lack of oxygen and nutrients. The cascade results in decreased production of adenosine triphosphate (ATP), which is a high-energy molecule needed for cells in the brain to function. [37] Consumption of ATP continues in spite of insufficient production, this causes total levels of ATP to decrease and lactate acidosis to become established (ionic homeostasis in neurons is lost). The downstream mechanisms of the ischemic cascade thus begins. Ion pumps no longer transport Ca2+ out of cell, this triggers release of glutamate, which in turn allows calcium into cell walls. In the end the apoptosis pathway is initiated and cell death occurs. [38]

There are several arteries that supply oxygen to different areas of the brain, and damage or occlusion of any of them can result in stroke. [39] The carotid arteries cover the majority of the cerebrum. The common carotid artery divides into the internal and the external carotid arteries. The internal carotid artery becomes the anterior cerebral artery and the middle central artery. The ACA transmits blood to the frontal parietal. From the basilar artery are two posterior cerebral arteries. Branches of the basilar and PCA supply the occipital lobe, brain stem, and the cerebellum. [40] Ischemia is the loss of blood flow to the focal region of the brain. This produces heterogeneous areas of ischemia at the affected vascular region, furthermore, blood flow is limited to a residual flow. Regions with blood flow of less than 10 mL/100 g of tissue/min are core regions (cells here die within minutes of a stroke). The ischemic penumbra with a blood flow of <25 ml/100g tissue/min, remain usable for more time (hours). [41]

Types of stroke

There are two main divisions of strokes: ischemic and hemorrhagic. Ischemic stroke involves decreased blood supply to regions of the brain, while hemorrhagic stroke is bleeding into or around the brain. [42]

Ischemic

Hemorrhagic

Diagnosis

Diagnoses of cerebrovascular disease may include: [3]

It is important to differentiate the symptoms caused by a stroke from those caused by syncope (fainting) which is also a reduction in cerebral blood flow, almost always generalized, but they are usually caused by systemic hypotension of various origins: cardiac arrhythmias, myocardial infarction, hemorrhagic shock, among others. [50]

Treatment

Treatment for cerebrovascular disease may include medication, lifestyle changes, and surgery, depending on the cause. [4]

Examples of medications are:

Surgical procedures include:

Prognosis

Prognostics factors: Lower Glasgow Coma Scale score, higher pulse rate, higher respiratory rate and lower arterial oxygen saturation level is prognostic features of in-hospital mortality rate in acute ischemic stroke. [52]

Epidemiology

Disability-adjusted life year for cerebrovascular disease per 100,000 inhabitants in 2004. .mw-parser-output .legend{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .legend-color{display:inline-block;min-width:1.25em;height:1.25em;line-height:1.25;margin:1px 0;text-align:center;border:1px solid black;background-color:transparent;color:black}.mw-parser-output .legend-text{} less than 250 250-425 425-600 600-775 775-950 950-1125 1125-1300 1300-1475 1475-1650 1650-1825 1825-2000 more than 2000 Cerebrovascular disease world map - DALY - WHO2004.svg
Disability-adjusted life year for cerebrovascular disease per 100,000 inhabitants in 2004.
  less than 250
  250–425
  425–600
  600–775
  775–950
  950–1125
  1125–1300
  1300–1475
  1475–1650
  1650–1825
  1825–2000
  more than 2000

Worldwide, it is estimated there are 31 million stroke survivors, though about 6 million deaths were due to cerebrovascular disease (2nd most common cause of death in the world and 6th most common cause of disability). [54]

Cerebrovascular disease primarily occurs with advanced age; the risk for developing it goes up significantly after 65 years of age. CVD tends to occur earlier than Alzheimer's Disease (which is rare before the age of 80).[ citation needed ] In some countries such as Japan, CVD is more common than AD.[ medical citation needed ]

In 2012, 6.4 million adults from the US had a stroke, which corresponds to 2.7% of the US. This is approximately 129,000 deaths in 2013. [55]

Geographically, a "stroke belt" in the US has long been known, similar to the "diabetes belt" which includes all of Mississippi and parts of Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, and West Virginia. [56]

Related Research Articles

<span class="mw-page-title-main">Arteriovenous malformation</span> Vascular anomaly

An arteriovenous malformation (AVM) is an abnormal connection between arteries and veins, bypassing the capillary system. Usually congenital, this vascular anomaly is widely known because of its occurrence in the central nervous system, but can appear anywhere in the body. The symptoms of AVMs can range from none at all to intense pain or bleeding, and they can lead to other serious medical problems.

<span class="mw-page-title-main">Cerebral arteriovenous malformation</span> Medical condition

A cerebral arteriovenous malformation is an abnormal connection between the arteries and veins in the brain—specifically, an arteriovenous malformation in the cerebrum.

A transient ischemic attack (TIA), commonly known as a mini-stroke, is a minor stroke whose noticeable symptoms usually end in less than an hour. TIA causes the same symptoms associated with strokes, such as weakness or numbness on one side of the body, sudden dimming or loss of vision, difficulty speaking or understanding language, slurred speech, or confusion.

<span class="mw-page-title-main">Intracranial aneurysm</span> Cerebrovascular disorder

An intracranial aneurysm, also known as a cerebral aneurysm, is a cerebrovascular disorder in which weakness in the wall of a cerebral artery or vein causes a localized dilation or ballooning of the blood vessel.

<span class="mw-page-title-main">Cerebral edema</span> Excess accumulation of fluid (edema) in the intracellular or extracellular spaces of the brain

Cerebral edema is excess accumulation of fluid (edema) in the intracellular or extracellular spaces of the brain. This typically causes impaired nerve function, increased pressure within the skull, and can eventually lead to direct compression of brain tissue and blood vessels. Symptoms vary based on the location and extent of edema and generally include headaches, nausea, vomiting, seizures, drowsiness, visual disturbances, dizziness, and in severe cases, death.

<span class="mw-page-title-main">Stroke</span> Death of a region of brain cells due to poor blood flow

Stroke is a medical condition in which poor blood flow to the brain causes cell death. There are two main types of stroke: ischemic, due to lack of blood flow, and hemorrhagic, due to bleeding. Both cause parts of the brain to stop functioning properly.

<span class="mw-page-title-main">Subarachnoid hemorrhage</span> Bleeding into the subarachnoid space

Subarachnoid hemorrhage (SAH) is bleeding into the subarachnoid space—the area between the arachnoid membrane and the pia mater surrounding the brain. Symptoms may include a severe headache of rapid onset, vomiting, decreased level of consciousness, fever, weakness, numbness, and sometimes seizures. Neck stiffness or neck pain are also relatively common. In about a quarter of people a small bleed with resolving symptoms occurs within a month of a larger bleed.

<span class="mw-page-title-main">Intracranial hemorrhage</span> Hemorrhage, or bleeding, within the skull

Intracranial hemorrhage (ICH), also known as intracranial bleed, is bleeding within the skull. Subtypes are intracerebral bleeds, subarachnoid bleeds, epidural bleeds, and subdural bleeds.

<span class="mw-page-title-main">Cerebral angiography</span> Angiography that produces images of blood vessels in and around the brain

Cerebral angiography is a form of angiography which provides images of blood vessels in and around the brain, thereby allowing detection of abnormalities such as arteriovenous malformations and aneurysms. It was pioneered in 1927 by the Portuguese neurologist Egas Moniz at the University of Lisbon, who also helped develop thorotrast for use in the procedure.

A thunderclap headache is a headache that is severe and has a sudden onset. It is defined as a severe headache that takes seconds to minutes to reach maximum intensity. Although approximately 75% are attributed to "primary" headaches—headache disorder, non-specific headache, idiopathic thunderclap headache, or uncertain headache disorder—the remainder are secondary to other causes, which can include some extremely dangerous acute conditions, as well as infections and other conditions. Usually, further investigations are performed to identify the underlying cause.

<span class="mw-page-title-main">Intracerebral hemorrhage</span> Type of intracranial bleeding that occurs within the brain tissue itself

Intracerebral hemorrhage (ICH), also known as hemorrhagic stroke, is a sudden bleeding into the tissues of the brain, into its ventricles, or into both. An ICH is a type of bleeding within the skull and one kind of stroke. Symptoms can vary dramatically depending on the severity, acuity, and location (anatomically) but can include headache, one-sided weakness, numbness, tingling, or paralysis, speech problems, vision or hearing problems, memory loss, attention problems, coordination problems, balance problems, dizziness or lightheadedness or vertigo, nausea/vomiting, seizures, decreased level of consciousness or total loss of consciousness, neck stiffness, and fever.

<span class="mw-page-title-main">Intraparenchymal hemorrhage</span> Medical condition

Intraparenchymal hemorrhage (IPH) is one form of intracerebral bleeding in which there is bleeding within brain parenchyma. The other form is intraventricular hemorrhage (IVH).

<span class="mw-page-title-main">Cerebral infarction</span> Medical condition

Cerebral infarction, also known as an ischemic stroke, is the pathologic process that results in an area of necrotic tissue in the brain. In mid to high income countries, a stroke is the main reason for disabilty among people and the 2nd cause of death. It is caused by disrupted blood supply (ischemia) and restricted oxygen supply (hypoxia). This is most commonly due to a thrombotic occlusion, or an embolic occlusion of major vessels which leads to a cerebral infarct. In response to ischemia, the brain degenerates by the process of liquefactive necrosis.

<span class="mw-page-title-main">Brain ischemia</span> Medical condition

Brain ischemia is a condition in which there is insufficient bloodflow to the brain to meet metabolic demand. This leads to poor oxygen supply or cerebral hypoxia and thus leads to the death of brain tissue or cerebral infarction/ischemic stroke. It is a sub-type of stroke along with subarachnoid hemorrhage and intracerebral hemorrhage.

<span class="mw-page-title-main">Vertebral artery dissection</span> Tear of the inner lining of the vertebral artery

Vertebral artery dissection (VAD) is a flap-like tear of the inner lining of the vertebral artery, which is located in the neck and supplies blood to the brain. After the tear, blood enters the arterial wall and forms a blood clot, thickening the artery wall and often impeding blood flow. The symptoms of vertebral artery dissection include head and neck pain and intermittent or permanent stroke symptoms such as difficulty speaking, impaired coordination, and visual loss. It is usually diagnosed with a contrast-enhanced CT or MRI scan.

The Center for Cerebrovascular Research at the University of California, San Francisco is a collective of faculty and staff investigating matters related to cerebral circulation, particularly cerebrovascular disease resulting from narrowing of major blood vessels in the brain and vascular malformation of the brain. While research offices are located on Parnassus campus, San Francisco General Hospital hosts the center's laboratories and facilities. The center coordinates with additional faculty in various fields of neuroscience and vascular biology. Sponsors include the National Institute of Neurological Disorders and Stroke and the UCSF departments of Anesthesia, Neurological Surgery and Neurology.

<span class="mw-page-title-main">Bonnet–Dechaume–Blanc syndrome</span> Medical condition

Bonnet–Dechaume–Blanc syndrome, also known as Wyburn-Mason syndrome, is a rare congenital disorder characterized by arteriovenous malformations of the brain, retina or facial nevi. The syndrome has a number of possible symptoms and can, more rarely, affect the skin, bones, kidneys, muscles, and gastrointestinal tract. When the syndrome affects the brain, people can experience severe headaches, seizures, acute stroke, meningism, and progressive neurological deficits due to acute or chronic ischaemia caused by arteriovenous shunting.

Joshua B. Bederson is an American neurosurgeon, Leonard I. Malis, MD/Corinne and Joseph Graber Professor of Neurosurgery, and System Chair of Neurosurgery at the Mount Sinai Health System in New York City. He is a Fellow of the American College of Surgeons, and an attending neurosurgeon at The Mount Sinai Hospital.

<span class="mw-page-title-main">Vein of Galen aneurysmal malformations</span> Medical condition

Vein of Galen aneurysmal malformations(VGAMs) and Vein of Galen aneurysmal dilations (VGADs) are the most frequent arteriovenous malformations in infants and fetuses. A VGAM consists of a tangled mass of dilated vessels supplied by an enlarged artery. The malformation increases greatly in size with age, although the mechanism of the increase is unknown. Dilation of the great cerebral vein of Galen is a secondary result of the force of arterial blood either directly from an artery via an arteriovenous fistula or by way of a tributary vein that receives the blood directly from an artery. There is usually a venous anomaly downstream from the draining vein that, together with the high blood flow into the great cerebral vein of Galen causes its dilation. The right sided cardiac chambers and pulmonary arteries also develop mild to severe dilation.

Interventional neuroradiology (INR) also known as neurointerventional surgery (NIS), endovascular therapy (EVT), endovascular neurosurgery, and interventional neurology is a medical subspecialty of neurosurgery, neuroradiology, intervention radiology and neurology specializing in minimally invasive image-based technologies and procedures used in diagnosis and treatment of diseases of the head, neck, and spine.

References

  1. 1 2 Caplan, Louis R. "Stroke symptoms and diagnosis". UpToDate. Archived from the original on Dec 19, 2017. Retrieved 2017-12-12.
  2. 1 2 3 4 "Cerebrovascular disease – Introduction". NHS Choices. Archived from the original on Sep 19, 2015. Retrieved 2015-09-01.
  3. 1 2 Serena-Leal, Joaquín; Ustrell-Roig, Xavier (July 2007). "Stroke. Diagnosis and Therapeutic Management of Cerebrovascular Disease | Revista Española de Cardiología (English Version)". www.revespcardiol.org. 60 (7): 753–769. doi:10.1016/S1885-5857(08)60011-0. S2CID   618662 . Retrieved 2015-09-01.
  4. 1 2 3 MedlinePlus Encyclopedia : Stroke
  5. ↑ "Who Is at Risk for a Stroke?". NHLBI, NIH. Archived from the original on Oct 5, 2017. Retrieved 2017-11-25.
  6. ↑ Prakash, Dibya (2014-04-10). Nuclear Medicine: A Guide for Healthcare Professionals and Patients. Springer Science & Business Media. p. 142. ISBN   9788132218265.
  7. ↑ "AccessMedicine | Content". accessmedicine.mhmedical.com. Retrieved 2015-11-05.
  8. ↑ "AccessMedicine | Content". accessmedicine.mhmedical.com. Archived from the original on 2016-03-04. Retrieved 2015-11-05.
  9. 1 2 3 4 5 6 Sabiston textbook of surgery : the biological basis of modern surgical practice. Townsend, Courtney M., Jr.; Beauchamp, R. Daniel; Evers, B. Mark; Mattox, Kenneth L. (20th ed.). Philadelphia, PA: Elsevier. 2017. pp. 1900–1937. ISBN   978-0323299879. OCLC   951748294.{{cite book}}: CS1 maint: others (link)
  10. ↑ Salmela, Michael B; Mortazavi, Shabnam; Jagadeesan, Bharathi D; Broderick, Daniel F; Burns, Judah; Deshmukh, Tejaswini K; Harvey, H. Benjamin; Hoang, Jenny; Hunt, Christopher H; Kennedy, Tabassum A; Khalessi, Alexander A; Mack, William; Patel, Nandini D; Perlmutter, Joel S; Policeni, Bruno; Schroeder, Jason W; Setzen, Gavin; Whitehead, Matthew T; Cornelius, Rebecca S; Corey, Amanda S; Corey, A. S (2017). "ACR Appropriateness Criteria ® Cerebrovascular Disease". Journal of the American College of Radiology. 14 (5): S34–S61. doi: 10.1016/j.jacr.2017.01.051 . PMID   28473091.
  11. ↑ Kuźma, Elżbieta; Lourida, Ilianna; Moore, Sarah F.; Levine, Deborah A.; Ukoumunne, Obioha C.; Llewellyn, David J. (2018). "Stroke and dementia risk: A systematic review and meta-analysis". Alzheimer's & Dementia. 14 (11): 1416–1426. doi:10.1016/j.jalz.2018.06.3061. hdl:2027.42/152961. ISSN   1552-5260. PMC   6231970 . PMID   30177276.
  12. ↑ "Vascular dementia - Causes - NHS Choices". www.nhs.uk. Retrieved 2015-09-01.
  13. 1 2 3 4 Portegies, M.L.P; Koudstaal, P.J; Ikram, M.A (2016). "Cerebrovascular disease". Neuroepidemiology. Handbook of Clinical Neurology. Vol. 138. pp. 239–261. doi:10.1016/b978-0-12-802973-2.00014-8. ISBN   9780128029732. PMID   27637962.
  14. ↑ "Acute ischemic stroke syndromes". UpToDate. Archived from the original on 2022-09-04. Retrieved 2017-12-05.
  15. ↑ "Pediatric Cerebrovascular Disorders". childrensnational.org. Archived from the original on 2017-12-08. Retrieved 2017-12-07.
  16. ↑ "the definition of congenital". Dictionary.com. Retrieved 2017-12-12.
  17. ↑ Kim, H; Al-Shahi Salman, R; McCulloch, C. E; Stapf, C; Young, W. L (2014). "Untreated brain arteriovenous malformation: Patient-level meta-analysis of hemorrhage predictors". Neurology. 83 (7): 590–597. doi:10.1212/wnl.0000000000000688. PMC   4141996 . PMID   25015366.
  18. 1 2 3 "Clinical manifestations and diagnosis of intraventricular hemorrhage in the newborn". UpToDate. Retrieved 2017-12-07.
  19. 1 2 Joutel, Anne; Corpechot, Christophe; Ducros, Anne; Vahedi, Katayoun; Chabriat, Hugues; Mouton, Philippe; Alamowitch, Sonia; Domenga, Valérie; Cécillion, Michaelle; Maréchal, Emmanuelle; MacIazek, Jacqueline; Vayssière, Céline; Cruaud, Corinne; Cabanis, Emmanuel-Alain; Ruchoux, Marie Madeleine; Weissenbach, Jean; Bach, Jean François; Bousser, Marie Germaine; Tournier-Lasserve, Elisabeth (1996). "Notch3 mutations in CADASIL, a hereditary adult-onset condition causing stroke and dementia". Nature. 383 (6602): 707–710. Bibcode:1996Natur.383..707J. doi:10.1038/383707a0. PMID   8878478. S2CID   4351873.
  20. ↑ "Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL)". UpToDate. Retrieved 2017-12-09.
  21. ↑ "AANS | Cerebrovascular Disease". www.aans.org. Retrieved 2017-12-11.
  22. ↑ "Cerebrovascular disease – NHS Choices – Risks and prevention". www.nhs.uk. Retrieved 2015-09-01.
  23. ↑ Mitsios, John Peter; Ekinci, Elif Ilhan; Mitsios, Gregory Peter; Churilov, Leonid; Thijs, Vincent (2018). "Relationship Between Glycated Hemoglobin and Stroke Risk: A Systematic Review and Meta‐Analysis". Journal of the American Heart Association. 7 (11): e007858. doi:10.1161/JAHA.117.007858. PMC   6015363 . PMID   29773578.
  24. ↑ Alloubani, Aladeen; Saleh, Abdulmoneam; Abdelhafiz, Ibrahim (2018). "Hypertension and diabetes mellitus as a predictive risk factors for stroke". Diabetes & Metabolic Syndrome: Clinical Research & Reviews. 12 (4): 577–584. doi:10.1016/j.dsx.2018.03.009. PMID   29571978. S2CID   4231800.
  25. ↑ Kernan, W. N; Ovbiagele, B; Black, H. R; Bravata, D. M; Chimowitz, M. I; Ezekowitz, M. D; Fang, M. C; Fisher, M; Furie, K. L; Heck, D. V; Johnston, S. C; Kasner, S. E; Kittner, S. J; Mitchell, P. H; Rich, M. W; Richardson, D; Schwamm, L. H; Wilson, J. A; American Heart Association Stroke Council, Council on Cardiovascular Stroke Nursing (2014). "Guidelines for the Prevention of Stroke in Patients with Stroke and Transient Ischemic Attack: A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association". Stroke. 45 (7): 2160–2236. doi: 10.1161/STR.0000000000000024 . PMID   24788967.
  26. ↑ Litchfield, W. R; Anderson, B. F; Weiss, R. J; Lifton, R. P; Dluhy, R. G (1998). "Intracranial aneurysm and hemorrhagic stroke in glucocorticoid-remediable aldosteronism". Hypertension. 31 (1 Pt 2): 445–50. doi: 10.1161/01.HYP.31.1.445 . PMID   9453343.
  27. ↑ Pepin, Melanie; Schwarze, Ulrike; Superti-Furga, Andrea; Byers, Peter H (2000). "Clinical and Genetic Features of Ehlers–Danlos Syndrome Type IV, the Vascular Type". New England Journal of Medicine. 342 (10): 673–680. CiteSeerX   10.1.1.603.1293 . doi:10.1056/NEJM200003093421001. PMID   10706896.
  28. ↑ Vlak, Monique HM; Algra, Ale; Brandenburg, Raya; Rinkel, Gabriël JE (2011). "Prevalence of unruptured intracranial aneurysms, with emphasis on sex, age, comorbidity, country, and time period: A systematic review and meta-analysis". The Lancet Neurology. 10 (7): 626–636. doi:10.1016/S1474-4422(11)70109-0. PMID   21641282. S2CID   19706811.
  29. ↑ Thompson, B. Gregory; Brown, Robert D; Amin-Hanjani, Sepideh; Broderick, Joseph P; Cockroft, Kevin M; Connolly, E. Sander; Duckwiler, Gary R; Harris, Catherine C; Howard, Virginia J; Johnston, S. Claiborne (Clay); Meyers, Philip M; Molyneux, Andrew; Ogilvy, Christopher S; Ringer, Andrew J; Torner, James; American Heart Association Stroke Council, Council on Cardiovascular Stroke Nursing (2015). "Guidelines for the Management of Patients with Unruptured Intracranial Aneurysms". Stroke. 46 (8): 2368–2400. doi: 10.1161/STR.0000000000000070 . PMID   26089327.
  30. ↑ Debette, Stéphanie (2014). "Pathophysiology and risk factors of cervical artery dissection". Current Opinion in Neurology. 27 (1): 20–28. doi:10.1097/WCO.0000000000000056. PMID   24300790.
  31. ↑ Liebeskind, David S. "Spontaneous cerebral and cervical artery dissection: Clinical features and diagnosis". UpToDate. Archived from the original on Aug 18, 2017. Retrieved 2017-12-09.
  32. ↑ "idiopathic definition". Dictionary.com. Retrieved 2017-12-12.
  33. ↑ "Cerebral Ischemia". Columbia Neurosurgery. Retrieved 2015-11-05.
  34. ↑ "Stroke: Hope Through Research". National Institute of Neurological Disorders and Stroke. September 1, 2015. Archived from the original on 2015-10-04. Retrieved 2015-11-05.
  35. ↑ Wang, Hai-Rong; Chen, Miao; Wang, Fei-Long; Dai, Li-hua; Fei, Ai-hua; Liu, Jia-fu; Li, Hao-jun; Shen, Sa; Liu, Ming; Pan, Shu-Ming (2015). "Comparison of Therapeutic Effect of Recombinant Tissue Plasminogen Activator by Treatment Time after Onset of Acute Ischemic Stroke". Scientific Reports. 5: 11743. Bibcode:2015NatSR...511743W. doi:10.1038/srep11743. PMC   4513278 . PMID   26206308.
  36. ↑ "Neurological disorders: public health challenges" (PDF). 2006.{{cite journal}}: Cite journal requires |journal= (help)
  37. ↑ "adenosine triphosphate | coenzyme". Encyclopedia Britannica. Retrieved 2017-12-12.
  38. ↑ Xing, Changhong; Arai, Ken; Lo, Eng H; Hommel, Marc (2012). "Pathophysiologic Cascades in Ischemic Stroke". International Journal of Stroke. 7 (5): 378–385. doi:10.1111/j.1747-4949.2012.00839.x. PMC   3985770 . PMID   22712739.
  39. ↑ "Clinical diagnosis of stroke subtypes". UpToDate. Retrieved 2017-12-12.
  40. ↑ Cipolla, Marilyn J. (2009-01-01). "Anatomy and Ultrastructure". Morgan & Claypool Life Sciences.{{cite journal}}: Cite journal requires |journal= (help)
  41. ↑ Ischemic Stroke at eMedicine
  42. 1 2 R., Caplan, Louis (2009). Caplan's stroke : a clinical approach (4th ed.). Philadelphia: Elsevier/Saunders. ISBN   9781416047216. OCLC   460932706.{{cite book}}: CS1 maint: multiple names: authors list (link)
  43. ↑ "Stroke". MedlinePlus. Retrieved 2015-09-01.
  44. ↑ Stroke Imaging at eMedicine
  45. ↑ Sacco, R. L; Kasner, S. E; Broderick, J. P; Caplan, L. R; Connors, J. J; Culebras, A; Elkind, M. S. V; George, M. G; Hamdan, A. D; Higashida, R. T; Hoh, B. L; Janis, L. S; Kase, C. S; Kleindorfer, D. O; Lee, J.-M; Moseley, M. E; Peterson, E. D; Turan, T. N; Valderrama, A. L; Vinters, H. V; American Heart Association Stroke Council, Council on Cardiovascular Surgery Anesthesia; Council on Cardiovascular Radiology Intervention; Council on Cardiovascular Stroke Nursing; Council on Epidemiology Prevention; Council on Peripheral Vascular Disease; Council On Nutrition, Physical Activity Metabolism (2013). "An Updated Definition of Stroke for the 21st Century: A Statement for Healthcare Professionals from the American Heart Association/American Stroke Association". Stroke. 44 (7): 2064–2089. doi: 10.1161/STR.0b013e318296aeca . PMID   23652265.
  46. ↑ Easton, J. Donald; Saver, Jeffrey L.; Albers, Gregory W.; Alberts, Mark J.; Chaturvedi, Seemant; Feldmann, Edward; Hatsukami, Thomas S.; Higashida, Randall T.; Johnston, S. Claiborne; Kidwell, Chelsea S.; Lutsep, Helmi L.; Miller, Elaine; Sacco, Ralph L. (2009). "Definition and evaluation of transient ischemic attack: a scientific statement for healthcare professionals from the American Heart Association/American Stroke Association Stroke Council; Council on Cardiovascular Surgery and Anesthesia; Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular Nursing; and the Interdisciplinary Council on Peripheral Vascular Disease. The American Academy of Neurology affirms the value of this statement as an educational tool for neurologists". Stroke. 40 (6): 2276–2293. doi: 10.1161/STROKEAHA.108.192218 . ISSN   1524-4628. PMID   19423857.
  47. ↑ Van Gijn, Jan; Kerr, Richard S; Rinkel, Gabriel JE (2007). "Subarachnoid haemorrhage". The Lancet. 369 (9558): 306–318. doi:10.1016/S0140-6736(07)60153-6. PMID   17258671. S2CID   29126514.
  48. ↑ Xi, Guohua; Keep, Richard F; Hoff, Julian T (2006). "Mechanisms of brain injury after intracerebral haemorrhage". The Lancet Neurology. 5 (1): 53–63. doi:10.1016/S1474-4422(05)70283-0. PMID   16361023. S2CID   30474999.
  49. ↑ Meretoja, A; Strbian, D; Putaala, J; Curtze, S; Haapaniemi, E; Mustanoja, S; Sairanen, T; Satopaa, J; Silvennoinen, H; Niemela, M; Kaste, M; Tatlisumak, T (2012). "SMASH-U: A Proposal for Etiologic Classification of Intracerebral Hemorrhage". Stroke. 43 (10): 2592–2597. doi: 10.1161/STROKEAHA.112.661603 . PMID   22858729.
  50. ↑ Bonanno, Fabriziogiuseppe (2011). "Clinical pathology of the shock syndromes". Journal of Emergencies, Trauma, and Shock. 4 (2): 233–43. doi: 10.4103/0974-2700.82211 . PMC   3132364 . PMID   21769211.
  51. ↑ Research, Center for Drug Evaluation and (2018-11-03). "Postmarket Drug and Biologic Safety Evaluations Completed from July 2016 – September 2016". FDA.
  52. ↑ Shah, Bhupendra; Bartaula, Bijay; Adhikari, Janak; Neupane, Harishankar; Shah, Birendraprasad; Poudel, Gunaraj (2017). "Predictors of in-hospital mortality of acute ischemic stroke in adult population". Journal of Neurosciences in Rural Practice. 8 (4): 591–594. doi: 10.4103/jnrp.jnrp_265_17 . PMC   5709883 . PMID   29204020.
  53. ↑ "WHO Disease and injury country estimates". World Health Organization. 2009. Retrieved Nov 11, 2009.
  54. ↑ Ward, Helen; Toledano, Mireille B.; Shaddick, Gavin; Davies, Bethan; Elliott, Paul (2012-05-24). Oxford Handbook of Epidemiology for Clinicians. OUP Oxford. p. 310. ISBN   9780191654787.
  55. ↑ "FastStats". www.cdc.gov. Retrieved 2015-09-01.
  56. ↑ BORHANI NO (1965). "Changes and Geographic Distribution of Mortality from Cerebrovascular Disease". American Journal of Public Health and the Nation's Health. 55 (5): 673–81. doi:10.2105/AJPH.55.5.673. PMC   1256296 . PMID   14287837.

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