engleski

Classification and clinical picture of stroke

The term cerebrovascular disease is very broad, due to significant variations in vascular territory, various classifications, and new major developments in understanding the pathogenetic processes that are closely dependent on the development of diagnostic tools over the last twenty-five years. Clinical classifications that depend on the duration of disease have been replaced by morphological localization as visualized by 'neuroimaging' tools (CT, MRI). There are several categories of cerebrovascular disease according to the duration of disease and severity of neurologic deficit, i.e. transient ischemic attacks (TIA), reversible neurologic deficit, and completed stroke, that can occur immediately or following a progressive stroke. Another factor is severity of neurologic deficit, where recovery ranges from persistent major deficit to minimal residual deficit. One of stroke classifications distinguishes ischemic disease that is predominantly extracranial or intracranial. Extracranial disease can be stenotic-occlusive or of dilatative type with tortuous carotid arteries. Such a dilatative form is commonly associated with intracranial microangiopathy, i.e. disease of distal vessels, characteristic of angiopathies, seen in diabetic and hypertensive patients. Basic topographic criteria try to incorporate ischemia into carotid or vertebrobasilar distribution. Primarily, the territory of main arteries is important, i.e. anterior, middle and posterior cerebral artery or their partial circulatory territory. Ischaemic territories of cerebellar arteries are divided in the same way. There are hemodynamic maps that depend on the supplying arteries, and tables of related neurovascular syndromes they cause. Ischemia can also develop in border territories between cerebral arteries and is a sign of hemodynamic variation. The microangiopathic group consists of lacunar infarcts, i.e. ischemia of deep perforated branches or multiple subcortical ischemia. The need to compare and to evaluate therapeutic success has produced different numerical scales of the clinical picture of stroke.

stroke; classification

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