Too much lumping in ischemic stroke - a new classification.
BACKGROUND
The heterogeneity of ischemic stroke syndromes with treatment of disparate categories may be a factor in clinical stroke trial failure. Recent advances include a multitude of stroke investigative modalities that are noninvasive, allowing more precise mechanistic determination.


METHODS
We retrospectively analyzed our young stroke patient population for stroke etiology according to the TOAST classification with five different etiological groups. Patients were assessed quantitatively according to the National Institute of Health Stroke Scale for neurological deficit and Rankin Scale for neurological handicap. Investigations included laboratory, Doppler sonograms of the cervicocephalic vessels, cardiac echocardiography and multimodality magnetic resonance imaging in all patients. Statistical analysis was performed, using a logit model for nominal response: log piJ/piJ)=alphaj+betajX.


RESULTS
Amongst young stroke patients (n=133, women n=72) causes included other (n=77/119;65%), large vessel disease (LVD) (n=8/119;7%), small vessel disease (SVD) (n=17/119;14%), unknown (n=3/119;2%) and cardiac (n=14/119;12%). Within the other category at least 20 different etiologies were delineated. There were significant differences among the various categories (multinomial distribution with equal probabilities p=<0.0001).


CONCLUSIONS
We recommend an expanded classification for stroke to include large vessel cerebrovascular disease, small vessel cerebrovascular disease, cardiogenic, dissection, prothrombotic states, migraine induced, cerebral venous thrombosis, vasculitides, vasculopathy other, miscellaneous and unknown.
Hoffmann
Michael
M
Department of Neurology, University of South Florida, Tampa, Florida 33612, USA. mhoffman@hsc.usf.edu
Chichkova
Rossitza
R
Ziyad
Mafhoud
M
Malek
Ali
A
D000293:Adolescent; D000328:Adult; D002545:Brain Ischemia / Q000097:blood / Q000145:classification / Q000175:diagnosis / Q000209:etiology; D002544:Cerebral Infarction / Q000097:blood / Q000145:classification / Q000175:diagnosis / Q000209:etiology; D002986:Clinical Trials as Topic; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020521:Stroke / Q000097:blood / Q000145:classification* / Q000175:diagnosis / Q000209:etiology