Pathogenetic stroke subtypes and their diagnostic criteria in patients with ischemic heart disease and intracranial atherosclerosis: a clinical-morphological study

Abstract

Introduction. An important objective of vascular neurology is to improve understanding of the pathogenetic subtypes of ischemic stroke and their diagnostic criteria, making it possible to perform targeted treatment and adequate prevention of cerebral circulation disorders. Objective. To identify the pathogenetic stroke subtypes and to specify whether their differential diagnosis is possible in patients with ischemic heart disease (IHD) combined with intracranial atherosclerosis. Materials and methods. The results of the morphological study and the findings of intravital examination of patients in 40 postmortem cases are compared. Results. It is shown that the same forms of IHD (atrial fibrillation, myocardial infarction, or postinfarction cardiosclerosis) combined with intracranial atherosclerosis may result in stroke classified as belonging to different pathogenetic subtypes: cardiogenic embolic or hemodynamic stroke, with an almost identical incidence rate (51 and 49%, respectively). In at least 90% of cases, diagnosis of cardiogenic embolic strokes can be based on revealing the infarction outside the regions of the adjacent blood supply of cerebral arteries if a patient had the embolic form of IHD and did not have pronounced stenosis and embologenic atherosclerotic plaques on the ipsilateral side to the infarction. In at least 72% of cases, hemodynamic strokes were determined by the IHD-related hemodynamic factor that was responsible for the development of infarction in the zones of adjacent blood supply or lacunar stroke if there was pronounced ipsilateral stenosis. The hemorrhagic component in brain infarctions (38%) and asymptomatic embolism of the internal organs (46%) were found to be associated with cardiogenic and embolic strokes, as well as hemodynamic strokes with atypical localization and extent of infarction related to intracranial tandem stenosis. Conclusion. The early risks of developing both cardiogenic embolic stroke and hemodynamic stroke were shown to be equal in patients with IHD and intracranial atherosclerosis. It has been proved that these stroke subtypes have distinctive features that enable differential diagnosis of these two diseases.