The Analysis Of Etiology Of Acute Cerebral Ischemic Stroke

Objective: Stroke was a common disease with characteristic of high incidence, mutilation ratio and mortality. It was the main cause of middle and old population's death and disability in China, threatening people's life severely and giving a heavy burden to families and society. Furthermore, Eighty percent of stroke was ischemic stroke. On account of this, it was very important to normalize the diagnosis and treatment of ischemic stroke, and to make clear the etiology of acute ischemic stroke was the foundation.In this paper, we would make an analysis of etiology of acute cerebral ischemic stroke following the TOAST subtype criteria. From January 2002 to June 2007, 1164 patients with acute ischemic stroke onset were enrolled in the study, who all were the inpatients in Department of Neurology, the Third hospital of Hebei Medical University.TOAST whose complete name was Trial of 0rg l0172 in Acute Stroke Treatment[1-2] was a subtype to aim at etiology based on patients'clinical manifestation, outcomes of computed tomography, magnetic resonance imaging, transcranial Doppler sonography and/ or magnetic resonance angiography and related laboratory examinations. Because of its practicability, TOAST subtype had been admitted by more and more people and used widely in clinical investigation.Methods: From January 2002 to June 2007, 1164 patients with acute ischemic stroke onset were enrolled in this study, who all were the inpatients in Department of Neurology, the Third hospital of Hebei Medical University. All the patients were made physical examination and detected by computed tomography, magnetic resonance imaging, transcranial doppler sonography and/ or magnetic resonance angiography and other related examinations, and furthermore registered clinical and laboratory information, including age, sex, blood pressure, fasting plasma glucose, fasting serum lipids, drinking, smoking, family history and so on.Acute cerebral infarction was classified into 5 categories according to the TOAST subtype criteria:1. Large-artery atherosclerosis, LAA: the patients of this type were all detected by transcranial Doppler sonography, magnetic resonance angiography and/or carotis Doppler ultrasound and diagnosed atherosclerotic stenosis or occlusion. And furthermore the degree of stenosis of the responsibility blood vessel was more than 50%.2. Small-artery occlusion lacunars, SAA: To be provided with one of the three standard was final diagnosis. 1) To have the typical appearance of lacouna infarction syndrome, and the imaging examination was matched to the clinical appearance; the biggest diameter of the responsibility focus of infection was shorter than 1.5cm. 2) Having the appearance of lacouna infarction syndrome, but there was not the responsibility focus of infarction with the imaging examination. 3) There was not typical appearance of lacouna infarction syndrome, but the imaging examination was matched to the clinical appearance, the biggest diameter of the responsibility focus of infarction was shorter than 1.5cm.3. Cardioembolism, CE: this type included that all kinds diseases which have cardiogenical embolus initiated cerebral embolism.4. Stroke of other demonstrated etiology, SOE: this type is the cerebral infarction initiated by other demonstrated etiology including hypercoa-gulabale state, hematological system disease, importation dope, et al.5. Stroke of other undemonstrated etiology, SUE: this type includes the cerebral infarction which didn't belong to the other four types. It was divided into two types: 1) The absence of diagnostic tests that, under the examiner's judgment, their presence would have been essential to uncover the underlying etiology. 2) The presence of >1 evident mechanism in which there is either probable evidence for each, or no probable evidence to be able to establish a single cause.The stenosis or occlusions of cervical and intracranial vascular lesion were diagnosed by transcranial Doppler sonography and/or magnetic resonance angiography[4-7].Statistics outcomes were calculated by SPSS17.0 software. Measurement data showed in form of average value±standard deviation, and numeration data in masccline number and constituent ratio.Makingχ2-test analysis of the constituent ratio of TOAST subtypes between male and female patients.Results: 1164 patients with acute ischemic stroke onset were enrolled in this study. Among all 1164 patients, 723 were male (62.1%) and 441 were female (37.9%) with an average age of 62.5±12.1 years old (range from 18 to 89).According to the TOAST criteria, stroke of LAA was 832(71.48%) with 553 men and 279 women; stroke of SAA was 249(21.39%) with 116 men and 133 women; stroke of CE was 36(3.09%) with 21 men and 15 women; stroke of SOE was 10(0.86%) with 6 men and 4 women, and stroke of SUE was 37(3.18%) with 27 men and 10 women.The constituent ratio of TOAST subtype were obviously different between male patients and female patients according toχ2-test analysis.Conclusion: The proportions of TOAST subtypes in our area from maximal to minimal were: large-artery atherosclerosis; small-artery occlusion lacunars; stroke of other undemonstrated etiology; cardioembolism; stroke of other demonstrated etiology. The constituent ratio of TOAST subtype were obviously different between male patients and female patients according toχ2-test analysis.