The Study Of Classification And Prognosis Of Ischemic Stroke Subtypes According To TOAST Criteria

PAKT â… Objective: To analysis the proportion and prognosis of ischemic stroke subtypes according to the TOAST criteria.Methods: Data were collected prospectively from 337 consecutive ischemic stroke inpatients in our department from 1 August 2004 to 28 February 2005. After completing medical records and auxiliary diagnostic studies, all included patients were classified into 5 major ischemic stroke subtype based on TOAST criteria, We analyzed the relation between prognosis and subtypes. Blood glucose was recorded to explore its impaction on prognosis on the basis of TOAST subtypes.Results: Three hundred and thirty-seven patients were included in this study. The proportion of ischemic stroke subtype according to TOAST criteria was as follows: cardioembolism 17.21%, large-artery atherosclerosis 11.87%, small-vessel occlusion 40.36%, stroke of other etiology 2.67 %, stroke of undetermined etiology 27. 89%. The mark of functional deficiency is different among ischemic stroke subtypes. Cardioembolism, had the highest morbidity and worst outcome. Acute blood glucose may worsen the clinical outcome in nonlacunar stroke.Conclusions: TOAST classification should be useful to estimate the prognosis of stroke. Acute blood glucose level had an influence on outcomeof different subtypes based on TOAST criterion.PART HObjective: To analysis the differences of risk factors -. clinical variables among ischemic stroke subtypes according to the TOAST criteria.Methods: Data were collected prospectively within 24 hours according to the table designed just for this topic from consecutive stroke inpatients in our department from 1 August 2004 to 28 February 2005. All included patients were classified into 5 major ischemic stroke subtype based on TOAST criteria. The differences of risk factors, clinical variables were analyses among ischemic stroke subtypesResults: There is no significant differences in the time of occurrence among subtypes. Acute inflammatory events increase the risk of acute ischemic stroke of LAA and CE type, but had little impact on SVO. Prevalence of hypertension, diabetes mellitus and drinking is not notably different among subtypes, They are risk factors of all subtypes. LAA showed highest level of fibrinogen and highest prevalence of ST depression on ECG , previous transient ischemic attack, current smoking among subtypes. LAA also had higher blood uric acid, but it is not significant. The risk of atrialfibrillation for cardioembolic infarction was outstandingly high ,but the lowest prevalence of current smoking , and hyperlipidemia was found in the cardioembolic infarction .Left ventricular hypertrophy were more common in small-vessel occlusion. It also had higher level of triglyceride and blood viscosity than cardioembolism. Acute blood glucose was little different among subtypes.Conclusions: Ischemic stroke subtypes had different risk factors, clinical variables. TOAST classification as an etiological classification should be useful to secondary prevention and clinical therapy of ischemic stroke.PART IHObjective: To determine if lesion patterns on early diffusion-weighted imaging(DWI) are associated with stroke subtypes determined by the TOAST classification.Methods: Data were collected prospectively from 191 stroke inpatients in our department from 1 August 2004 to 28 February 2005. All included patients were classified into 5 major ischemic stroke subtypes based on TOAST criteria.DWI was performed within 24 hours of stroke onset. Lesions on DWI were classified into 10 lesion patterns. The relation between different patterns and different subtypes were analyses by Cross-sectional study.Results: We found corticosubcortical single lesion, multiple lesions in anterior and posterior circulation were associated with cardioembolism. Scattered lesions in one vascular territory were related to large-artery atherosclerosis. A single cortical lesion and multiple lesions in the unilateral anterior circulation tended to be associated with LAA. Part of patients with a single subcortical lesion that was 15mm or larger were classified as having cryptogenic strokes. Hemorrhagic infarction is more common among patients of cardioembolism and large-artery atherosclerosis than cryptogenic strokes, but it is not significant.Conclusions: An overall significant relationship between DWI lesions patterns and TOAST stroke subtypes was found in our study. The use of DWI may provide early clues to stroke mechanism and guide therapeutic options in the acute phase of stroke.