The hunt for a stroke etiology: Ischemic stroke

Once the acute phase of ischemic stroke is managed appropriately, the next crucial step is to prescribe a therapeutic regimen to prevent subsequent strokes. The prerequisite to this is determining the mechanism and the etiology of ischemic stroke. A simple "rule of thumb" can be applied and that is investigating the three components of the cardio-cerebral circulatory axis: the pipes (vasculature), the pump (the heart), and the blood. Most underlying causes for stroke will influence one of these three constituents. With respect to each one, specific diagnostic strategies can be utilized to explore and detect the associated pathology. In this chapter, approaches utilized in determining the mechanisms and etiologies of ischemic stroke will be discussed. History and physical examination In taking a focused history in a patient with ischemic stroke, special attention should be placed upon common, traditional risk factors and causes. Non-modifiable traditional risk factors: Age Gender Ethnicity Family history Some genetic disorders. Modifiable traditional risk factors: Prior stroke or transient ischemic attack (TIA) Hypertension Cigarette smoking Diabetes mellitus Hypercholesterolemia Coronary artery disease Arial fibrillation Metabolic syndrome Cardiomyopathy (especially with low left ventricular ejection fraction) Obstructive sleep apnea Obesity and elevated body mass index Substance abuse (particularly sympathomimetics).