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The basic classification of stroke is:

Ischaemic stroke

(a) Cerebral artery thrombosis – clots forming in the brain artery

(b) Cerebral artery embolus – a clot or other particle from elsewhere in the body lodges in a brain artery. More than 85% of particles blocking arteries are clots, the rest are usually bits of atheromatous plaque. This is relevant because the treatment for this is highly specialised and must be started quickly to be effective.

(c) Systemic hypoperfusion – this is a general circulatory problem (not common) whose main effects happen to be seen in the brain.

A further classification specifies whether the arteries involved are located inside or outside of the brain, and whether they are large or small vessels. An overview of all these shows that by far the commonest cause of ischaemic stroke is a blood clot of some kind (85%) either forming in the brain artery, or coming from somewhere else.

Very often, there is underlying atherosclerosis of either the brain arteries, or of the other arteries providing the source of the clots. It follows, thus, that the underlying causes contributing to the formation of atherosclerosis will be relevant here too. Often, the source of clots is the heart itself, when clots form inside the heart due to chronic rhythm disturbances such as Atrial Fibrillation. (AF) AF can occur alone or associated with Coronary Artery Disease, or Valve problems.

Heamhorrhagic stroke

(a) Intracerebral - inside the brain tissue itself. Here the blood gradually accumulates and compresses surrounding brain tissue more and more until the brain cells actually die. The immediate need here is to stop the bleeding, and identify and treat the cause. Uncontrolled hypertension is a common cause, but bleeding into a tumour, vasculitis, or a bleeding disorder may be involved.

(b) Subarachnoid – here the bleeding is into one of the membranes surrounding the brain. The commonest cause is rupture of an aneurysm ( a blowout) of a brain artery, or a bleed from an abnormal artery.

Read more:
Diagnosis of stroke

The Heart and Stroke Foundation South Africa
 

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