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Stroke. 1993;24:35-41

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Stroke, Vol 24, 35-41, Copyright © 1993 by American Heart Association

ARTICLES

Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment

HP Adams Jr, BH Bendixen, LJ Kappelle, J Biller, BB Love, DL Gordon and EE Marsh 3d
Department of Neurology, University of Iowa, Iowa City 52242-1053.

BACKGROUND AND PURPOSE: The etiology of ischemic stroke affects prognosis, outcome, and management. Trials of therapies for patients with acute stroke should include measurements of responses as influenced by subtype of ischemic stroke. A system for categorization of subtypes of ischemic stroke mainly based on etiology has been developed for the Trial of Org 10172 in Acute Stroke Treatment (TOAST). METHODS: A classification of subtypes was prepared using clinical features and the results of ancillary diagnostic studies. "Possible" and "probable" diagnoses can be made based on the physician's certainty of diagnosis. The usefulness and interrater agreement of the classification were tested by two neurologists who had not participated in the writing of the criteria. The neurologists independently used the TOAST classification system in their bedside evaluation of 20 patients, first based only on clinical features and then after reviewing the results of diagnostic tests. RESULTS: The TOAST classification denotes five subtypes of ischemic stroke: 1) large-artery atherosclerosis, 2) cardioembolism, 3) small-vessel occlusion, 4) stroke of other determined etiology, and 5) stroke of undetermined etiology. Using this rating system, interphysician agreement was very high. The two physicians disagreed in only one patient. They were both able to reach a specific etiologic diagnosis in 11 patients, whereas the cause of stroke was not determined in nine. CONCLUSIONS: The TOAST stroke subtype classification system is easy to use and has good interobserver agreement. This system should allow investigators to report responses to treatment among important subgroups of patients with ischemic stroke. Clinical trials testing treatments for acute ischemic stroke should include similar methods to diagnose subtypes of stroke.


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The HMGB1 Receptor RAGE Mediates Ischemic Brain Damage
J. Neurosci., November 12, 2008; 28(46): 12023 - 12031.
[Abstract] [Full Text] [PDF]

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 StrokeHome page
A. P. Kansagra and E. C. Wong
Quantitative Assessment of Mixed Cerebral Vascular Territory Supply With Vessel Encoded Arterial Spin Labeling MRI
Stroke, November 1, 2008; 39(11): 2980 - 2985.
[Abstract] [Full Text] [PDF]

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 StrokeHome page
J. M. Wardlaw
What Is a Lacune?
Stroke, November 1, 2008; 39(11): 2921 - 2922.
[Full Text] [PDF]

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 StrokeHome page
U. Khan, C. Crossley, L. Kalra, A. Rudd, C. D.A. Wolfe, P. Collinson, and H. S. Markus
Homocysteine and Its Relationship to Stroke Subtypes in a UK Black Population: The South London Ethnicity and Stroke Study
Stroke, November 1, 2008; 39(11): 2943 - 2949.
[Abstract] [Full Text] [PDF]

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 Cleveland Clinic Journal of MedicineHome page
M. BAIN, A. M. MOHEET, and P. RASMUSSEN
Which patients benefit from carotid stenting? What recent trials show
Cleveland Clinic Journal of Medicine, October 1, 2008; 75(10): 714 - 720.
[Abstract] [Full Text] [PDF]

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 Mayo Clin Proc.Home page
K. Fatema, K. R. Bailey, G. W. Petty, I. Meissner, M. Osranek, A. A. Alsaileek, B. K. Khandheria, T. S. Tsang, and J. B. Seward
Increased Left Atrial Volume Index: Potent Biomarker for First-Ever Ischemic Stroke
Mayo Clin. Proc., October 1, 2008; 83(10): 1107 - 1114.
[Abstract] [Full Text] [PDF]

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 NEJMHome page
R. L. Sacco, H.-C. Diener, S. Yusuf, D. Cotton, S. Ounpuu, W. A. Lawton, Y. Palesch, R. H. Martin, G. W. Albers, P. Bath, et al.
Aspirin and Extended-Release Dipyridamole versus Clopidogrel for Recurrent Stroke
N. Engl. J. Med., September 18, 2008; 359(12): 1238 - 1251.
[Abstract] [Full Text] [PDF]

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 J Am Coll CardiolHome page
M. R. Di Tullio, S. Homma, Z. Jin, and R. L. Sacco
Aortic Atherosclerosis, Hypercoagulability, and Stroke: The APRIS (Aortic Plaque and Risk of Ischemic Stroke) Study
J. Am. Coll. Cardiol., September 2, 2008; 52(10): 855 - 861.
[Abstract] [Full Text] [PDF]

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 J Am Coll Cardiol ImgHome page
S. Kohsaka, Z. Jin, T. Rundek, B. Boden-Albala, S. Homma, R. L. Sacco, and M. R. Di Tullio
Impact of mitral annular calcification on cardiovascular events in a multiethnic community: the Northern Manhattan Study.
J. Am. Coll. Cardiol. Img., September 1, 2008; 1(5): 617 - 623.
[Abstract] [Full Text] [PDF]

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 StrokeHome page
S. B. Coutts, M. D. Hill, C. R. Campos, Y. B. Choi, S. Subramaniam, J. C. Kosior, A. M. Demchuk, and for the VISION study group
Recurrent Events in Transient Ischemic Attack and Minor Stroke: What Events Are Happening and to Which Patients?
Stroke, September 1, 2008; 39(9): 2461 - 2466.
[Abstract] [Full Text] [PDF]

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 StrokeHome page
F. J. Carod-Artal, L. F. Coral, D. S. Trizotto, and C. M. Moreira
The Stroke Impact Scale 3.0: Evaluation of Acceptability, Reliability, and Validity of the Brazilian Version
Stroke, September 1, 2008; 39(9): 2477 - 2484.
[Abstract] [Full Text] [PDF]

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 J. Neurol. Neurosurg. PsychiatryHome page
S-H Lee, B-S Kang, N Kim, and J-K Roh
Does microbleed predict haemorrhagic transformation after acute atherothrombotic or cardioembolic stroke?
J. Neurol. Neurosurg. Psychiatry, August 1, 2008; 79(8): 913 - 916.
[Abstract] [Full Text] [PDF]

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 Arch NeurolHome page
O. Ozdemir, V. Beletsky, R. Chan, and V. Hachinski
Thrombolysis in Patients With Marked Clinical Fluctuations in Neurologic Status Due to Cerebral Ischemia
Arch Neurol, August 1, 2008; 65(8): 1041 - 1043.
[Abstract] [Full Text] [PDF]

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 StrokeHome page
J. Montaner, M. Perea-Gainza, P. Delgado, M. Ribo, P. Chacon, A. Rosell, M. Quintana, M. E. Palacios, C. A. Molina, and J. Alvarez-Sabin
Etiologic Diagnosis of Ischemic Stroke Subtypes With Plasma Biomarkers
Stroke, August 1, 2008; 39(8): 2280 - 2287.
[Abstract] [Full Text] [PDF]

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 NeurologyHome page
J. F. Arenillas, L. Ispierto, M. Millan, D. Escudero, N. Perez de la Ossa, L. Dorado, C. Guerrero, J. Serena, J. Castillo, and A. Davalos
Metabolic syndrome and resistance to IV thrombolysis in middle cerebral artery ischemic stroke
Neurology, July 15, 2008; 71(3): 190 - 195.
[Abstract] [Full Text] [PDF]

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 StrokeHome page
Y. Bejot, A. Catteau, M. Caillier, O. Rouaud, J. Durier, C. Marie, A. Di Carlo, G.-V. Osseby, T. Moreau, and M. Giroud
Trends in Incidence, Risk Factors, and Survival in Symptomatic Lacunar Stroke in Dijon, France, From 1989 to 2006: A Population-Based Study
Stroke, July 1, 2008; 39(7): 1945 - 1951.
[Abstract] [Full Text] [PDF]

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 StrokeHome page
O. Ozdemir, A. Leung, M. Bussiere, V. Hachinski, and D. Pelz
Hyperdense Internal Carotid Artery Sign: A CT Sign of Acute Ischemia
Stroke, July 1, 2008; 39(7): 2011 - 2016.
[Abstract] [Full Text] [PDF]

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 NeurologyHome page
T. N. Kreisl, T. Toothaker, S. Karimi, and L. M. DeAngelis
Ischemic stroke in patients with primary brain tumors
Neurology, June 10, 2008; 70(24): 2314 - 2320.
[Abstract] [Full Text] [PDF]

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 NeurologyHome page
S. Y. Kang and J. S. Kim
Anterior cerebral artery infarction: Stroke mechanism and clinical-imaging study in 100 patients
Neurology, June 10, 2008; 70(24_Part_2): 2386 - 2393.
[Abstract] [Full Text] [PDF]

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 NeurologyHome page
S. Sato, K. Toyoda, T. Uehara, N. Toratani, C. Yokota, H. Moriwaki, H. Naritomi, and K. Minematsu
Baseline NIH Stroke Scale Score predicting outcome in anterior and posterior circulation strokes
Neurology, June 10, 2008; 70(24_Part_2): 2371 - 2377.
[Abstract] [Full Text] [PDF]

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 Am. J. Neuroradiol.Home page
T. Ohara, K. Toyoda, R. Otsubo, K. Nagatsuka, Y. Kubota, M. Yasaka, H. Naritomi, and K. Minematsu
Eccentric Stenosis of the Carotid Artery Associated with Ipsilateral Cerebrovascular Events
AJNR Am. J. Neuroradiol., June 1, 2008; 29(6): 1200 - 1203.
[Abstract] [Full Text] [PDF]

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 Diabetes CareHome page
B. Boden-Albala, S. Cammack, J. Chong, C. Wang, C. Wright, T. Rundek, M. S.V. Elkind, M. C. Paik, and R. L. Sacco
Diabetes, Fasting Glucose Levels, and Risk of Ischemic Stroke and Vascular Events: Findings from the Northern Manhattan Study (NOMAS)
Diabetes Care, June 1, 2008; 31(6): 1132 - 1137.
[Abstract] [Full Text] [PDF]

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 J. Neurol. Neurosurg. PsychiatryHome page
A Harloff, P Dudler, A Frydrychowicz, C Strecker, A L Stroh, A Geibel, C Weiller, A Hetzel, J Hennig, and M Markl
Reliability of aortic MRI at 3 Tesla in patients with acute cryptogenic stroke
J. Neurol. Neurosurg. Psychiatry, May 1, 2008; 79(5): 540 - 546.
[Abstract] [Full Text] [PDF]

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 ANGIOLOGYHome page
B. Guldiken, S. Guldiken, B. Turgut, N. Turgut, M. Demir, Y. Celik, E. Arikan, and A. Tugrul
The Roles of Oxidized Low-Density Lipoprotein and Interleukin-6 Levels in Acute Atherothrombotic and Lacunar Ischemic Stroke
Angiology, May 1, 2008; 59(2): 224 - 229.
[Abstract] [PDF]

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 StrokeHome page
J. Eggers, I. R. Konig, B. Koch, G. Handler, and G. Seidel
Sonothrombolysis With Transcranial Color-Coded Sonography and Recombinant Tissue-Type Plasminogen Activator in Acute Middle Cerebral Artery Main Stem Occlusion: Results From a Randomized Study
Stroke, May 1, 2008; 39(5): 1470 - 1475.
[Abstract] [Full Text] [PDF]

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K. Chu, K.-H. Jung, S.-T. Lee, H.-K. Park, D.-I. Sinn, J.-M. Kim, D.-H. Kim, J.-H. Kim, S.-J. Kim, E.-C. Song, et al.
Circulating Endothelial Progenitor Cells as a New Marker of Endothelial Dysfunction or Repair in Acute Stroke * Supplemental Methods
Stroke, May 1, 2008; 39(5): 1441 - 1447.
[Abstract] [Full Text] [PDF]

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 NEJMHome page
M. A. Meyer, C. Kunavarapu, J. A. Switzer, F. Nichols III, B. Silver, A. Russman, D. M. Kent, T. A. Trikalinos, D. E. Thaler, M. Handke, et al.
Patent Foramen Ovale and Cryptogenic Stroke
N. Engl. J. Med., April 3, 2008; 358(14): 1518 - 1521.
[Full Text] [PDF]

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 StrokeHome page
S. Schwarz, F. Al-Shajlawi, C. Sick, S. Meairs, and M. G. Hennerici
Effects of Prophylactic Antibiotic Therapy With Mezlocillin Plus Sulbactam on the Incidence and Height of Fever After Severe Acute Ischemic Stroke: The Mannheim Infection in Stroke Study (MISS)
Stroke, April 1, 2008; 39(4): 1220 - 1227.
[Abstract] [Full Text] [PDF]

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 StrokeHome page
S. Bevan, M. Dichgans, H. E. Wiechmann, A. Gschwendtner, T. Meitinger, and H. S. Markus
Genetic Variation in Members of the Leukotriene Biosynthesis Pathway Confer an Increased Risk of Ischemic Stroke: A Replication Study in Two Independent Populations
Stroke, April 1, 2008; 39(4): 1109 - 1114.
[Abstract] [Full Text] [PDF]

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 Neurorehabil Neural RepairHome page
S. Prabhakaran, E. Zarahn, C. Riley, A. Speizer, J. Y. Chong, R. M. Lazar, R. S. Marshall, and J. W. Krakauer
Inter-individual Variability in the Capacity for Motor Recovery After Ischemic Stroke
Neurorehabil Neural Repair, February 1, 2008; 22(1): 64 - 71.
[Abstract] [PDF]

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 StrokeHome page
H. P. Mattle, M. Arnold, D. Georgiadis, C. Baumann, K. Nedeltchev, D. Benninger, L. Remonda, C. von Budingen, A. Diana, A. Pangalu, et al.
Comparison of Intraarterial and Intravenous Thrombolysis for Ischemic Stroke With Hyperdense Middle Cerebral Artery Sign
Stroke, February 1, 2008; 39(2): 379 - 383.
[Abstract] [Full Text] [PDF]

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 StrokeHome page
A. Bruno, T. A. Kent, B. M. Coull, R. R. Shankar, C. Saha, K. J. Becker, B. M. Kissela, and L. S. Williams
Treatment of Hyperglycemia In Ischemic Stroke (THIS): A Randomized Pilot Trial
Stroke, February 1, 2008; 39(2): 384 - 389.
[Abstract] [Full Text] [PDF]

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 StrokeHome page
B. H. Buck, D. S. Liebeskind, J. L. Saver, O. Y. Bang, S. W. Yun, S. Starkman, L. K. Ali, D. Kim, J. P. Villablanca, N. Salamon, et al.
Early Neutrophilia Is Associated With Volume of Ischemic Tissue in Acute Stroke
Stroke, February 1, 2008; 39(2): 355 - 360.
[Abstract] [Full Text] [PDF]

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 StrokeHome page
R. Sciolla, F. Melis, and for the SINPAC Group
Rapid Identification of High-Risk Transient Ischemic Attacks: Prospective Validation of the ABCD Score
Stroke, February 1, 2008; 39(2): 297 - 302.
[Abstract] [Full Text] [PDF]


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