This Article Full Text Full Text (PDF) All Versions of this Article: 36/12/2523    most recent 01.STR.0000194560.65809.47v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Barnett, H. J.M. Search for Related Content PubMed PubMed Citation Articles by Barnett, H. J.M. Pubmed/NCBI databases Medline Plus Health Information Stroke Related Collections Related Article

(Stroke. 2005;36:2523.)
© 2005 American Heart Association, Inc.

Editorials

Stroke by Cause

Some Common, Some Exotic, Some Controversial

Henry J.M. Barnett, MD

From the The John P Robarts Research Institute, 100 Perth Dr, London, Ontario, Canada N6A5K8

Correspondence to Henry J.M. Barnett,14865 7th Concession, King City, ON, Canada L7B 1K4. E-mail hjmb@sympatico.ca

An extract of the first 250 words of the full text is provided, because this article has no abstract.

See related article, pages 2533–2537

In this exciting era of stroke prevention and treatment, the stroke neurologist is privileged and obliged to determine with reasonable certainty the cause of every cerebral or ocular vascular event. Investigation must seek evidence for either cardiac, large-artery, penetrating artery (lacunar) or, in their absence, for a growing miscellany of "other"causes. Thanks to the increasing accuracy of cardiac, aortic, arterial, and brain imaging, precise evidence about the cause but also the site, size, and type (hemorrhagic or bland) of the lesion will be available. In conjunction with a careful history of the mode of onset of present symptoms and of past events, the modern imaging data will allow for specific and particular short and long-term treatment programs for most patients. Decisions about the use of anticoagulants, platelet inhibitors, or recommendations for surgical procedures directed to the heart or the great vessels depend on the accurate accumulation of data about stroke-by-cause.

When rheumatic heart disease virtually disappeared and as the population aged, nonvalvular atrial fibrillation (NVAF) became increasingly prevalent. Scepticism greeted the hypothesis that there was a causal relationship between AF without valve disease and stroke. These doubts were reduced when observational studies reported an increasing incidence of stroke with NVAF.¹ Dispute ceased when clinical trials proved without equivocation that the occurrence of stroke in these individuals was significantly and substantially reduced with the use of anticoagulants. Apart from rhythm monitoring and echocardiography, extensive cardiac investigation is not required. NVAF is a disease to which . . . [Full Text of this Article]

Related Article:

Mitral Annular Calcification, Aortic Valve Sclerosis, and Incident Stroke in Adults Free of Clinical Cardiovascular Disease: The Strong Heart Study

Jorge R. Kizer, David O. Wiebers, Jack P. Whisnant, James M. Galloway, Thomas K. Welty, Elisa T. Lee, Lyle G. Best, Helaine E. Resnick, Mary J. Roman, and Richard B. Devereux
Stroke 2005 36: 2533-2537. [Abstract] [Full Text] [PDF]

This article has been cited by other articles:

				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]

				D J H McCabe and R D Rakhit Antithrombotic and interventional treatment options in cardioembolic transient ischaemic attack and ischaemic stroke J. Neurol. Neurosurg. Psychiatry, January 1, 2007; 78(1): 14 - 24. [Abstract] [Full Text] [PDF]

				Mitral Annular Calcification and Stroke Journal Watch Cardiology, January 19, 2006; 2006(119): 5 - 5. [Full Text]