Published Online
on November 6, 2003

A more recent version of this article appeared on December 1, 2003

This Article Full Text (PDF) All Versions of this Article: 34/12/2995    most recent 01.STR.0000098902.69855.A9v1 Alert me when this article is cited Alert me if a correction is posted 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 Kidwell, C. S. Articles by Warach, S. Search for Related Content PubMed PubMed Citation Articles by Kidwell, C. S. Articles by Warach, S. Related Collections Acute Cerebral Infarction Acute Stroke Syndromes Emergency treatment of Stroke Angiography Computerized tomography and Magnetic Resonance Imaging Doppler ultrasound, Transcranial Doppler etc. PET and SPECT Other imaging Primary and Secondary Stroke Prevention Neuroprotectors Thrombolysis

Submitted on June 14, 2003
Accepted on July 23, 2003

Acute Ischemic Cerebrovascular Syndrome. Diagnostic Criteria

Chelsea S. Kidwell MD and Steven Warach MD, PhD^*

From the University of California at Los Angeles Stroke Center and Department of Neurology, University of California at Los Angeles Medical Center (C.S.K.), and National Institutes of Health, National Institute of Neurological Disorders and Stroke, Stroke Branch, Bethesda, Md (S.W.).

^* To whom correspondence should be addressed. E-mail: warachs{at}ninds.nih.gov.

Background--Existing diagnostic classification systems for cerebrovascular disease are based primarily on clinical impression of temporal features, clinical syndrome, inferred localization, or ischemic mechanism. Diagnostic certainty of the ischemic pathology based on supportive or refuting laboratory or radiological evidence has been of secondary importance.

Summary of Comment--Acute ischemic cerebrovascular syndrome (AICS) describes a spectrum of clinical presentations that share a similar underlying pathophysiology: cerebral ischemia. Diagnostic criteria for AICS incorporate prior classification systems and currently available information provided by neuroimaging and laboratory data to define 4 categories ranging from "definite AICS" to "not AICS," which define the degree of diagnostic certainty.

Conclusions--Clinical trials testing new treatments for acute ischemic stroke or secondary stroke prevention should limit enrollment to patients with "definite" AICS whenever feasible.

Key words: brain imaging • classification • diagnosis

This article has been cited by other articles:

				J. D. Easton, J. L. Saver, G. W. Albers, M. J. Alberts, S. Chaturvedi, E. Feldmann, T. S. Hatsukami, R. T. Higashida, S. C. Johnston, C. S. Kidwell, et al. Definition and Evaluation of Transient Ischemic Attack: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association Stroke Council; Council on Cardiovascular Surgery and Anesthesia; Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular Nursing; and the Interdisciplinary Council on Peripheral Vascular Disease: The American Academy of Neurology affirms the value of this statement as an educational tool for neurologists. Stroke, June 1, 2009; 40(6): 2276 - 2293. [Abstract] [Full Text] [PDF]

				J. L. Saver Proposal for a Universal Definition of Cerebral Infarction Stroke, November 1, 2008; 39(11): 3110 - 3115. [Abstract] [Full Text] [PDF]

				F. Purroy, J. Montaner, C. A. Molina, P. Delgado, M. Ribo, and J. Alvarez-Sabin Patterns and Predictors of Early Risk of Recurrence After Transient Ischemic Attack With Respect to Etiologic Subtypes Stroke, December 1, 2007; 38(12): 3225 - 3229. [Abstract] [Full Text] [PDF]

				L. R. Caplan Transient Ischemic Attack With Abnormal Diffusion-Weighted Imaging Results: What's in a Name? Arch Neurol, August 1, 2007; 64(8): 1080 - 1082. [Full Text] [PDF]

				S. Prabhakaran, J. Y. Chong, and R. L. Sacco Impact of Abnormal Diffusion-Weighted Imaging Results on Short-term Outcome Following Transient Ischemic Attack Arch Neurol, August 1, 2007; 64(8): 1105 - 1109. [Abstract] [Full Text] [PDF]

				K. R. Nandalur, E. Baskurt, K. D. Hagspiel, C. D. Phillips, and C. M. Kramer Calcified Carotid Atherosclerotic Plaque Is Associated Less with Ischemic Symptoms Than Is Noncalcified Plaque on MDCT Am. J. Roentgenol., January 1, 2005; 184(1): 295 - 298. [Abstract] [Full Text] [PDF]

				B. Ovbiagele, J. L. Saver, A. Fredieu, S. Suzuki, S. Selco, V. Rajajee, N. McNair, T. Razinia, and C. S. Kidwell In-Hospital Initiation of Secondary Stroke Prevention Therapies Yields High Rates of Adherence at Follow-up Stroke, December 1, 2004; 35(12): 2879 - 2883. [Abstract] [Full Text] [PDF]

				C. S. Kidwell, J. A. Chalela, J. L. Saver, S. Starkman, M. D. Hill, A. M. Demchuk, J. A. Butman, N. Patronas, J. R. Alger, L. L. Latour, et al. Comparison of MRI and CT for Detection of Acute Intracerebral Hemorrhage JAMA, October 20, 2004; 292(15): 1823 - 1830. [Abstract] [Full Text] [PDF]

				F. Purroy, J. Montaner, A. Rovira, P. Delgado, M. Quintana, and J. Alvarez-Sabin Higher Risk of Further Vascular Events Among Transient Ischemic Attack Patients With Diffusion-Weighted Imaging Acute Ischemic Lesions Stroke, October 1, 2004; 35(10): 2313 - 2319. [Abstract] [Full Text] [PDF]

				S. Warach and C. S. Kidwell The redefinition of TIA: The uses and limitations of DWI in acute ischemic cerebrovascular syndromes Neurology, February 10, 2004; 62(3): 359 - 360. [Full Text] [PDF]

				S. Warach and J.-C. Baron Neuroimaging Stroke, February 1, 2004; 35(2): 351 - 353. [Full Text] [PDF]