Stroke: causes and clinical features

Stroke represents a clinical syndrome rather than a specific disease. It can be caused by a number of different pathologies which all result in a usually sudden-onset focal cerebral damage. This article reviews risk factors for stroke, and the different pathologies which can cause stroke. Approximately 20% of strokes are due to cerebral haemorrhage most of which is intracerebral, with a significant minority due to subarachnoid haemorrhage. The remaining 80% are due to ischaemic stroke which itself has a number of different subtypes, including large artery disease, cardioembolism, and small vessel disease. Differentiation of cerebral ischaemia from haemorrhage is impossible without brain imaging. Assessment of a patient with ischaemic stroke requires knowledge of the cerebral arterial supply and cerebral anatomy which allows one to determine which particular vascular territory (anterior versus posterior) is involved.