Strokes most commonly develop in the presence of vascular or cardiac changes based
on lifestyle-related diseases, such as hypertension, diabetes mellitus and hyperlipidemia.
Therefore, the prevention of the progression of vascular or cardiac changes has to
be taken into consideration in the acute phase of stroke treatment and in the chronic
management of such stroke patients. Apart from the common types, there are special
types of strokes which are not based on lifestyle-related diseases, such as cerebrovascular
changes caused by physical pressure, cerebrovascular lesions of unknown cause, congenital
cardiovascular abnormalities, or blood vessel inflammation. The representative cases
are hemorrhagic or ischemic stroke associated with intracranial/extracranial arterial
dissection, stroke associated with moyamoya disease (occlusion of the circle of Willis),
paradoxical cerebral embolism, cerebral venous/sinus thrombosis, cerebral amyloid
angiopathy, fibromuscular dysplasia, and aortitis syndrome. When treating these conditions,
special strategies and particular attention or specific surgical treatments are often
required, different from those for general stroke based on lifestyle-related diseases.
For instance, in cases of cerebral infarction due to moyamoya disease administration
of tissue plasminogen activator (t-PA), a thrombolytic drug, is prohibited, even if
the patient’s arrival at the stroke care unit is 1-2 hours after onset.1 Likewise, in cases of infarction occurring due to intracranial cerebral arterial
dissection, careful attention is needed to choose the administration of antiplatelet
or anticoagulant agents during the acute phase.2,3 In the Japanese Guidelines for the Management of Stroke 2009, these special types
of cerebrovascular disorders are grouped under “Other types of cerebrovascular disorders”
separately from general cerebral infarction, intracerebral hemorrhage (ICH) and subarachnoid
hemorrhage (SAH), and their treatment guidelines are documented individually in this
chapter. The “other types of cerebrovascular disorders” include also hypertensive
encephalopathy, vascular dementia and vascular cognitive impairment.
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Article info
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2011.05.013
Copyright
© 2011 Published by Elsevier Inc.
