Other Causes of Stroke

There are many other causes of stroke, most of which are rare. Inflammatory disorders can cause thickening of the vessel walls, with obstruction of blood flow, hemorrhage, and multifocal infarction. There are several forms of angiitis or vasculitis (Table II), including Moyamoya disease, Wegener's granulomatosis, and polyarteritis nodosa. Some forms of vascular disease are notoriously difficult to diagnose, and the vascular pathology is poorly understood (e.g., the vasculopathy of systemic lupus erythematosus). Traumatic causes of stroke include air, fat, and marrow embolism. Increased intracranial pressure resulting from trauma can lead to reduced cerebral perfusion pressure with watershed ischemia and infarction. Infections may cause stroke due to associated inflammatory changes in the vasculature (e.g., herpes zoster). Developmental vascular anomalies, such as cavernous, venous, or capillary malformations, may lead to stroke. Cardiac abnormalities such as atrial septal aneurysm can predispose to cardiogenic cerebral embolism. Infection or thrombus formation within the cavernous sinus obstructs venous flow leaving the brain and may cause stroke. Neoplasm is commonly encountered in association with nonbacterial throm-botic endocarditis, a notoriously devastating cause of cardiogenic embolism. Atrial myxomas are tumors within the atrium that may produce tumor emboli. Cryoglobulinemia is one of the many causes of hypercoagulable state that may produce stroke. The list of stroke etiologies is extensive, and Table II is therefore incomplete.

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