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Stroke is characterized by the acute onset of a focal neurological deficit referable to an insult of the cerebral vascular system. Stroke is the third leading cause of death in the United States. There are approximately 500,000 new strokes each year causing 200,000 deaths. Many patients have significant functional impairment and require long-term medical or rehabilitative care, thus adding to the socioeconomic impact of stroke. Risk factors for the development of stroke include hypertension, hyperlipidemia, diabetes, cardiac disease (e.g., atrial fibrillation), vascular disease (such as sickle cell disease), and smoking.

Stroke may be classified into ischemic or hemor-rhagic subtypes. Ischemic stroke is far more common, comprising approximately 85% of cases (Table III). Ischemic stroke may be either focal (affecting discrete regions) or global (affecting much of the forebrain with predilection for watershed regions between major vessels). Ischemic stroke may occur secondary to embolic or thrombotic phenomenon. Global ischemia usually results from systemic hypoperfusion as seen with cardiac arrest. Hemorrhagic stroke may be due to

Brain Vein
Figure 5 Superficial and deep venous systems. From Nolte (1993), The Human Brain: An Introduction to Its Functional Anatomy, 3rd ed. Mosby, St. Louis. Used with permission.
Brain Vein
Figure 6 Cerebral venous system. From Nolte (1993), The Human Brain: An Introduction to Its Functional Anatomy, 3rd ed. Mosby, St. Louis. Used with permission.

Figure 7 Superficial cerebral veins. (From Grant's Atlas of Anatomy, 9th Ed., Copyright © Lippincott Williams & Wilkins.).

Table III

Classification System for Stroke

Ischemic (85%) Focal Embolic Cardiac Intraarterial Aortic Thrombotic

Large artery disease (intracranial and intracranial) Small penetrating artery disease (lacunar) Global

Systemic hypoperfusion (e.g., cardiac arrest) Hemorrhagic (15%)

Subarachnoid hemorrhage Intracerebral hemorrhage subarachnoid hemorrhage (SAH) or intracerebral hemorrhage (ICH).

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