Stroke as a Complication of Medical Disease

 

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ABSTRACT

This article focuses on the medical diseases that not only lead to cerebrovascular complications, but at times initially manifest as cerebral infarction. Specifically, I examine the relationships between stroke and various medical diseases (inflammatory disease, migraine and other vasoconstrictive disorders, congenital heart disease, connective tissue disorders, infectious disease, malignancy, and polycystic kidney disease). Many of these conditions may cause cerebrovascular ischemia via nonatherosclerotic mechanisms. Understanding these relationships between stroke and medical disease will allow the reader to better recognize etiologic relationships, and thereby reach more accurate diagnoses.

REFERENCES

• 1 Machado E BV, Michet C J, Ballard D J et al.. Trends in incidence and clinical presentation of temporal arteritis in Olmsted County, Minnesota. 1950–1985.  Arthritis Rheum. 1988;  31 745-749
  CrossrefPubMedGoogle Scholar
• 2 Goodman B W. Temporal arteritis.  Am J Med. 1979;  67 839
  CrossrefPubMedGoogle Scholar
• 3 Hunder G G, Bloch D A, Michel B A et al.. The American College of Rheumatology 1990 criteria for the classification of giant cell arteritis.  Arthritis Rheum. 1990;  33 1122-1128
  CrossrefPubMedGoogle Scholar
• 4 Masugata H, Yasuno M, Nishino M et al.. Takayasu's arteritis with collateral circulation from the right coronary artery to intracranial vessels: a case report.  Angiology. 1992;  43 448-452
  CrossrefPubMedGoogle Scholar
• 5 Kitagawa Y, Gotoh F, Koto A, Okayasu H. Stroke in systemic lupus erythematosus.  Stroke. 1990;  21 1533-1539
  PubMedGoogle Scholar
• 6 Johnson R T, Richardson E P. The neurological manifestations of systemic lupus erythematosus.  Medicine. 1968;  47 337-369
  CrossrefPubMedGoogle Scholar
• 7 Devinsky O, Petito C K, Alonso D R. Clinical and neuropathological findings in systemic lupus erythematosus: the role of vasculitis, heart emboli, and thrombotic thrombocytopenic purpura.  Ann Neurol. 1988;  23 380-384
  CrossrefPubMedGoogle Scholar
• 8 Levine S R, Brey R L, Tilley B C et al.. Antiphospholipid antibodies and subsequent thrombo-occlusive events in patients with ischemic stroke.  JAMA. 2004;  291(5) 576-584
  CrossrefPubMedGoogle Scholar
• 9 Nagel M A, Cohrs R J, Mahalingam R et al.. The varicella zoster virus vasculopathies: clinical, CSF, imaging, and virologic features.  Neurology. 2008;  70 853-860
  CrossrefPubMedGoogle Scholar
• 10 Harrison P E. Granulomatous angiitis of the central nervous system.  J Neurol Sci. 1976;  29 335-341
  CrossrefPubMedGoogle Scholar
• 11 Classification and diagnostic criteria for headache disorders, cranial neuralgias and facial pain.  Headache Classification Committee of the International Headache Society . Cephalalgia. 1988;  8(Suppl 7) 1-96
  CrossrefPubMedGoogle Scholar
• 12 Rascol A, Cambier J, Guiraud B, Manelfe C, David J, Clanet M. Accidents ischemiques cerebraux au cours de crises migraineuses. A propos des migraines compliquees.  Rev Neurol (Paris). 1980;  135 867-884
  PubMedGoogle Scholar
• 13 Caplan L R. Migraine and vertebrobasilar ischemia.  Neurology. 1991;  41(1) 55-61
  CrossrefPubMedGoogle Scholar
• 14 Ducros A, Boukobza M, Porcher R, Sarov M, Valade D, Bousser M G. The clinical and radiological spectrum of reversible cerebral vasoconstriction syndrome. A prospective series of 67 patients.  Brain. 2007;  130 3091-3101
  CrossrefPubMedGoogle Scholar
• 15 Hinchey J, Chaves C, Appignani B et al.. A reversible posterior leukoencephalopathy syndrome.  N Engl J Med. 1996;  334 494-500
  CrossrefPubMedGoogle Scholar
• 16 Johansson B B. The blood-brain barrier and cerebral blood flow in acute hypertension.  Acta Med Scand Suppl. 1983;  678 107-112
  PubMedGoogle Scholar
• 17 Bartleson J D, Swanson J W, Whisnant J P. A migrainous syndrome with cerebrospinal fluid pleocytosis.  Neurology. 1981;  31 1257-1262
  CrossrefPubMedGoogle Scholar
• 18 Barnett H J, Jones M W, Boughner D R, Kostuk W J. Cerebral ischemic events associated with prolapsing mitral valve.  Arch Neurol. 1976;  33 777-782
  PubMedGoogle Scholar
• 19 Gilon D, Buonanno F S, Joffe M M et al.. Lack of evidence of an association between mitral-valve prolapse and stroke in young patients.  N Engl J Med. 1999;  341 8-13
  CrossrefPubMedGoogle Scholar
• 20 Hagen P T, Scholz D G, Edwards W D. Incidence and size of patent foramen ovale during the first 10 decades of life: an autopsy study of 965 normal hearts.  Mayo Clin Proc. 1984;  59 17-20
  CrossrefPubMedGoogle Scholar
• 21 Mattioli A V, Bonetti L, Aquilina M, Oldani A, Longhini C, Mattioli G. Association between atrial septal aneurysm and patent foramen ovale in young patients with recent stroke and normal carotid arteries.  Cerebrovasc Dis. 2003;  15 4-10
  CrossrefPubMedGoogle Scholar
• 22 Schievink W I, Mokri B, Jackers G. Spontaneous dissection of cervicocephalic arteries in childhood and adolescence.  Neurology. 1994;  44 1607-1612
  CrossrefPubMedGoogle Scholar
• 23 Saver J L, Easton J D. Dissections and trauma of cervicocerebral arteries. In: Barnett HJM, Mohr JP, Stein BM, et al Stroke: Pathophysiology, Diagnosis and Management. 3rd ed. New York, NY; Churchill Livingstone 1998: 769
  Google Scholar
• 24 Schievink W I. Spontaneous dissection of the carotid and vertebral arteries.  N Engl J Med. 2001;  334 898-906
  PubMedGoogle Scholar
• 25 Mokri B, Piepgras D G, Houser O W. Traumatic and spontaneous extracranial internal carotid artery dissections.  J Neurol. 1990;  237 356-361
  CrossrefPubMedGoogle Scholar
• 26 de Bray J M, Pennison-Besnier L, Dupas F, Emile J. Extracranial and intracranial vertebrobasilar dissections: diagnosis and prognosis.  J Neurol Neurosurg Psychiatry. 1997;  63 46-51
  CrossrefPubMedGoogle Scholar
• 27 Beighton P, De Paepe A, Steinmann B et al.. Ehlers-Danlos syndromes: revised nosology, Villefranche, 1997. Ehlers-Danlos National Foundation (USA) and Ehlers-Danlos Support Group (UK).  Am J Med Genet. 1998;  77 31-37
  CrossrefPubMedGoogle Scholar
• 28 Tonarelli S B, Benavente O. Heritable connective tissue disorders and stroke.  Semin Cerebrovasc Dis Stroke. 2005;  5 2-12
  PubMedGoogle Scholar
• 29 Schievink W I, Michels V V, Piepgras D G. Neurovascular manifestations of heritable connective tissue disorders. A review.  Stroke. 1994;  25 889-903
  PubMedGoogle Scholar
• 30 Okamura T, Yamamoto M, Ohta K, Matsuoka T, Takahashi M, Uozumi T. A case of ruptured cerebral aneurysm associated with fenestrated vertebral artery in osteogenesis imperfecta.  No Shinkei Geka. 1995;  23 451-455
  PubMedGoogle Scholar
• 31 Emsley H C, Hopkins S J. Acute ischaemic stroke and infection: recent and emerging concepts.  Lancet Neurol. 2008;  7 341-353
  CrossrefPubMedGoogle Scholar
• 32 Cermak J, Key N S, Bach R R, Balla J, Jacob H S, Vercellotti G M. C-reactive protein induces human peripheral blood monocytes to synthesize tissue factor.  Blood. 1993;  82 513-520
  PubMedGoogle Scholar
• 33 Kreutz R P, Bliden K P, Tantry U S, Gurbel P A. Viral respiratory tract infections increase platelet reactivity and activation: an explanation for the higher rates of myocardial infarction and stroke during viral illness.  J Thromb Haemost. 2005;  3 2108-2109
  CrossrefPubMedGoogle Scholar
• 34 Grau A J, Buggle F, Becher H et al.. Recent bacterial and viral infection is a risk factor for cerebrovascular ischemia: clinical and biochemical studies.  Neurology. 1998;  50 196-203
  PubMedGoogle Scholar
• 35 Grau A J, Brandt T, Buggle F et al.. Association of cervical dissection with recent infection.  Arch Neurol. 1999;  56 851-856
  CrossrefPubMedGoogle Scholar
• 36 Davis M M, Taubert K, Benin A L et al.. Influenza vaccination as secondary prevention for cardiovascular disease: a science advisory from the American Heart Association/American College of Cardiology.  Circulation. 2006;  114 1549-1553
  CrossrefPubMedGoogle Scholar
• 37 Pfister H W, Borasio G D, Dirnagl U, Bauer M, Einhäupl K M. Cerebrovascular complications of bacterial meningitis in adults.  Neurology. 1992;  42 1497-1504
  CrossrefPubMedGoogle Scholar
• 38 Salgado A V, Furlan A J, Keys T F, Nichols T R, Beck G J. Neurologic complications of endocarditis: a 12-year experience.  Neurology. 1989;  39 173-178
  PubMedGoogle Scholar
• 39 Anderson D J, Goldstein L B, Wilkinson W E et al.. Stroke location, characterization, severity, and outcome in mitral vs. aortic valve endocarditis.  Neurology. 2003;  61 1341-1346
  PubMedGoogle Scholar
• 40 Hart R G, Foster J W, Luther M F, Kanter M C. Stroke in infective endocarditis.  Stroke. 1990;  21 695-700
  CrossrefPubMedGoogle Scholar
• 41 Del Brutto O H. Infections and stroke.  Handb Clin Neurol. 2008;  93 851-872
  PubMedGoogle Scholar
• 42 Asdaghi N, Muayqil T, Scozzafava J, Jassal R, Saqqur M, Jeerakathil T J. The re-emergence in Canada of meningovascular syphilis: 2 patients with headache and stroke.  CMAJ. 2007;  176 1699-1700
  CrossrefPubMedGoogle Scholar
• 43 Cantú C, Barinagarrementeria F. Cerebrovascular complications of neurocysticercosis. Clinical and neuroimaging spectrum.  Arch Neurol. 1996;  53 233-239
  PubMedGoogle Scholar
• 44 Walsh T J, Hier E B, Caplan L R. Aspergillosis of the central nervous system: clinicopathological analysis of 17 patients.  Ann Neurol. 1985;  18 574-582
  CrossrefPubMedGoogle Scholar
• 45 Saul R F, Gallagher J G, Mateer J E. Sudden hemiparesis as the presenting sign in cryptococcal meningoencephalitis.  Stroke. 1986;  17 753-754
  PubMedGoogle Scholar
• 46 Rangel-Guerra R, Martinez H R, Saenz C. Mucormycosis. Report of 11 cases.  Arch Neurol. 1985;  42 578-581
  PubMedGoogle Scholar
• 47 Connor M D, Lammie G A, Bell J E, Warlow C P, Simmonds P, Brettle R D. Cerebral infarction in adult AIDS patients: observations from the Edinburgh HIV autopsy cohort.  Stroke. 2000;  31 2117-2126
  CrossrefPubMedGoogle Scholar
• 48 Haller S, Lyrer P. Malignancy and stroke.  Semin Cerebrovasc Dis Stroke. 2005;  5 47-54
  PubMedGoogle Scholar
• 49 Züchner S, Kawohl W, Selhaus B, Mull M, Mayfrank L, Kosinski C Ml. A case of gliosarcoma appearing as ischaemic stroke.  J Neurol Neurosurg Psychiatry. 2003;  74(3) 364-366
  CrossrefPubMedGoogle Scholar
• 50 Rogers L R. Cerebrovascular complications in cancer patients.  Neurol Clin. 2003;  21(1) 167-192
  CrossrefPubMedGoogle Scholar
• 51 Newton H B. Neurologic complications of systemic cancer.  Am Fam Physician. 1999;  59(4) 878-886
  PubMedGoogle Scholar
• 52 Ekinci E I, Donnan G A. Neurological manifestations of cardiac myxoma: a review of the literature and report of cases.  Intern Med J. 2004;  34(5) 243-249
  CrossrefPubMedGoogle Scholar
• 53 Hutson 3rd J, Torres V E, Sullivan P P, Offord K P, Wiebers D O. Value of magnetic resonance angiography for the detection of intracranial aneurysms in autosomal dominant polycystic kidney disease.  J Am Soc Nephrol. 1993;  3 1871-1877
  PubMedGoogle Scholar

Michael ChenM.D. 

Assistant Professor in Neurology, Neurosurgery, and Radiology, Department of Neurological Sciences

Rush University Medical Center, 1725 West Harrison Street, Suite 1118, Chicago, IL 60612

Email: Michael_Chen@rush.edu