Later we will cover in more detail the evaluation of stroke patients and how to choose secondary prevention strategies in relation to the results of the diagnostic considerations.
With brain imaging and vascular evaluation we try to find a specific etiology such as cardioembolic source, arterial stenosis, etc. At the same time, we look for reversible risk factors for recurrent stroke such as hypertension, diabetes, hypercholesterolemia, and smoking/substance abuse that will need to be addressed.
There are several different ways to classify strokes (based on severity, location, size, etc.), but for planning a secondary stroke prevention strategy we find the following TOAST
Classification most useful, since it is based on stroke mechanism.
. Large-artery atherosclerosis: intracranial, extracranial (carotid, aortic arch).
. Cardioembolic: atrial fibrillation, segmental wall akinesis, paradoxical embolus, etc.
. Small vessel: lacunar infarction.
. Other: unusual causes (dissection, venous thrombosis, drugs, etc.).
. Unknown: cryptogenic.
