Question

A 68-year-old right-handed woman was brought to the emergency room with sudden onset face, arm, and leg paralysis on the left side. She was speaking in a dysarthric situation. Past medical history was notable for hypertension. On neurologic examination; the patient had right gaze preference. No movement on the left arm and left leg with hyperreflexia and Babinski’s sign on the same side. When the doctor asks the patient to hold up her left arm, she was holding the arm on the right side instead of right. the doctor heard a right carotid bruit continuing into diastole.

What do you think about the stroke etiology for the above-mentioned patient? (classify it according to TOAST classification) (explain with a maximum of 100 words)

Answer 1

A stroke occurs when a part of the brain is not getting adequate blood or blood supply to the brain is interrupted.

For the given scenario, the patient is getting a stroke due to ischemic stroke. Ischemic stroke occurs due to the narrowness of the blood vessel in the brain due to the fatty deposition in the vessels or block of the blood vessel due to any clot that travels to the brain from the body. This leads to a lack of oxygen supply to the brain.

According to the TOAST classification, it is divided into

1. Large artery atherosclerosis: It occurs due to stenosis of the major brain artery, branch carotic artery, presumed atherosclerotic.

2. Cardio- embolism: It is related to the cardiac source of embolus like atrial fibrillation, prosthetic valves, infective carditis.

3. Small vessel occlusion or lacunar stroke: in this only small vessel occlusion are involve due to HTN or DM.

4. stroke of other determined etiology: It occurs due to any rare condition like hypercoagulable state, nonatherosclerotic vasculopahties.

5. stroke of undetermined etiology: In this, the etiology is not able to identify properly due to two or more causes are identified, negative evaluation, incomplete evaluation.

For this patient while examine there is found of carotid bruit, it indicates narrow down of the carotid artery. So accordint to the TOAST classification the etiology is large artery atherosclerosis.