Annals of Indian Academy of Neurology
  Users Online: 633 Home | About the Journal | InstructionsCurrent Issue | Back IssuesLogin      Print this page Email this page  Small font size Default font size Increase font size
Year : 2022  |  Volume : 25  |  Issue : 6  |  Page : 1019-1028

An MRI based ischemic stroke classification – A mechanism oriented approach

Department of Neurology, Government Medical College Kozhikode, Kozhikode, Kerala, India

Correspondence Address:
Joe James
Department of Neurology, Government Medical College Kozhikode, Kozhikode, Kerala
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/aian.aian_365_22

Rights and Permissions

Oxfordshire Community Stroke Project and Trial of Org 10172 in acute stroke treatment are the commonly used ischemic stroke classification systems at present. However, they underutilize the newer imaging technologies. Diffusion-weighted magnetic resonance imaging (DW-MRI) of the brain can detect the site and extent of infarcts accurately. From the MRI patterns, the mechanisms of ischemic stroke can be inferred. We propose to classify ischemic infarcts into the following types based on their DW-MRI appearance: cortical territorial infarcts, striatocapsular infarcts, superficial perforator infarcts, cortical and deep watershed infarcts, lacunar infarcts, long insular artery (LIA) infarcts, branch atheromatous disease (BAD) infarcts, corpus callosal infarcts, infratentorial infarcts, and unclassifiable infarcts. This DW-MRI-based classification of ischemic stroke is easy, fast, and mechanism oriented. A review of the literature reveals that cortical territorial, striatocapsular, and corpus callosal infarcts are associated with embolic sources and large artery intracranial atherosclerosis. Superficial perforator and LIA infarcts are also probably embolic. Watershed infarcts are frequently associated with severe carotid disease with microembolism or hemodynamic failure. Mechanisms of BAD infarcts include microatheroma, junctional plaque or a plaque within a parent artery blocking the orifice of a large, deep penetrating, or circumferential artery. Small lacunar infarcts are due to the lipohyalinosis of penetrating arteries. Types and mechanisms of infratentorial infarcts are similar to supratentorial infarcts. Such a classification system is useful for prognosticating acute stroke, arranging specific investigations, and planning strategies for secondary prevention and research.

Print this article     Email this article
 Next article
 Previous article
 Table of Contents

 Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
 Citation Manager
 Access Statistics
 Reader Comments
 Email Alert *
 Add to My List *
 * Requires registration (Free)

 Article Access Statistics
    PDF Downloaded164    
    Comments [Add]    

Recommend this journal