Clinical-morphological features of hemodynamic strokes

Introduction. An important objective of neurology is to clarify the pathogenesis of ischemic strokes and the diagnostic distinction of their pathogenetic subtypes that determines the possibility of targeted treatment and adequate prevention of strokes. Objective: Definition of clinical and morphological features of the hemodynamic subtype of ischemic stroke. Materials and methods. A clinical-pathological comparison in 32 cases of hemodynamic strokes. Results. It was established that hemodynamic strokes were caused by the presence of factors reducing systemic and cerebral hemodynamics in combination with tandem atherostenosis of carotid arteries (40% of strokes) and vertebrobasilar arteries (43%), and, occasionally, stenosis of both brain arterial systems or isolated cerebral arterial stenosis (10% and 7%, respectively). The severity of tandem stenosis on the side of the cerebral infarction ranged from 50% to 90%, and some strokes developed with minimal stenosis of each of the vessels. Eighty eight percent of strokes developed in patients having combination of stenosis on the side of the infarction with significant contralateral stenosis. In 43% of strokes, single or multiple small-sized cortical or medium-sized cortical-subcortical infarctions in areas of adjacent blood supply of cerebral hemispheres, as well as lacunar or medium-sized infarctions in the white matter of the hemispheres were seen. Thirty nine percent of strokes were associated with infarctions in the areas of adjacent blood supply of the cerebellar and the brainstem arteries. Eighty percent of cases were associated with atypical for this stroke subtype large-sized and medium-sized cortical-subcortical infarctions outside the areas of adjacent blood supply, resulting from inability to compensate cerebral blood supply deficiency through arterial anastomoses because of severe insi- and contralateral stenoses. Conclusions. Our clinical-pathological comparisons confirmed the previously established differential diagnostic criteria of hemodynamic strokes and, in addition, showed some specific features of their realization.