[The probability of assessing the pathogenesis of ischemic stroke. Study of 81 patients]

81 patients with ischemic stroke were studied in order to assess the pathogenesis, the accuracy of the pathogenetic diagnosis and the relationship between pathogenesis and infarct site. The pathogenetic mechanisms were grouped according to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) system. TOAST system settles five pathogenetic diagnosis: 1) Large artery atherosclerosis (LM); 2) Cardioembolism (CE); 3) Small artery occlusion (SAO); 4) Other etiologies (SOE); 5) Undetermined pathogenesis. As regards the site, the patients were divided into the following groups: Posterior Circulation Infarcts (POCI) 8.6%, Total Anterior Circulation Infarcts (TACI) 19.8%, Partial Anterior Circulation Infarcts (PACI) 29.6%, Lacunar Anterior Circulation Infarcts (LACI) 30.9%, Multiple Site Infarcts 11.1%. A probable or certain diagnosis was issued only in 33.3%. The diagnosis was not complete in 22.2%. That was due either to the severe clinical status or the patient and his relatives' refusal. Most of the incomplete diagnosis occurred in TACI patients. The undetermined pathogenesis due to absent clues occurred in 18.5%. CE often brought about TACI, whereas LM was likely to provoke PACI. SOE, like systemic hypotension, brought about Multiple Site Infarcts. Unfortunately assessing the pathogenetic diagnosis is still a controversial issue and TOAST method itself is not satisfactory as an overall classification system.