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Related Concept Videos

Ischemic Stroke l: Introduction01:15

Ischemic Stroke l: Introduction

Ischemic stroke is an acute cerebrovascular condition in which blood flow to a brain region is suddenly interrupted, leading to tissue infarction. Neurons depend on continuous oxygen and glucose supply, so even brief reductions in perfusion cause energy failure, ionic imbalance, and irreversible injury. Ischemic strokes are classified into thrombotic and embolic types based on their underlying mechanisms.Thrombotic MechanismsThrombotic stroke develops when a clot forms within a cerebral artery.
Ischemic Stroke ll: Pathophysiology01:15

Ischemic Stroke ll: Pathophysiology

An ischemic stroke occurs when a cerebral blood vessel becomes obstructed, most often by a thrombus or embolus, interrupting the delivery of oxygen and glucose to brain tissue. Because neurons rely on continuous aerobic metabolism, energy failure begins within minutes of reduced perfusion. The region receiving the least blood flow becomes the infarct core, an area of irreversible cellular death. Surrounding this core lies the penumbra, a zone of hypoperfused but still viable tissue that is...
Stroke: Introduction and Types01:29

Stroke: Introduction and Types

A stroke is an acute neurological event caused by the sudden disruption of cerebral blood flow, leading to rapid loss of neuronal function. Neurons depend on continuous oxygen and glucose supply, so even brief interruptions can cause irreversible injury within minutes. Strokes are classified into ischemic and hemorrhagic types.Ischemic StrokeIschemic strokes are most common and occur due to arterial occlusion, depriving brain tissue of oxygen and nutrients. This leads to energy failure, ionic...
Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT01:25

Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT

Calcium-Scoring CT ScanA calcium-scoring CT scan, also known as coronary artery calcium (CAC) scan, detects calcium deposits in the coronary arteries. This test assesses the risk of coronary artery disease (CAD), which can lead to cardiovascular events such as angina, heart failure, and sudden cardiac arrest.A calcium-scoring CT scan is generally recommended for individuals at intermediate risk of CAD without symptoms. It includes:Men aged 40-75 and women aged 50-75: Especially those with a...
Hemorrhagic Stroke ll: Pathophysiology01:29

Hemorrhagic Stroke ll: Pathophysiology

A hemorrhagic stroke develops when a cerebral blood vessel ruptures, allowing blood to escape into the surrounding brain tissue, as in intracerebral hemorrhage (ICH), or into the subarachnoid space, as in subarachnoid hemorrhage (SAH). Because the skull is a rigid compartment, the sudden presence of extravascular blood rapidly increases intracranial pressure and compresses adjacent neural structures, leading to immediate tissue injury and impaired cerebral perfusion.Mass Effect and Primary...
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Transient Ischemic Attack l: Introduction

A transient ischemic attack (TIA) is a brief episode of neurological dysfunction caused by a temporary, focal reduction in cerebral blood flow. Although symptoms resemble those of an ischemic stroke, the interruption in perfusion is short-lived and does not cause permanent infarction. TIAs are clinically important because they often serve as early warning events for future stroke.Mechanisms of Transient Cerebral IschemiaTransient cerebral ischemia may arise through several mechanisms. One...

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Related Experiment Video

Updated: Jul 11, 2026

The Stroke Preclinical Assessment Network Multi-Laboratory Model of Thromboembolic Stroke with Thrombolysis: TE-MCAo
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A computerized algorithm for etiologic classification of ischemic stroke: the Causative Classification of Stroke

Hakan Ay1, Thomas Benner, E Murat Arsava

  • 1AA Martinos Center for Biomedical Imaging and Stroke Service, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, 149 13th Street, Room 2301, Charlestown, MA 02129, USA. hay@partners.org

Stroke
|September 29, 2007
PubMed
Summary

The Causative Classification System (CCS) is a reliable, web-based tool for classifying acute ischemic stroke etiology. This automated system demonstrates excellent agreement among neurologists, improving stroke subtyping accuracy in multicenter research.

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Area of Science:

  • Neurology
  • Medical Informatics

Background:

  • Acute ischemic stroke classification relies on identifying the underlying cause.
  • The SSS-TOAST algorithm provides an evidence-based approach to determine stroke etiology.
  • Standardizing stroke classification is crucial for multicenter research and clinical trials.

Purpose of the Study:

  • To introduce an automated version of the SSS-TOAST algorithm, named the Causative Classification System (CCS).
  • To facilitate the utility of the SSS-TOAST algorithm in multicenter settings through a web-based platform.
  • To assess the reliability and accuracy of the CCS for classifying acute ischemic stroke subtypes.

Main Methods:

  • The CCS is a web-based system utilizing a questionnaire format for data entry.
  • Clinical and diagnostic evaluation results are inputted via checkboxes.
  • The automated algorithm generates stroke subtype classifications and rationale.
  • Inter-examiner reliability was assessed using 50 ischemic stroke cases evaluated by 5 neurologists from 4 academic centers.

Main Results:

  • High inter-examiner agreement was observed for the CCS, with kappa values ranging from 0.80 to 0.86 across different item breakdowns (5-item, 8-item, 16-item).
  • Intra-examiner reliability was also excellent, with kappa values ranging from 0.86 to 0.90.
  • The system demonstrated strong performance in classifying stroke subtypes, including large artery atherosclerosis, cardio-aortic embolism, and small artery occlusion.

Conclusions:

  • The web-based CCS provides rapid analysis of patient data for acute ischemic stroke classification.
  • The system exhibits excellent intra- and inter-examiner reliability.
  • The CCS has significant potential to enhance the accuracy and consistency of stroke subtyping in multicenter trials and research databases.