The Usefulness of the TOAST Classification and Prognostic Significance of Pyramidal Symptoms During the Acute Phase of Cerebellar Ischemic Stroke

Abstract

Cerebellar stroke is a rare condition with very nonspecific clinical features. The symptoms in the acute phase could imitate acute peripheral vestibular disorders or a brainstem lesion. The aim of this study was to assess the usefulness of the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification in cerebellar stroke and the impact of clinical features on the prognosis. We retrospectively analyzed 107 patients with diagnosed ischemic cerebellar infarction. We studied the clinical features and compared them based on the location of the ischemic lesion and its distribution in the posterior interior cerebellar artery (PICA), superior cerebellar artery (SCA), and anterior inferior cerebellar artery (AICA) territories. According to the TOAST classification, stroke was more prevalent in atrial fibrillation (26/107) and when the lesion was in the PICA territory (39/107). Pyramidal signs occurred in 29/107 of patients and were more prevalent when the lesion was distributed in more than two vascular regions (p = 0.00640). Mortality was higher among patients with ischemic lesion caused by cardiac sources (p = 0.00094) and with pyramidal signs (p = 0.00640). The TOAST classification is less useful in assessing supratentorial ischemic infarcts. Cardioembolic etiology, location of the ischemic lesion, and pyramidal signs support a negative prognosis.

Collateral Circulation and BNP in Predicting Outcome of Acute Ischemic Stroke Patients with Atherosclerotic versus Cardioembolic Cerebral Large-Vessel Occlusion Who Underwent Endovascular Treatment

“…The study collected various information of patients who underwent EVT for large-vessel occlusion, including the National Institutes of Health Stroke Scale (NIHSS) score, age, gender, time information, risk factors of cerebrovascular disease (such as hypertension, diabetes mellitus, hyperlipidemia, coronary heart disease, previous stroke, atrial fibrillation, and smoking), laboratory test results (such as blood fibrinogen, INR, serum BNP, etc. ), stroke types based on Trial of ORG 10,172 in Acute Stroke Treatment (TOAST) classification [ 17 ], and good or poor outcomes based on mRS score (0–2 for good and 3–6 for poor).…”

Venous collaterals in acute ischemic stroke patients after endovascular treatments: a novel scoring system using 4D computed tomography angiography

“…The following information was collected: (I) the National Institutes of Health Stroke Scale (NIHSS; scale ranged from 0 to 42 points); (II) general data, including age and gender; (III) the risk factors of cerebrovascular disease; and (IV) the type of stroke, which was determined based on Trial of ORG 10172 in Acute Stroke Treatment (TOAST) classification ( 18 ).…”

Cerebellar Stroke

“…Pyramidal symptoms can occur, especially when multiple cerebellar artery territories are affected. The presence of pyramidal symptoms indicates poor prognosis of acute stroke in the cerebellum (Dziadkowiak et al 2016). In rare cases, the presentation of cerebellar infarction, particularly in association with incipient basilar artery thrombosis, can be severe (e.g., coma and quadriplegia) Tohgi et al 1993).…”

“…In the largest series of cerebellar infarctions, about 90% of cases were unilateral (Tohgi et al 1993), but the unilateral infarctions sometimes involve more than one vascular territory (Canaple and Bogousslavsky 1999). As for patients with stroke in the anterior circulation, the two common etiologies of cerebellar infarction are cardioembolism and large artery atherosclerosis Bogousslavsky et al 1993;Tohgi et al 1993;Chaves et al 1994;Dziadkowiak et al 2016). Vascular risk factors for ischemic stroke including hypertension, diabetes, dyslipidemia, cigarette smoking, atrial fibrillation, and history of stroke or TIA also apply to cerebellar infarction Tohgi et al 1993).…”