Where in the Brain do Strokes Occur? A Pilot Study and Call for Data.

Nichols, Larry; Bridgewater, Joshua C; Wagner, Nicholas B; Karivelil, Mathew; Koelmeyer, Himara; Goings, Denise; Hope, Thomas D

Background: Every year, more than 795,000 people in the United States have a stroke and each year stroke kills about 140,000 Americans. Although there is abundant information on the epidemiology, risk factors, pathophysiology, and many clinical features of strokes, there is a glaring lack of specific numerical quantitation on the neuroanatomical distribution of strokes.Methods: This retrospective study utilized de-identified reports of radiologic imaging to determine the neurovascular anatomical location of acute ischemic cerebral infarcts in a 637-bed regional hospital in a rural area during the one year interval from October 1, 2018 through September 30, 2019.Results: In this study, during a one-year period, there were 418 acute ischemic strokes and 54.6% (228/418) were in the territory of a single large vessel. Of the single large vessel strokes, 62.3% (142/228) were in a middle cerebral artery (MCA) territory, 12.1% (29/228) in a posterior cerebral artery (PCA) territory, 8.8% (20/228) in a basilar artery distribution, 7.5% (17/228) in a posterior inferior cerebellar artery (PICA) distribution, 6.6% (15/228) in an anterior cerebral artery (ACA) distribution, 1.8% (4/228) in a superior cerebellar artery (SCA) distribution and 0.4% (1/228) in an anterior inferior cerebellar artery (AICA) territory. Subcortical motor strokes accounted for 17.7% (74/418) of the total, subcortical brainstem strokes for 8.1% (34/418) and subcortical sensory strokes for 5% (21/418) of the infarctions. Watershed infarctions accounted for 2.9% (12/418) of the strokes, 9 in the MCA/PCA watershed area and 3 in the MCA/ACA watershed area.Conclusion: This small pilot study illustrates a methodology for collecting the data to substitute specific numerical quantitation for vague generalities about the neuroanatomical distribution of strokes. Such quantification can enable evidence-based data-driven improvements in the care of stroke patients.