Epidemiology and Classification of Strokes

  • Werner Hacke
  • Herman J. Gelmers
  • Michael Hennerici
  • Günter Krämer


Epidemiology concerns the occurrence and distribution of diseases in the population. By prevalence is meant the number of cases of the disease at a particular moment in a given group of persons, for example, in the entire population of a certain territory or in a clearly demarcated population group. Incidence refers to the number of new cases of the disease occurring in a population in a particular period of time. Figures on prevalence and incidence are meaningful only if the given disease is unequivocally defined. If the definition is too specific, many cases are not included (false-negative cases), whereas too broad a definition leads to many false-positive identifications (Table 3.1). Disease mortality indicates the number of patients who die of the disease in a particular period of time (e.g., within a year). Since only a proportion of patients with cerebrovascular diseases die in the short term (early mortality), mortality data represent only an approximate estimate of incidence.


Cerebrovascular Disease Cerebral Infarction Cerebral Blood Volume Ischemic Insult Sinus Thrombosis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Awad IA, Johnson PC, Spetzler RF, Hodak J A (1986) Incidental subcortical lesions identified on magnetic resonance imaging in the elderly. II. Postmortem pathological correlations. Stroke 17: 1090PubMedCrossRefGoogle Scholar
  2. Baum HM (1981) The national survey of stroke. Stroke 12: 59Google Scholar
  3. Bogousslavsky J, Regli F (1984) Cerebral infarction with transient signs (CITS): do TIAs correspond to small deep infarcts in internal carotid artery occlusion? Stroke 15: 536PubMedCrossRefGoogle Scholar
  4. Broderick JP, Phillips SJ, Whisnant JP, O’Fallon M, Bergstrahl EJ (1989) Incidence rates of stroke in the eighties: the end of the decline in stroke? Stroke 20: 577PubMedCrossRefGoogle Scholar
  5. Caplan LR (1983) Are terms such as completed stroke or RIND of continued usefulness? Stroke 14: 431PubMedCrossRefGoogle Scholar
  6. Caplan LR (1988) TIAs: we need to return to the question, “what is wrong with Mr. Jones?” Neurology 38: 791PubMedGoogle Scholar
  7. Chambers BR, Norris JW (1986) Outcome in patients with asymptomatic neck bruits. N Engl J Med 315: 860PubMedCrossRefGoogle Scholar
  8. Chambers BR, Norris JW, Shurwell BL, Hachinski V (1987) Prognosis of acute stroke. Neurology 37: 221PubMedGoogle Scholar
  9. Courbier R (1985) Basis for a classification of cerebral arterial diseases. Excerpta Medica, Amsterdam, p 308Google Scholar
  10. Duke RS, Bloch RF, Turpie AG (1986) Intravenous heparin for the prevention of stroke progression in acute partial stable stroke: a randomized controlled trial. Ann Intern Med 105: 825PubMedGoogle Scholar
  11. Fratiglioni L, Mattey EW, Schoenberg AG, Schoenberg BS (1983) Mortality from cerebrovascular disease. International comparisons and temporal trends. Neuroepidemiology 2: 101CrossRefGoogle Scholar
  12. Garraway WM, Whisnant JP, Furlan AJ (1979) The declining incidence of stroke. N Engl J Med 300: 449PubMedCrossRefGoogle Scholar
  13. Gautier JC (1985) Stroke in progression. Stroke 16: 729PubMedCrossRefGoogle Scholar
  14. Hachinski V, Norris JW (1985) The acute stroke. Davis, PhiladelphiaGoogle Scholar
  15. Hacke W, del Zoppo GJ, Harker LA (1987) Thrombosis and cerebro-vascular disease. In: Poeck K, Ringelstein EB, Hacke W (eds) Recent advances in diagnosis and management of stroke. Springer, Berlin Heidelberg New York, p 59Google Scholar
  16. Hennerici M, Rautenberg W, Mohr S (1982) Stroke risk from symptomless extracranial arterial disease. Lancet 11: 1180CrossRefGoogle Scholar
  17. Hennerici M, Hülsbömer HB, Hefter H, Lammerts D, Rautenberg W (1987) Natural history of asymptomatic extracranial artery disease—results of a long-term prospective study. Brain 110: 777PubMedCrossRefGoogle Scholar
  18. Klag MJ, Kelton PK, Seidler AJ (1989) Decline in US stroke mortality. Demographic trends and antihypertensive treatment. Stroke 20: 14PubMedCrossRefGoogle Scholar
  19. Kurtzke JF (1985) Epidemiology of cerebrovascular disease. In: McDowell FH, Caplan LR (eds) Cerebrovascular survey report. National Institute of Neurology and Communicative Disorders and Stroke, Bethesda, p 1Google Scholar
  20. Levy DE (1988) How transient are transient ischemic attacks? Neurology 38: 674PubMedGoogle Scholar
  21. Matsumoto N, Whisnant JP, Kurland LT (1973) Natural history of stroke in Rochester, Minnesota 1955 through 1969: an extension of a previous study, 1945 through 1954. Stroke 4: 20PubMedCrossRefGoogle Scholar
  22. Millikan CH, McDowell F, Easton JD (1987) Stroke. Lea and Febiger, PhiladelphiaGoogle Scholar
  23. Mohr JP, Barnett HJM (1986) Classification of ischemic stroke. In: Barnett HJM, Mohr JP, Stein BM, Yatsu FM (eds) Stroke—pathophysiology, diagnosis and management. Churchill Livingstone, New York, p 281Google Scholar
  24. Poeck K (1986) Moderne Diagnostik und Therapie beim Schlaganfall. Dtsch Med Wochenschr 111: 1369PubMedCrossRefGoogle Scholar
  25. Powers WJ, Raichle ME (1985) Positron emission tomography and its application to the study of cerebrovascular disease in man. Stroke 16: 361PubMedCrossRefGoogle Scholar
  26. Ringelstein EB, Zeumer H, Schneider R (1985) Der Beitrag der zerebralen Computertomographie zur Differentialtypologie und Differentialtherapie des ischämischen Großhirninfarktes. Fortschr Neurol Pychiatr 53: 315CrossRefGoogle Scholar
  27. Rodda RA, Path FRC (1986) The arterial patterns associated with internal carotid infarcts. Stroke 17: 69PubMedCrossRefGoogle Scholar
  28. Roederer GO, Langlois YE, Jager KA, Primozich JF, Beach KW, Phillips DJ, Strandness DWE (1984) The natural history of carotid arterial disease in symptomatic patients with cervical bruits. Stroke 15: 605PubMedCrossRefGoogle Scholar
  29. Salgado ED, Weinstein M, Furlan AJ, Modic MT, Beck GS, Estes M, Awad I, Little JR (1986) Proton magnetic resonance imaging in ischemic cerebrovascular disease. Ann Neurol 20: 502–507PubMedCrossRefGoogle Scholar
  30. Takeya Y, Popper JS, Shimizu Y (1984) Epidemiologic studies of coronary heart disease and stroke in Japanese men living in Japan, Hawaii and California: incidence of stroke in Japan and Hawaii. Stroke 15: 15PubMedCrossRefGoogle Scholar
  31. Vollmar JF (1980) Rekonstruktive Chirurgie der Arterien, 3rd edn. Thieme, StuttgartGoogle Scholar
  32. Vollmar JF (1985) Classification for surgery of cerebrovascular insufficiency. In: Courbier R (ed) Basis for classification of cerebral arterial diseases. Excerpta Medica, AmsterdamGoogle Scholar
  33. Waxman SG, Toole JF (1983) Temporal profile resembling TIA in the setting of cerebral infarction. Stroke 14: 433PubMedCrossRefGoogle Scholar
  34. Weisberg LA (1982) Lacunar infarcts: clinical and computed tomographic correlations. Arch Neurol 39: 37PubMedGoogle Scholar
  35. Whisnant JP (1983) The role of the neurologist in the decline of stroke. Ann Neurol 14:1PubMedCrossRefGoogle Scholar
  36. Whisnant JP (1984) The decline of stroke. Stroke 15: 160PubMedCrossRefGoogle Scholar
  37. Wodarz R (1980) Watershed infarctions and computed tomography. A topographical study in cases with stenosis or occlusion of the carotid artery. Neuroradiology 19: 245PubMedGoogle Scholar
  38. Wolf PA, Kannel WB, Verter J (1983) Current status of risk factors for stroke. Neurol Clin 1: 317PubMedGoogle Scholar
  39. Zeumer H, Hacke W (1988) Ischämische Insulte. In: Hacke W (ed) Neurologische Intensivmedizin, 2nd edn. Perimed, Erlangen, p 89Google Scholar
  40. Zülch KJ (1985) The cerebral infarct. Pathology, pathogenesis, and computed tomography. Springer, Berlin Heidelberg New YorkGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1991

Authors and Affiliations

  • Werner Hacke
    • 1
  • Herman J. Gelmers
    • 2
  • Michael Hennerici
    • 3
  • Günter Krämer
    • 4
  1. 1.Department of NeurologyUniversity of HeidelbergHeidelbergFederal Republic of Germany
  2. 2.Department of NeurologyStreekziekenhuisAlmeloThe Netherlands
  3. 3.Department of Neurology Klinikum MannheimUniversity of HeidelbergMannheimFederal Republic of Germany
  4. 4.Department of NeurologyUniversity of MainzMainz 1Federal Republic of Germany

Personalised recommendations