Stroke is a cerebrovascular accident with sudden onset of focal neurological deficits(s) from either infarction or hemorrhage within the brain.
• Ischemic stroke (thrombotic or embolic); 87%
• Hemorrhagic stroke (intracerebral or subarachnoid); 13%
Risk factors
• Age: >45 years; highest during the 7th and 8th decades
• Male > Female (3:1), equalizes after menopause
• Family history/genetics
• Prior stroke or TIA
• Smoking, heavy alcohol use, substance abuse (cocaine, amphetamines)
• Diabetes mellitus, obesity, metabolic syndrome, impaired glucose tolerance
• Hypertension, atrial fibrillation, valvular heart disease, severe carotid artery stenosis
• Hypercoagulable states (including use of OCP), pregnancy and postpartum states
Etiology
• …show more content…
• Hemorrhagic stroke: Hypertension, intracranial aneurysms, cerebral amyloid angiopathy, secondary hemorrhage into previous infarcts.
Diagnosis:
I. History:
Acute onset of focal arm/leg weakness, facial weakness, difficulty with speech or swallowing, vertigo, visual disturbances, diminished consciousness; presence of vomiting and severe headache favor diagnosis of hemorrhagic stroke
II. Physical Exam
• Anterior (carotid) circulation: Hemiparesis/hemiplegia, neglect, aphasia, visual field defects
• Posterior (vertebrobasilar) circulation: Diplopia, vertigo, ataxia, facial paresis, Horner syndrome, dysphagia, dysarthria
III.Tests
Primarily used to narrow differential and identify etiology of
• Ischemic stroke (thrombotic or embolic); 87%
• Hemorrhagic stroke (intracerebral or subarachnoid); 13%
Risk factors
• Age: >45 years; highest during the 7th and 8th decades
• Male > Female (3:1), equalizes after menopause
• Family history/genetics
• Prior stroke or TIA
• Smoking, heavy alcohol use, substance abuse (cocaine, amphetamines)
• Diabetes mellitus, obesity, metabolic syndrome, impaired glucose tolerance
• Hypertension, atrial fibrillation, valvular heart disease, severe carotid artery stenosis
• Hypercoagulable states (including use of OCP), pregnancy and postpartum states
Etiology
• …show more content…
• Hemorrhagic stroke: Hypertension, intracranial aneurysms, cerebral amyloid angiopathy, secondary hemorrhage into previous infarcts.
Diagnosis:
I. History:
Acute onset of focal arm/leg weakness, facial weakness, difficulty with speech or swallowing, vertigo, visual disturbances, diminished consciousness; presence of vomiting and severe headache favor diagnosis of hemorrhagic stroke
II. Physical Exam
• Anterior (carotid) circulation: Hemiparesis/hemiplegia, neglect, aphasia, visual field defects
• Posterior (vertebrobasilar) circulation: Diplopia, vertigo, ataxia, facial paresis, Horner syndrome, dysphagia, dysarthria
III.Tests
Primarily used to narrow differential and identify etiology of