STROKE

Stroke

• Classification• Risk Factors• Signs and Symptoms• Management

– Prehospital– In-hospital

Classification of Stroke

• Ischemic Stroke (75% “Brain Infarct”)– Occlusive:

• Thrombosis• Embolism

– Anterior Circulation• Occlusion of carotid artery involve cerebral

hemispheres

– Posterior Circulation• Vertebro-basilar artery distribution involve

brainstem or cerebellum

Classification of Stroke

• Hemorrhagic Stroke– Subarachnoid

• Aneurysm (most common)• Arteriovenous malformation

– Intracerebral• Hypertension (most common)• Amyloid angiopathy in elderly

Stroke – Risk Factors• Modifiable

– Hypertension– Tobacco use– Hx of TIA’s– Heart Disease– Diabetes Mellitus– Hypercoagulopathy

• Pregnancy, cancer, etc.

– Sickle Cell and increased RBC

– Hx of carotid Bruit

• Unmodifiable– Age– Gender– Race– Previous CVA– Heredity

Stroke – Signs and Symptoms

• Ischemic– Carotid Circulation

• Unilateral paralysis (opposite side)

• Numbness (opposite side)

• Language disturbance– Aphasia – difficult comprehension, nonsense,

difficult reading/writing– Dysarthria – slurred speech, abnormal

pronunciation.• Visual disturbance (opposite side)

• Monocular blindness (same side)

Stroke – Signs and Symptoms• Ischemic

– Vertebrobasilar Circulation• Vertigo• Visual disturbance

– Both eyes simultaneously

• Diplopia– Ocular palsy – inability to move to one side– Dysconjugate gaze – asynchronous movement

• Paralysis• Numbness• Dysarthria• Ataxia

Netter; Atlas of Human Anatomy

Stroke – Signs and Symptoms• Hemorrhagic

– Subarachnoid hemorrhage• Sudden severe HA• Transient LOC• Nausea/Vomiting• Neck pain• Intolerance of noise/light• AMS

– Intracerebral hemorrhage• Focal sx w/ LOC, N/V

Stroke – Signs and Symptoms• Differential Diagnosis of Stroke

– Head/Cervical trauma– Meningitis/encephalitis– Hypertensive encephalopathy– Intracranial mass

• Tumor• Sub/epi dural hematoma

– Todd’s paralysis– Migraine w/ neuro sx– Metabolic

• Hyper/hypo glycemia• Post arrest ischemia• Drug OD