Stroke (main)

Stroke Types

• Ischemic Stroke
  • Cerebellar Stroke
  • Transient Ischemic Attack (TIA)
• Hemorrhagic Stroke
  • Intracerebral Hemorrhage
  • Subarachnoid Hemorrhage (SAH)

** Hypertension

Background

• Vascular injury that reduces CBF to specific region of brain causing neuro impairment
• Accurate determination of last known time when pt was at baseline is essential

Sensory Homonculus - courtesy AnatomyZone.com

Causes

• Ischemic (87%)
  • Thrombotic (80% of ischemic CVA)
    • Atherosclerosis
    • Vasculitis
    • Arterial dissection
    • Polycythemia
    • Hypercoagulable state
    • Infection
  • Embolic (20% of ischemic CVA)
    • Valvular vegetations
    • Mural thrombi
    • Arterial-arterial emboli from proximal source
    • Fat emboli
    • Septic emboli
  • Hypoperfusion
    • Cardiac failure resulting in systemic hypotension
• Hemorrhagic (13%)
  • Intracerebral
    • Hypertension
    • Amyloidosis
    • Anticoagulation
    • Vascular malformations
    • Cocaine use
  • SAH
    • Berry aneurysm rupture
    • Vascular malformation rupture

Differential Diagnosis

Stroke-like Symptoms

• Stroke
• Seizures/postictal paralysis (Todd paralysis)
• Syncope
• Subdural hemorrhage
• Epidural hemorrhage
• Hypoglycemia
• Hyponatremia
• Meningitis/encephalitis
• Hyperosmotic Coma
• Labyrinthitis
• Drug toxicity
  • Lithium, phenytoin, carbamazepine
• Bell's Palsy
• Complicated migraine
• Meniere Disease
• Demyelinating disease (MS)
• Conversion disorder
• Transient global amnesia
• Giant cell arteritis
• Cerebral sinus thrombosis

See Also

• Transient Ischemic Attack (TIA)
• Thrombolysis in Acute Ischemic Stroke (tPA)
• CVA (Post-tPA Hemorrhage)
• Intracerebral Hemorrhage
• Subarachnoid Hemorrhage (SAH)
• Cervical Artery Dissection
• NIH Stroke Scale
• Cerebellar Stroke

External Links

• MDCalc - NIH Stroke Scale/Score