Stroke

From Anvita Health Wiki

Jump to: navigation, search

Contents

More Specific Terms

Introduction

Etiology

  • (see specific type of stroke)

Epidemiology

  • 4% of individuals ( mean age 75 years) will suffer from stroke within 4 years [10]
  • no association with dietary fat [16]
  • incidence of stroke is declining, but severity is not [19]

Pathology

  • (gross) 

*  6 hrs.        no changes 
*  8 - 48 hrs.   swelling 
*  > 48 hrs.     soft, friable 
*  2 weeks       liquifaction 
*  > 3 weeks     cavitation (~1mL/3 months)


  • cell sensitivity to ischemia:
  • neurons > oligodendrocytes > astrocytes > microglia > blood vessels
  • brain region sensitivity to ischemia:
  • hippocampus (CA1) > extrapyramidal layer (3) of neocortex > cerebellar Purkinje cells > inferior olivary neurons > subthalamic nucleus

Microscopic-pathology 


*  8 - 12 hrs.     classic ischemic changes (eg. eosinophilic  
*                  degeneration, glassy cytoplasm, loss of Nissl 
*                  substance, hyperchromatic nuclei, neuronal 
*                  shrinkage & increase in perineuronal space) 
*  12 - 48 hrs.    macrophages appear 
*  48 hrs.         macrophages become foamy 
*  3rd day         proliferating astrocytes, gemistocytes 
*  7th day         capillary wall thickening 
*  > 30 days       astrocytes only remaining (depends on size)


History

Clinical-manifestations

  • involvement of upper &/or lower extremity &/or face on opposite side, opposite visual field or eye on same side
  • motor dysfunction:
  • common with:

Laboratory

  • all patients [4]
  • selected patients

Diagnostic-procedures

  • all patients
  • selected patients

Radiology

  • all patients
  • selected patients

Complications

Differential-diagnosis

Management

  • telestroke systems of benefit for rural areas (see telehealth)
  • follow-up:
  • anxiety is common after stroke (27-40%) [8]
  • * 1/6 of patients will have another stroke within 5 years [9]

More General Terms

Additional Terms

Internet Database

OMIM: 601367

References

  1. Harrison's Principles of Internal Medicine, 13th ed. Companion Handbook, Isselbacher et al (eds), McGraw-Hill Inc. NY, 1995, pg 703
  2. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 1019-20
  3. Chan & Winkle, Diagnostic History & Physical Examination, Current Clinical Strategies Publishing. Laguna Hills, 1996
  4. Medical Knowledge Self Assessment Program (MKSAP) 11, 15, American College of Physicians, Philadelphia 1998, 2009
  5. Prescriber's Letter 7(9):53 2000
  6. Journal Watch 21(1):4, 2001 Bladin CF et al Seizures after stroke: a prospective multicenter study. Arch Neurol 57:1617, 2000 PMID: [1]
  7. Prescriber's Letter 8(7):38 2001
  8. UCLA Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 12-15, 2001 & Sept 25-28 2002
  9. Journal Watch 21(21):167, 2001 PROGRESS Collaborative Group, Lancet 358:1033, 2001
  10. Journal Watch 21(22):178, 2001 Bernick C et al Silent MRI infarcts and the risk of future stroke: the cardiovascular health study. Neurology 57:1222, 2001 PMID: [2]
  11. Journal Watch 22(10):77, 2002 Bosch J et al Use of ramipril in preventing stroke: double blind randomised trial. BMJ 324:699, 2002 PMID: [3]
    - Schrader J & Luders S Preventing stroke. BMJ 324:687, 2002 PMID: [4]
  12. Geriatrics Review Syllabus, American Geriatrics Society, 5th edition, 2002-2004
  13. Geriatrics Review Syllabus, American Geriatrics Society, 7th edition 2010
  14. Journal Watch 22(19):149, 2002 Green DM et al, Serum potassium level and dietary potassium intake as risk factors for stroke. Neurology 59:314, 2002 PMID: [5]
    - Levine SR & Coull BM, Potassium depletion as a risk factor for stroke: will a banana a day keep your stroke away? Neurology 59: 302, 2002 PMID: [6]
  15. Journal Watch 22(24):183, 2002 Ikeda M et al Using vital signs to diagnose impaired consciousness: cross sectional observational study. BMJ 325:800, 2002 <PubMed> PMID: [7] <Internet> [8]
  16. Journal Watch 23(23):183, 2003 He K et al Dietary fat intake and risk of stroke in male US healthcare professionals: 14 year prospective cohort study. BMJ 327:777, 2003 <PubMed> PMID: [9] <Internet> [10]
  17. Prescriber's Letter 10(12):68 2003
    - Jorge RE et al. Escitalopram and enhancement of cognitive recovery following stroke. Arch Gen Psychiatry 2010 Feb; 67:187. PMID: [11]
  18. Journal Watch 24(23):176, 2004 Kidwell CS, Chalela JA, Saver JL, Starkman S, Hill MD, Demchuk AM, Butman JA, Patronas N, Alger JR, Latour LL, Luby ML, Baird AE, Leary MC, Tremwel M, Ovbiagele B, Fredieu A, Suzuki S, Villablanca JP, Davis S, Dunn B, Todd JW, Ezzeddine MA, Haymore J, Lynch JK, Davis L, Warach S. Comparison of MRI and CT for detection of acute intracerebral hemorrhage. JAMA. 2004 Oct 20;292(15):1823-30. PMID: [12]
  19. Carandang R, Seshadri S, Beiser A, Kelly-Hayes M, Kase CS, Kannel WB, Wolf PA. Trends in incidence, lifetime risk, severity, and 30-day mortality of stroke over the past 50 years. JAMA. 2006 Dec 27;296(24):2939-46. PMID: [13]
  20. Chalela JA, Kidwell CS, Nentwich LM, Luby M, Butman JA, Demchuk AM, Hill MD, Patronas N, Latour L, Warach S. Magnetic resonance imaging and computed tomography in emergency assessment of patients with suspected acute stroke: a prospective comparison. Lancet. 2007 Jan 27;369(9558):293-8. PMID: [14]
    - Candelise L, Gattinoni M, Bersano A, Micieli G, Sterzi R, Morabito A; PROSIT Study Group. Stroke-unit care for acute stroke patients: an observational follow-up study. Lancet. 2007 Jan 27;369(9558):299-305. PMID: [15]
    - Donnan GA, Dewey HM, Davis SM. MRI and stroke: why has it taken so long? Lancet. 2007 Jan 27;369(9558):252-4. No abstract available. PMID: [16]
  21. Nys GM et al, Cognitive disorders in acute stroke: Prevalence and clinical determinants. Cerebrovascular Disease 2007, 23:408 PMID: [17]
  22. Robinson RG et al, Escitalopram and problem-solving therapy for prevention of poststroke depression: A randomized controlled trial. JAMA 2008, 299:2391 PMID: [18]
  23. Turner-Lawrence DE et al A feasibility study of the sensitivity of emergency physician dysphagia screening in acute stroke patients. Ann Emerg Med 2009 Sep; 54:344. PMID: [19]
  24. Furie KL et al Guidelines for the Prevention of Stroke in Patients With Stroke or Transient Ischemic Attack A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association Stroke. 2011;42:00-00 <PubMed> PMID: [20] <Internet> [21]
  25. Adams HP et al Guidelines for the Early Management of Adults With Ischemic Stroke. Stroke. 2007;38:1655 [22]
  26. Morgenstern LB et al Guidelines for the Management of Spontaneous Intracerebral Hemorrhage. Stroke. 2010;41:2108 [23]
  27. Sandset EC et al. The angiotensin-receptor blocker candesartan for treatment of acute stroke (SCAST): A randomised, placebo-controlled, double-blind trial. Lancet 2011 Feb 26; 377:741. PMID: [24]
  28. Oldenbeuving AW et al. Delirium in the acute phase after stroke: Incidence, risk factors, and outcome. Neurology 2011 Mar 15; 76:993. PMID: [25]
  29. Beghi E et al. Incidence and predictors of acute symptomatic seizures after stroke. Neurology 2011 Nov 15; 77:1785 PMID: [26]
    - De Herdt V et al. Early seizures in intracerebral hemorrhage: Incidence, associated factors, and outcome. Neurology 2011 Nov 15; 77:1794. PMID: [27]
  30. El Husseini N et al Depression and Antidepressant Use After Stroke and Transient Ischemic Attack Stroke March 29, 2012 <PubMed> PMID: [28] <Internet> [29]
  31. NIH Institute & Center Resources [30]
    - NINDS Stroke Information Page [31]
    - Post-stroke rehabilitation fact sheet [32]
    - Stroke Risk Factors and Symptoms [33]
  32. National Guideline Clearinghouse VA/DoD clinical practice guideline for the management of stroke rehabilitation. ngc-guideline: [34]
    - Management of patients with stroke: identification and management of dysphagia. A national clinical guideline. ngc-guideline: [35]
    - Emergency interventional stroke therapy: a statement from the American Society of Interventional and Therapeutic Neuroradiology and the Society of Interventional Radiology. ngc-guideline: [36]
    - Stroke management and prevention in the long-term care setting. (American Medical Directors Association) ngc-guideline: [37]
    - Stroke: 2005 International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. American Heart Association ngc-guideline: [38]
    - EFNS guideline on neuroimaging in acute stroke. Report of an EFNS task force. (European Federation of Neurological Societies) ngc-guideline: [39]
    - Implementation strategies for emergency medical services within stroke systems of care: A policy statement from the American Heart Association/American Stroke Association expert panel on emergency medical services systems and the Stroke Council. ngc-guideline: [40]
    - Rehabilitation. In: Clinical guidelines for stroke management 2010. National Stroke Foundation (Australia) ngc-guideline: [41]
    - Living with stroke. In: Clinical guidelines for stroke rehabilitation and recovery. National Stroke Foundation (Australia) ngc-guideline: [42]
    - Management of consequences of stroke. In: Clinical guidelines for stroke rehabilitation and recovery. National Stroke Foundation (Australia) ngc-guideline: [43]
    - Organisation of care. In: Clinical guidelines for stroke rehabilitation and recovery. National Stroke Foundation (Australia) ngc-guideline: [44]
    - Acute medical and surgical management. In: Clinical guidelines for acute stroke management. National Stroke Foundation (Australia) ngc-guideline: [45]
    - Assessment and management of the consequences of stroke. In: Clinical guidelines for acute stroke management. National Stroke Foundation (Australia) ngc-guideline: [46]
    - Discharge planning, transfer of care and integrated community care. In: Clinical guidelines for acute stroke management. National Stroke Foundation (Australia) ngc-guideline: [47]
    - Early assessment and diagnosis. In: Clinical guidelines for acute stroke management. National Stroke Foundation (Australia) ngc-guideline: [48]
    - Organisation of services. In: Clinical guidelines for acute stroke management. National Stroke Foundation (Australia) ngc-guideline: [49]
    - Community participation and long-term recovery. In: Clinical guidelines for stroke management 2010. National Stroke Foundation (Australia) ngc-guideline: [50]
    - Stroke recognition and pre-hospital care. In: Clinical guidelines for stroke management 2010. National Stroke Foundation (Australia) ngc-guideline: [51]
    - Managing complications. In: Clinical guidelines for stroke management 2010. National Stroke Foundation (Australia) ngc-guideline: [52]
    - Secondary prevention. In: Clinical guidelines for acute stroke management. National Stroke Foundation (Australia) ngc-guideline: [53]
    - EFNS guidelines on the molecular diagnosis of channelopathies, epilepsies, migraine, stroke and dementias. European Federation of Neurological Societies ngc-guideline: [54]
    - (1) Stroke assessment across the continuum of care. (2) Stroke assessment across the continuum of care 2011 supplement. Registered Nurses' Association of Ontario (RNAO) ngc-guideline: [55]

Retrieved from "http://www.anvita.info/wiki/Stroke"
Personal tools