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Mehdi's sanbox
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Stroke Main page | |
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Diagnosis | |
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Treatment | |
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Case Studies | |
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Sandbox:MP On the Web | |
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American Roentgen Ray Society Images of Sandbox:MP | |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Aysha Anwar, M.B.B.S[2]; Tarek Nafee, M.D. [3]; Sara Mehrsefat, M.D. [4]
Overview
| Stroke | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Ischemic stoke (85%) | Hemorrhagic stroke (15%)Ischemic stoke (85%) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Based on duration of onset of symptoms | Based on cause | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Transient Ischemic stroke (symptoms lasts <24 hrs) | Acute Ischemic stroke (symptoms lasts >24 hrs) | Chronic ischemic stroke | Thrombotic | Embolic[1] 1.Atrial fibrillation | Vasculitic Takayasu arteritis | Systemic hypoperfusion
1.Myocardial infarction | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| TOAST classification[2] 1.Large artery atherosclerosis | Arterial thrombosis
1.Carotid artery 2.Vertebral artery 3.Circle of Willis 4.Middle cerbral artery | Venous thrombosis Central venous thrombosis | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Large vessel involvement
1.Atherosclerosis | Small vessel involvement
1.Fibrinoid degeneration | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Historical Perspective
- Hippocrates (460 to 370 BC) was first to describe the phenomenon of sudden paralysis.
- Apoplexy, from the Greek word meaning "struck down with violence,” first appeared in Hippocratic writings to describe this phenomenon.[3]
- The word stroke was used as a synonym for apoplectic seizure as early as 1599,[4] and is a fairly literal translation of the Greek term.
- In 1658, in his Apoplexia, Johann Jacob Wepfer (1620–1695) identified the cause of hemorrhagic stroke when he suggested that people who had died of apoplexy had bleeding in their brains.[3]
- Wepfer also identified the main arteries supplying the brain, the vertebral and carotid arteries, and identified the cause of ischemic stroke when he suggested that apoplexy might be caused by a blockage to those vessels.
Synopsis
| Diseases | Laboratory Findings | Physical Examination | History and Symptoms | Other Findings | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Lab Test 1 | Lab Test 2 | Lab Test 3 | Lab Test 4 | Physical Finding 1 | Physical Finding 2 | Physical Finding 3 | Physical Finding 4 | Finding 1 | Finding 2 | Finding 3 | Finding 4 | ||
| Differential Diagnosis 1 | + | ✔ | |||||||||||
| Differential Diagnosis 2 | ↑ | ✘ | |||||||||||
| Differential Diagnosis 3 | ↓ | ||||||||||||
| Differential Diagnosis 4 | |||||||||||||
| Differential Diagnosis 5 | |||||||||||||
Imaging Studies
| Types of Stroke | Imaging Findings | |||
|---|---|---|---|---|
| CT | MRI | |||
| Sensitivity | Specificity | Sensitivity | Specificity | |
| TIA | ||||
| Ischemic Stroke | ||||
| Hemorrhagic Stroke | ||||
Prevention
Epidemiology and Demographics
Stroke in USA
- Stroke is a leading cause of serious long-term disability
- In USA, the incidence and mortality rates of stroke has significantly decreased compared to previous years.
- From year 2003 to 2013, the mortality rates due to stroke declined by 18.5%.[5]
- In 2013, stroke became the fifth leading cause of death.
- The case fatality rate of stroke is estimated to be 41.7 deaths per 100, 000 population[5]
- The incidence of new (610, 000) or recurrent stroke (185, 000) is estimated to be 795000 people annually or 250 cases per 100, 000.[5]
- It is estimated that one incidence of stroke happens every 4 sec with death occuring every 4 min.[5]
- About 87% of all strokes are ischemic strokes[6]
- Stroke costs the United States an estimated $34 billion each year[6]
Worldwide
- According to WHO, the incidence of stroke is estimated to be 15 million people annually, worldwide.[7].
- Out of these, 5 million die and 5 million are left permanently disbaled.[7].
Age
- Stroke can occur in all age groups. However, the incidence of stroke is less among individuals age less than 40 years of age and the risk increases with increasing age. [6]
- According to WHO, stroke also occurs in about 8% of children with sickle cell disease.[7].
- In 2009, 34% of people hospitalized for stroke were younger than 65 years[6]
- The incidence of stroke in people aged 18 to 50 years is estimated to be approximately 10%. [5]
The rate of decline in mortality rates of stroke in different age groups is as follows:[5]
- >65 years of age: from 534.1 to 245.2 per 100,000
- 45-65 years of age: from 43.5 to 20.2 per 100,000
- 18 to 44 years of age: from from 3.7 to 2.0 per 100,000
Gender
There is increased incidence of stroke in men as compared to women.
Race
- The risk of incidence of first stroke is twice in african american population as compared to whites with increased mortality rates.[6]
- Hispanics’ risk for stroke falls between that of whites and blacks [6]
Geographical distribution
- There is increased incidence and mortality rates of stroke in developing countries as compared to developed countries due to low socio economic status and heath facilites.
- In USA, the highest death rates from stroke are in the southeastern United States.[6]
References
- ↑ Montanaro VV, da Silva CM, de Viana Santos CV, Lima MI, Negrão EM, de Freitas GR (2016). "Ischemic stroke classification and risk of embolism in patients with Chagas disease". J Neurol. doi:10.1007/s00415-016-8275-0. PMID 27624118 : 27624118 Check
|pmid=value (help). - ↑ Adams HP, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL; et al. (1993). "Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment". Stroke. 24 (1): 35–41. PMID 7678184.
- ↑ 3.0 3.1 Thompson JE (1996). "The evolution of surgery for the treatment and prevention of stroke. The Willis Lecture". Stroke. 27 (8): 1427–34. PMID 8711815.
- ↑ R. Barnhart, ed. The Barnhart Concise Dictionary of Etymology (1995)
- ↑ 5.0 5.1 5.2 5.3 5.4 5.5 Writing Group Members. Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ; et al. (2016). "Heart Disease and Stroke Statistics-2016 Update: A Report From the American Heart Association". Circulation. 133 (4): e38–360. doi:10.1161/CIR.0000000000000350. PMID 26673558.
- ↑ 6.0 6.1 6.2 6.3 6.4 6.5 6.6 http://www.cdc.gov/stroke/facts.htm Accessed on November 3, 2016
- ↑ 7.0 7.1 7.2 Mackay, Judith, et al. The atlas of heart disease and stroke. World Health Organization, 2004 Accessed on November 3 2016