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Stroke Main page
Patient Information
Overview
Causes
Classification Hemorrhagic stroke Ischemic stroke
Differentiating Stroke from other Diseases
Epidemiology and Demographics
Diagnosis NIH stroke scale Glasgow coma scale
Epidemiology and Demographics
Risk Factors
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Natural History, Complications and Prognosis
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History and Symptoms
Physical Examination
Laboratory Findings
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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.Atrial fibrillation 2.Fat 3.Septic 4.Air 5.Cancer

Vasculitic Giant cell arteritis Takayasu arteritis

Systemic hypoperfusion 1.Myocardial infarction 2.Pulmonary embolism 3.Pericardial effusion 4.Bleeding

TOAST classification 1.Large artery atherosclerosis 2.Cardioembolism 3.Small vessel occlusion 4.Stroke of determined etiology 5.Stroke of undetermined etiology

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 2.Vasculitis 3.Noninflammatory vasculopathy 4.Fibromuscular dysplasia

Small vessel involvement 1.Fibrinoid degeneration 2.Lipohyalinosis 3.Microatheroma

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.
• The word stroke was used as a synonym for apoplectic seizure as early as 1599, 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.
• 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

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%.
• 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
• The incidence of new (610, 000) or recurrent stroke (185, 000) is estimated to be 795000 people annually or 250 cases per 100, 000.
• It is estimated that one incidence of stroke happens every 4 sec with death occuring every 4 min.
• About 87% of all strokes are ischemic strokes
• Stroke costs the United States an estimated $34 billion each year

Worldwide

• According to WHO, the incidence of stroke is estimated to be 15 million people annually, worldwide..
• Out of these, 5 million die and 5 million are left permanently disbaled..

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.
• According to WHO, stroke also occurs in about 8% of children with sickle cell disease..
• In 2009, 34% of people hospitalized for stroke were younger than 65 years
• The incidence of stroke in people aged 18 to 50 years is estimated to be approximately 10%.

The rate of decline in mortality rates of stroke in different age groups is as follows:

• >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.
• Hispanics’ risk for stroke falls between that of whites and blacks

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.