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__NOTOC__
__NOTOC__
{{Stroke}}
{{Stroke}}
{{CMG}} {{AE}} {{AA}}; {{TarekNafee}}; {{SaraM}}
'''For patient information, click [[Stroke (patient information)|here]]'''
==Overview==


==Causes==
{{CMG}}; {{AE}} {{MHP}}
#[[Ischemic stroke]]


==Classification==
{{SK}}  
{{familytree/start |summary=Stroke}}
{{familytree | | | | | | | | | | | | | | | | A01 |A01='''Stroke'''}}
{{familytree | | | | | |,|-|-|-|-|-|-|-|-|-|-|^|-|-|-|-|-|-|-|-|-|.| | | }}
{{familytree | | | | | B01 | | | | | | | | | | | | | | | | | | | B02 | | |B01=[[Ischemic stroke|Ischemic]]|B02=[[Hemorrhagic stroke|Hemorrhagic]]}}
{{familytree | |,|-|-|-|+|-|-|-|.| | | |,|-|-|-|-|-|-|-|-|-|-|-|-|^|-|-|-|-|-|-|-|.|}}
{{familytree | D01 | | D02 | | D03 | | D04 | | | | | | | | | | | | | | | | | | | D05 |D01=Large vessel thromboembolism|D02=Cardioembolic|D03=Small vessel or Lacunar infarct|D04=Intra-axial|D05=Extra-axial}}
{{familytree | | | | | | | | | | | | | |!| | | | | | | | | | | | | | | | | | | | |!|}}
{{familytree | | | | | | | | | | | | | |)|-|-|-|-|.|,|-|-|-|-|-|-|-|-|v|-|-|-|-|-|^|-|-|-|-|.}}
{{familytree | | | | | | | | | | | | | E01 | | | E02 | | | | | | | | E03 | | | | | | | | | E04 |E01=[[Intracerebral hemorrhage|Intracerebral]] (ICH)|E02=[[Subarachnoid hemorrhage]] (SAH)|E03=[[Subdural hematoma|Subdural Hemorrhage]]|E04=[[Epidural hematoma|Epidural Hemorrhage]]}}
{{familytree | | | | | | | | | | | | | |!| | | | | | | | |}}
{{familytree | | | | | | |,|-|-|-|-|-|-|+|-|-|-|-|-|-|.| }}
{{familytree | | | | | | F01 | | | | | F02 | | | | | F03 |F01=[[Intraparenchymal hemorrhage|Intraparenchymal hemorrhage]]|F02=[[Intraventricular hemorrhage]] (IVH)|F03=Cerebral microbleeds
}}
{{familytree/end}}


==Differential diagnosis==
==[[Stroke overview|Overview]]==
{|
|-style="background: #4479BA; color: #FFFFFF; text-align: center;"
! rowspan="2" |<small>Diseases</small>
! colspan="4" |<small>Diagnostic tests</small>
! colspan="5" |<small>Physical Examination</small>
! colspan="4" |<small>Symptoms
! colspan="1" |<small>Past medical history</small>
! rowspan="2" |<small>Other Findings</small>
|-style="background: #4479BA; color: #FFFFFF; text-align: center;"
!<small>Na+, K+, Ca2+</small>
!<small>CT /MRI</small>
!<small>CSF Findings</small>
!<small>Gold standard test</small>
!<small>Motor Deficit</small>
!<small>Sensory deficit</small>
!<small>Speech difficulty</small>
!<small>Gait abnormality</small>
!<small>Cranial nerves</small>
!<small>Headache</small>
!<small>LOC</small>
!<small>Motor weakness</small>
!<small>Abnormal sensations</small>
!
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" | Brain tumour<ref name="pmid10582668">{{cite journal| author=Morgenstern LB, Frankowski RF| title=Brain tumor masquerading as stroke. | journal=J Neurooncol | year= 1999 | volume= 44 | issue= 1 | pages= 47-52 | pmid=10582668 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10582668  }} </ref>
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px; text-align:center"|✔
|style="background: #F5F5F5; padding: 5px text-align:center" |Cancer cells<ref name="pmid21371327">{{cite journal| author=Weston CL, Glantz MJ, Connor JR| title=Detection of cancer cells in the cerebrospinal fluid: current methods and future directions. | journal=Fluids Barriers CNS | year= 2011 | volume= 8 | issue= 1 | pages= 14 | pmid=21371327 | doi=10.1186/2045-8118-8-14 | pmc=3059292 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21371327  }}</ref>
|style="background: #F5F5F5; padding: 5px;" |MRI
| style="background: #F5F5F5; padding: 5px; text-align:center" |      ✔
|style="background: #F5F5F5; padding: 5px; text-align:center" |✔
|style="background: #F5F5F5; padding: 5px; text-align:center" |✔
|style="background: #F5F5F5; padding: 5px;text-align:center" |✔
| style="background: #F5F5F5; padding: 5px; text-align:center" |      ✔
|style="background: #F5F5F5; padding: 5px; text-align:center" |✔
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |[[Cachexia]], gradual progression of symptoms
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Hemorrhagic stroke
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px; text-align:center" |✔
|style="background: #F5F5F5; padding: 5px;" |Xanthochromia<ref name="pmid1198628">{{cite journal| author=Lee MC, Heaney LM, Jacobson RL, Klassen AC| title=Cerebrospinal fluid in cerebral hemorrhage and infarction. | journal=Stroke | year= 1975 | volume= 6 | issue= 6 | pages= 638-41 | pmid=1198628 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1198628  }}</ref>
|style="background: #F5F5F5; padding: 5px;" |CT scan  without contrast<ref name="pmid21694755">{{cite journal| author=Birenbaum D, Bancroft LW, Felsberg GJ| title=Imaging in acute stroke. | journal=West J Emerg Med | year= 2011 | volume= 12 | issue= 1 | pages= 67-76 | pmid=21694755 | doi= | pmc=3088377 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21694755  }}</ref><ref name="pmid21807345">{{cite journal| author=DeLaPaz RL, Wippold FJ, Cornelius RS, Amin-Hanjani S, Angtuaco EJ, Broderick DF et al.| title=ACR Appropriateness Criteria® on cerebrovascular disease. | journal=J Am Coll Radiol | year= 2011 | volume= 8 | issue= 8 | pages= 532-8 | pmid=21807345 | doi=10.1016/j.jacr.2011.05.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21807345  }}</ref>
|style="background: #F5F5F5; padding: 5px; text-align:center" |✔
|style="background: #F5F5F5; padding: 5px; text-align:center" |✔
|style="background: #F5F5F5; padding: 5px;text-align:center" |✔
|style="background: #F5F5F5; padding: 5px;text-align:center" |✔
| style="background: #F5F5F5; padding: 5px; text-align:center" |      ✔
| style="background: #F5F5F5; padding: 5px; text-align:center" | ✔
|style="background: #F5F5F5; padding: 5px; text-align:center" |✔
|style="background: #F5F5F5; padding: 5px; text-align:center" |✔
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |[[Hypertension]]
|style="background: #F5F5F5; padding: 5px;" |Neck stiffness
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" | Subdural hemorrhage
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px; text-align:center" |✔
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |CT scan  without contrast<ref name="pmid21694755">{{cite journal| author=Birenbaum D, Bancroft LW, Felsberg GJ| title=Imaging in acute stroke. | journal=West J Emerg Med | year= 2011 | volume= 12 | issue= 1 | pages= 67-76 | pmid=21694755 | doi= | pmc=3088377 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21694755  }}</ref><ref name="pmid21807345">{{cite journal| author=DeLaPaz RL, Wippold FJ, Cornelius RS, Amin-Hanjani S, Angtuaco EJ, Broderick DF et al.| title=ACR Appropriateness Criteria® on cerebrovascular disease. | journal=J Am Coll Radiol | year= 2011 | volume= 8 | issue= 8 | pages= 532-8 | pmid=21807345 | doi=10.1016/j.jacr.2011.05.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21807345  }}</ref>
|style="background: #F5F5F5; padding: 5px; text-align:center" |✔
|style="background: #F5F5F5; padding: 5px; text-align:center" |✔
|style="background: #F5F5F5; padding: 5px;text-align:center" |✔
|style="background: #F5F5F5; padding: 5px;text-align:center" |✔
| style="background: #F5F5F5; padding: 5px; text-align:center" |    ✔
|style="background: #F5F5F5; padding: 5px; text-align:center" |✔
|style="background: #F5F5F5; padding: 5px; text-align:center" |✔
|style="background: #F5F5F5; padding: 5px; text-align:center" |✔
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |Trauma/fall
|style="background: #F5F5F5; padding: 5px;" |Confusion, dizziness, nausea, vomiting
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Neurosyphilis<ref name="pmid22482824">{{cite journal| author=Liu LL, Zheng WH, Tong ML, Liu GL, Zhang HL, Fu ZG et al.| title=Ischemic stroke as a primary symptom of neurosyphilis among HIV-negative emergency patients. | journal=J Neurol Sci | year= 2012 | volume= 317 | issue= 1-2 | pages= 35-9 | pmid=22482824 | doi=10.1016/j.jns.2012.03.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22482824  }} </ref><ref name="pmid24365430">{{cite journal |vauthors=Berger JR, Dean D |title=Neurosyphilis |journal=Handb Clin Neurol |volume=121 |issue= |pages=1461–72 |year=2014 |pmid=24365430 |doi=10.1016/B978-0-7020-4088-7.00098-5 |url=}}</ref>
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px; text-align:center" |✔
|style="background: #F5F5F5; padding: 5px;" |'''↑''' [[Leukocytes]] and [[protein]]
|style="background: #F5F5F5; padding: 5px;" |CSF [[VDRL]]-specifc
CSF FTA-Ab -sensitive<ref name="pmid22421697">{{cite journal| author=Ho EL, Marra CM| title=Treponemal tests for neurosyphilis--less accurate than what we thought? | journal=Sex Transm Dis | year= 2012 | volume= 39 | issue= 4 | pages= 298-9 | pmid=22421697 | doi=10.1097/OLQ.0b013e31824ee574 | pmc=3746559 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22421697  }}</ref>
|style="background: #F5F5F5; padding: 5px; text-align:center" |✔
|style="background: #F5F5F5; padding: 5px; text-align:center" |✔
|style="background: #F5F5F5; padding: 5px;text-align:center" |✔
|style="background: #F5F5F5; padding: 5px;text-align:center" |✔
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px; text-align:center" |✔
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px; text-align:center" |✔
|style="background: #F5F5F5; padding: 5px; text-align:center" |✔
|style="background: #F5F5F5; padding: 5px;" |STIs
|style="background: #F5F5F5; padding: 5px;" |Blindness, confusion, [[depression]],


Abnormal [[gait]]
==[[Stroke historical perspective|Historical Perspective]]==
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Complex or atypical migraine
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |Clinical assesment
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;text-align:center" |✔
|style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |   
|style="background: #F5F5F5; padding: 5px; text-align:center" |✔
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px; text-align:center" |✔
|style="background: #F5F5F5; padding: 5px;" |Family history of [[migraine]]
|style="background: #F5F5F5; padding: 5px;" |Presence of aura, [[nausea]], [[vomiting]]
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Hypertensive encephalopathy
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |✔
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |Clinical assesment
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |✔
|style="background: #F5F5F5; padding: 5px;" |✔
|style="background: #F5F5F5; padding: 5px;" |✔
|style="background: #F5F5F5; padding: 5px;" |✔
|style="background: #F5F5F5; padding: 5px;" |✔
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |History of hypertension
|style="background: #F5F5F5; padding: 5px;" |Delirium, cortical blindness, cerebral edema, seizure
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Wernicke’s encephalopathy
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |✔
|style="background: #F5F5F5; padding: 5px;" |✔
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |✔
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |History of alcohal abuse
|style="background: #F5F5F5; padding: 5px;" |Ophthalmoplegia, confusion
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |CNS abscess
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |✔
|style="background: #F5F5F5; padding: 5px;" |'''↑''' leukocytes, '''↓''' glucose and '''↑''' protien
|style="background: #F5F5F5; padding: 5px;" |MRI is more sensitive and specific
|style="background: #F5F5F5; padding: 5px;" |✔
|style="background: #F5F5F5; padding: 5px;" |✔
|style="background: #F5F5F5; padding: 5px;" |✔
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |✔
|style="background: #F5F5F5; padding: 5px;" |✔
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |History of drug abuse, endocarditis, '''↓''' immune status
|style="background: #F5F5F5; padding: 5px;" |High grade fever, fatigue,nausea, vomiting
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Drug toxicity
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |✔
|style="background: #F5F5F5; padding: 5px;" |✔
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |✔
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |Lithium, Sedatives, phenytoin, carbamazepine
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Conversion disorder
| style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |Diagnosis of exclusion
|style="background: #F5F5F5; padding: 5px; text-align:center" |✔
|style="background: #F5F5F5; padding: 5px; text-align:center" |✔
|style="background: #F5F5F5; padding: 5px;text-align:center" |✔
|style="background: #F5F5F5; padding: 5px;text-align:center" |✔
|style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px; text-align:center" | ✔
|style="background: #F5F5F5; padding: 5px; text-align:center" |✔
|style="background: #F5F5F5; padding: 5px; text-align:center" |✔
|style="background: #F5F5F5; padding: 5px; text-align:center" |✔
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |[[Tremor|Tremors]], [[blindness]], difficulty [[swallowing]]
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Electrolyte disturbance
|style="background: #F5F5F5; padding: 5px; text-align:center" |'''↓''' or '''↑'''
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |Depends on the cause
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |
|style="background: #F5F5F5; padding: 5px;" |Confusion, seizures
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Meningitis or encephalitis
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px; text-align:center" |'''↑''' Leukocytes,


'''↑''' Protein
==[[Stroke classification|Classification]]==


↓ Glucose
==[[Stroke pathophysiology|Pathophysiology]]==
| style="background: #F5F5F5; padding: 5px;" |[[CSF analysis]]<ref name="pmid19398286">{{cite journal| author=Carbonnelle E| title=[Laboratory diagnosis of bacterial meningitis: usefulness of various tests for the determination of the etiological agent]. | journal=Med Mal Infect | year= 2009 | volume= 39 | issue= 7-8 | pages= 581-605 | pmid=19398286 | doi=10.1016/j.medmal.2009.02.017 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19398286  }}</ref>
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px; text-align:center" |  ✔
| style="background: #F5F5F5; padding: 5px; text-align:center" |✔
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |[[Fever]], neck
rigidity
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Multiple sclerosis exacerbation
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px; text-align:center" |✔
| style="background: #F5F5F5; padding: 5px; text-align:center" |'''↑'''  CSF IgG levels
(monoclonal bands)
| style="background: #F5F5F5; padding: 5px;" |Clinical assesment and [[MRI]] <ref name="pmid8274111">{{cite journal| author=Giang DW, Grow VM, Mooney C, Mushlin AI, Goodman AD, Mattson DH et al.| title=Clinical diagnosis of multiple sclerosis. The impact of magnetic resonance imaging and ancillary testing. Rochester-Toronto Magnetic Resonance Study Group. | journal=Arch Neurol | year= 1994 | volume= 51 | issue= 1 | pages= 61-6 | pmid=8274111 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8274111  }}</ref>
| style="background: #F5F5F5; padding: 5px; text-align:center" |✔
| style="background: #F5F5F5; padding: 5px; text-align:center" |✔
| style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px; text-align:center" |✔
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px; text-align:center" |✔
| style="background: #F5F5F5; padding: 5px; text-align:center" |✔
| style="background: #F5F5F5; padding: 5px;" |History of relapses and remissions
| style="background: #F5F5F5; padding: 5px;" |Blurry vision, [[urinary incontinence]], [[fatigue]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Seizure
| style="background: #F5F5F5; padding: 5px; text-align:center" |↓ or '''↑'''
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |Clinical assesment and [[EEG]] <ref name="pmid11385043">{{cite journal| author=Manford M| title=Assessment and investigation of possible epileptic seizures. | journal=J Neurol Neurosurg Psychiatry | year= 2001 | volume= 70 Suppl 2 | issue=  | pages= II3-8 | pmid=11385043 | doi= | pmc=1765557 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11385043  }}</ref>
| style="background: #F5F5F5; padding: 5px; text-align:center" |✔
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px; text-align:center" |  ✔
| style="background: #F5F5F5; padding: 5px; text-align:center" |✔
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px; text-align:center" |✔
| style="background: #F5F5F5; padding: 5px;" |Previous history of seizures
| style="background: #F5F5F5; padding: 5px;" |Confusion, apathy, irritability,
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Hypoglycemia
| style="background: #F5F5F5; padding: 5px; text-align:center" |↓ or '''↑'''
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |Serum blood [[Glucose-1-phosphate adenylyltransferase|glucose]]
[[HbA1c]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;text-align:center" |✔
| style="background: #F5F5F5; padding: 5px;text-align:center" |✔
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px; text-align:center" |  ✔
| style="background: #F5F5F5; padding: 5px; text-align:center" |✔
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px; text-align:center" |✔
| style="background: #F5F5F5; padding: 5px;" |History of [[Diabetes mellitus|diabetes]]
| style="background: #F5F5F5; padding: 5px;" |[[Palpitation|Palpitations]], sweating, [[dizziness]], low serum, glucose
|}


==Epidemiology and Demographics ==
==[[Stroke causes|Causes]]==
===Stroke in USA===
 
*Stroke is a leading cause of serious long-term disability
==[[Stroke differential diagnosis|Differentiating Stroke from other Diseases]]==
*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%.<ref name="pmid26673558">{{cite journal| author=Writing Group Members. Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ et al.| title=Heart Disease and Stroke Statistics-2016 Update: A Report From the American Heart Association. | journal=Circulation | year= 2016 | volume= 133 | issue= 4 | pages= e38-360 | pmid=26673558 | doi=10.1161/CIR.0000000000000350 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26673558  }} </ref>
==[[Stroke epidemiology and demographics|Epidemiology and Demographics]]==
*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<ref name="pmid26673558">{{cite journal| author=Writing Group Members. Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ et al.| title=Heart Disease and Stroke Statistics-2016 Update: A Report From the American Heart Association. | journal=Circulation | year= 2016 | volume= 133 | issue= 4 | pages= e38-360 | pmid=26673558 | doi=10.1161/CIR.0000000000000350 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26673558  }} </ref>
==[[Stroke risk factors|Risk Factors]]==
*The incidence of new (610, 000) or recurrent stroke (185, 000) is estimated to be 795000 people annually or 250 cases per 100, 000.<ref name="pmid26673558">{{cite journal| author=Writing Group Members. Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ et al.| title=Heart Disease and Stroke Statistics-2016 Update: A Report From the American Heart Association. | journal=Circulation | year= 2016 | volume= 133 | issue= 4 | pages= e38-360 | pmid=26673558 | doi=10.1161/CIR.0000000000000350 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26673558  }} </ref>
 
*It is estimated that one incidence of stroke happens every 4 sec with death occuring every 4 min.<ref name="pmid26673558">{{cite journal| author=Writing Group Members. Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ et al.| title=Heart Disease and Stroke Statistics-2016 Update: A Report From the American Heart Association. | journal=Circulation | year= 2016 | volume= 133 | issue= 4 | pages= e38-360 | pmid=26673558 | doi=10.1161/CIR.0000000000000350 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26673558  }} </ref>
==[[Stroke screening|Screening]]==
*About 87% of all strokes are ischemic strokes<ref name=CDCstroke> http://www.cdc.gov/stroke/facts.htm Accessed on November 3, 2016</ref>
 
*Stroke costs the United States an estimated $34 billion each year<ref name=CDCstroke> http://www.cdc.gov/stroke/facts.htm Accessed on November 3, 2016</ref>
==[[Stroke natural history, complications and prognosis|Natural History, Complications and Prognosis]]==
===Worldwide===
*According to WHO, the incidence of stroke is estimated to be 15 million people annually, worldwide.<ref name=WHOSTROKE>Mackay, Judith, et al. The atlas of heart disease and stroke. World Health Organization, 2004 Accessed on November 3 2016</ref>.
*Out of these, 5 million die and 5 million are left permanently disbaled.<ref name=WHOSTROKE>Mackay, Judith, et al. The atlas of heart disease and stroke. World Health Organization, 2004 Accessed on November 3 2016</ref>.
===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. <ref name=CDCstroke> http://www.cdc.gov/stroke/facts.htm Accessed on November 3, 2016</ref>
*According to WHO, stroke also occurs in about 8% of children with sickle cell disease.<ref name=WHOSTROKE>Mackay, Judith, et al. The atlas of heart disease and stroke. World Health Organization, 2004 Accessed on November 3 2016</ref>.
*In 2009, 34% of people hospitalized for stroke were younger than 65 years<ref name=CDCstroke> http://www.cdc.gov/stroke/facts.htm Accessed on November 3, 2016</ref>
*The incidence of stroke in people aged 18 to 50 years is estimated to be approximately 10%. <ref name="pmid26673558">{{cite journal| author=Writing Group Members. Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ et al.| title=Heart Disease and Stroke Statistics-2016 Update: A Report From the American Heart Association. | journal=Circulation | year= 2016 | volume= 133 | issue= 4 | pages= e38-360 | pmid=26673558 | doi=10.1161/CIR.0000000000000350 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26673558  }} </ref>
The rate of decline in mortality rates of stroke in different age groups is as follows:<ref name="pmid26673558">{{cite journal| author=Writing Group Members. Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ et al.| title=Heart Disease and Stroke Statistics-2016 Update: A Report From the American Heart Association. | journal=Circulation | year= 2016 | volume= 133 | issue= 4 | pages= e38-360 | pmid=26673558 | doi=10.1161/CIR.0000000000000350 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26673558  }} </ref>
*>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.<ref name=CDCstroke> http://www.cdc.gov/stroke/facts.htm Accessed on November 3, 2016</ref>
*Hispanics’ risk for stroke falls between that of whites and blacks <ref name=CDCstroke> http://www.cdc.gov/stroke/facts.htm Accessed on November 3, 2016</ref>
===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.<ref name=CDCstroke> http://www.cdc.gov/stroke/facts.htm Accessed on November 3, 2016</ref>


==Diagnosis==
==Diagnosis==
[[Stroke  diagnostic study of choice|Diagnostic study of choice]] | [[Stroke history and symptoms|History and Symptoms]] | [[Stroke physical examination|Physical Examination]] | [[Stroke laboratory findings|Laboratory Findings]] | [[Stroke electrocardiogram|Electrocardiogram]] | [[Stroke x ray|X-Ray Findings]] | [[Stroke echocardiography and ultrasound|Echocardiography and Ultrasound]] | [[Stroke CT scan|CT-Scan Findings]] | [[Stroke MRI|MRI Findings]] | [[Stroke other imaging findings|Other Imaging Findings]] | [[Stroke other diagnostic studies|Other Diagnostic Studies]]
==Treatment==
[[Stroke medical therapy|Medical Therapy]] | [[Stroke interventions|Interventions]] | [[Stroke surgery|Surgery]] | [[Stroke  primary prevention|Primary Prevention]] | [[Stroke secondary prevention|Secondary Prevention]] | [[Stroke cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Stroke future or investigational therapies|Future or Investigational Therapies]]


==References==
==Case Studies==
{{reflist|2}}
[[Stroke case study one|Case #1]]


{{WS}}
[[Category: (name of the system)]]
{{WH}}

Latest revision as of 21:21, 23 March 2023

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Maryam Hadipour, M.D.[2]

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