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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}}
The following table lists causes for stroke.<ref name="pmid17043443">{{cite journal |vauthors=Kishimoto M, Arakawa KC |title=A patient with wegener granulomatosis and intraventricular hemorrhage |journal=J Clin Rheumatol |volume=9 |issue=6 |pages=354–8 |year=2003 |pmid=17043443 |doi=10.1097/01.rhu.0000089967.51779.d7 |url=}}</ref><ref name="pmid7336321">{{cite journal |vauthors=Challa VR, Richards F, Davis CH |title=Intraventricular hemorrhage from pituitary apoplexy |journal=Surg Neurol |volume=16 |issue=5 |pages=360–1 |year=1981 |pmid=7336321 |doi= |url=}}</ref><ref name="pmid18320145">{{cite journal |vauthors=Flint AC, Roebken A, Singh V |title=Primary intraventricular hemorrhage: yield of diagnostic angiography and clinical outcome |journal=Neurocrit Care |volume=8 |issue=3 |pages=330–6 |year=2008 |pmid=18320145 |doi=10.1007/s12028-008-9070-2 |url=}}</ref><ref name="pmid21215656">{{cite journal |vauthors=Fukutake T |title=Cerebral autosomal recessive arteriopathy with subcortical infarcts and leukoencephalopathy (CARASIL): from discovery to gene identification |journal=J Stroke Cerebrovasc Dis |volume=20 |issue=2 |pages=85–93 |year=2011 |pmid=21215656 |doi=10.1016/j.jstrokecerebrovasdis.2010.11.008 |url=}}</ref><ref name="pmid22858729">{{cite journal| author=Meretoja A, Strbian D, Putaala J, Curtze S, Haapaniemi E, Mustanoja S et al.| title=SMASH-U: a proposal for etiologic classification of intracerebral hemorrhage. | journal=Stroke | year= 2012 | volume= 43 | issue= 10 | pages= 2592-7 | pmid=22858729 | doi=10.1161/STROKEAHA.112.661603 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22858729  }} </ref><ref name=Hart> Hart, Robert G., Bradley S. Boop, and David C. Anderson. "Oral anticoagulants and intracranial hemorrhage facts and hypotheses." Stroke 26.8 (1995): 1471-1477.</ref><ref name=Knudsen> Knudsen, Katherine A., et al. "Clinical diagnosis of cerebral amyloid angiopathy: validation of the Boston criteria." Neurology 56.4 (2001): 537-539. </ref><ref name=Lovelock>Lovelock, C. E., A. J. Molyneux, and P. M. Rothwell. "Change in incidence and aetiology of intracerebral haemorrhage in Oxfordshire, UK, between 1981 and 2006: a population-based study." The Lancet Neurology 6.6 (2007): 487-493. </ref><ref name="pmid1117973">{{cite journal| author=Rümke CL| title=Letter: Implications of the statement: No side effects were observed. | journal=N Engl J Med | year= 1975 | volume= 292 | issue= 7 | pages= 372-3 | pmid=1117973 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1117973  }} </ref><ref name="pmid19246695">{{cite journal |vauthors=Hanley DF |title=Intraventricular hemorrhage: severity factor and treatment target in spontaneous intracerebral hemorrhage |journal=Stroke |volume=40 |issue=4 |pages=1533–8 |year=2009 |pmid=19246695 |pmc=2744212 |doi=10.1161/STROKEAHA.108.535419 |url=}}</ref>


{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
{{SK}}
! colspan="4" align="center" style="background:#DCDCDC;" |Cause
|-
! align="center" style="background:#DCDCDC;" |Disease
! align="center" style="background:#DCDCDC;" |Lethal causes
! align="center" style="background:#DCDCDC;" |Common causes
! align="center" style="background:#DCDCDC;" |Less common causes
|-
| align="center" style="background:#DCDCDC;" |[[Transient ischemic attack]] (TIA)
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Emboli]] from cardiac source (mostly secondary to [[Atrial fibrillation|AF]])
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[Atherosclerotic plaque]]
* [[Thrombosis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Arterial dissection]]
|-
| align="center" style="background:#DCDCDC;" |[[Ischemic stroke]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[Atrial fibrillation]]
* [[Eclampsia]]
* [[Infective endocarditis]]
* [[Myocardial infarction]]
* [[Pulmonary embolism]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[Aneurysm]]
* [[Arteriovenous malformations]]
* [[Atherosclerosis]]
* [[Atrial fibrillation]]
* [[Embolism]]
* [[Hypertension]]
* [[Subarachnoid hemorrhage]]
* [[Thrombosis]]
* [[Transient ischemic attack]]
* [[Traumatic brain injury]]
* [[Warfarin]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[Takayasu arteritis]]
* [[Vasculitis]]
* [[Vasoconstriction]]


* [[Infective endocarditis]]
==[[Stroke overview|Overview]]==
* [[Lacunar infarcts]]
* [[Left atrial myxoma]]
|-
| align="center" style="background:#DCDCDC;" |[[Intracerebral hemorrhage]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | ---
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[Hypertension|Long-standing hypertension]]


* [[Cerebral amyloid angiopathy]]
==[[Stroke historical perspective|Historical Perspective]]==
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[Arteriovenous malformation|Arteriovenous malformations (AVMs)]]
* [[Aneurysms]]


* [[Cocaine]]
==[[Stroke classification|Classification]]==
* [[Amphetamines]]


* [[Vasculitis]]
==[[Stroke pathophysiology|Pathophysiology]]==


* [[Liver disease]]
==[[Stroke causes|Causes]]==
* [[Anticoagulant]] medication
* [[Thrombolytic therapy]]


* [[Tumor|Brain tumor]]
==[[Stroke differential diagnosis|Differentiating Stroke from other Diseases]]==
* Hemorrhagic transformation of an [[ischemic stroke]]
* [[Moyamoya disease]]
* [[Tumor|Tumors]]


* [[Encephalitis]]
==[[Stroke epidemiology and demographics|Epidemiology and Demographics]]==
|-
| align="center" style="background:#DCDCDC;" |[[Subarachnoid hemorrhage]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
Rupture of an aneurysm
* [[Aneurysm|Saccular aneurysms]] (most common cause)
* Fusiform [[Aneurysm|aneurysms]]
* Mycotic [[Aneurysm|aneurysms]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
Rupture of an aneurysm
* [[Aneurysm|Saccular aneurysms]] (most common cause)
* Fusiform [[Aneurysm|aneurysms]]
* Mycotic [[Aneurysm|aneurysms]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[Arteriovenous malformation]]
* [[Dural arteriovenous fistula]]
* [[Perimesencephalic nonaneurysmal subarachnoid hemorrhage|Perimesencephalic]]
* [[Arterial dissection|Intracranial arterial dissection]]
* [[Amyloid angiopathy]]
* Cerebral [[venous thrombosis]]
* Cerebral [[vasculitis]]
* Reversible vasoconstriction syndrome


* Cerebral hyperperfusion syndrome after [[carotid endarterectomy]]
==[[Stroke risk factors|Risk Factors]]==
* Reversible posterior leukoencephalopathy syndrome
* Brain or cervical [[Tumor|tumors]]
* Illicit drug use ([[cocaine]], [[amphetamines]])
|-
| align="center" style="background:#DCDCDC;" |[[Subdural hematoma|Subdural hemorrhage]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Rupture of bridging vessels
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Trauma (motor vehicle accidents, falls, and assaults)
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Aneurysmal [[subarachnoid hemorrhage]]
* [[Arteriovenous malformation]]
* [[Meningioma]]
* Dural metastases
* [[Coagulopathy]]
* Neurosurgical procedures
* [[Cocaine abuse]]
|-
| align="center" style="background:#DCDCDC;" |[[Epidural hemorrhage]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Rupture of middle meningeal arteries
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Trauma (motor vehicle accidents, falls, and assaults)
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|-
| align="center" style="background:#DCDCDC;" |[[Intraparenchymal hemorrhage]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | ---
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Trauma (motor vehicle accidents, falls, and assaults)
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | Rupture of an aneurysm
* [[Aneurysm|Saccular aneurysms]] (most common cause)
* Fusiform [[Aneurysm|aneurysms]]
* Mycotic [[Aneurysm|aneurysms]]
[[Arteriovenous malformation]]
|-
| align="center" style="background:#DCDCDC;" |[[Intraventricular hemorrhage]] (IVH)
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | ---
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Secondary to [[intracerebral hemorrhage]]
* Trauma (motor vehicle accidents, falls, and assaults)
* Vascular malformations (usually [[Arteriovenous malformation|arteriovenous malformations]] or [[Arteriovenous fistula|arteriovenous fistulae]])
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Intraventricular tumors ([[papilloma]], neurocytoma, [[meningioma]], metastases, [[astrocytoma]], [[ependymoma]])
* Intraventricular aneurysms
* [[Moyamoya disease]]
* [[Pituitary apoplexy]]
* [[Vasculitis]]
|}


==Classification==
==[[Stroke screening|Screening]]==
===Transient ischemic attack===
*A transient ischemic attack is caused by the temporary disturbance of blood supply to a restricted area of the brain, resulting in brief neurologic dysfunction that usually persists for less than 24 hours.
===Stroke===
{{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 natural history, complications and prognosis|Natural History, Complications and Prognosis]]==
{|
|-style="background: #4479BA; color: #FFFFFF; text-align: center;"
! rowspan="2" |<small>Diseases</small>
! colspan="4" |<small>Symptoms
! colspan="5" |<small>Physical Examination</small>
! rowspan="2" |<small>Past medical history</small>
! colspan="3" |<small>Diagnostic tests</small>
! rowspan="2" |<small>Other Findings</small>
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
!<small>Headache</small>
!↓<small>LOC</small>
!<small>Motor weakness</small>
!<small>Abnormal sensory</small>
!<small>Motor Deficit</small>
!<small>Sensory deficit</small>
!<small>Speech difficulty</small>
!<small>Gait abnormality</small>
!<small>Cranial nerves</small>
!<small>CT /MRI</small>
!<small>CSF Findings</small>
!<small>Gold standard test</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 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 text-align:center" |✔
|style="background: #F5F5F5; padding: 5px text-align:center" |[[Weight loss]], [[fatigue]]
|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;" |[[Cachexia]], gradual progression of symptoms
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Hemorrhagic stroke
|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 text-align:center" | -
|style="background: #F5F5F5; padding: 5px text-align:center" |[[Hypertension]]
|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;" |Neck stiffness
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" | Subdural hemorrhage
|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 text-align:center" |✔
|style="background: #F5F5F5; padding: 5px text-align:center" |[[Trauma]], fall
|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;" |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 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 text-align:center" | -
|style="background: #F5F5F5; padding: 5px text-align:center" |[[Sexually transmitted disease|STI]]<nowiki/>s
|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;" |Blindness, confusion, [[depression]],


Abnormal [[gait]]
==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]]
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Complex or atypical migraine
|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 text-align:center" | -
|style="background: #F5F5F5; padding: 5px text-align:center" |Family history of [[migraine]]
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
|style="background: #F5F5F5; padding: 5px;" |Clinical assesment
|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 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 text-align:center" | -
|style="background: #F5F5F5; padding: 5px text-align:center" |[[Hypertension]]
|style="background: #F5F5F5; padding: 5px;" |✔
|style="background: #F5F5F5; padding: 5px;" | -
|style="background: #F5F5F5; padding: 5px;" |Clinical assesment
|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 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 text-align:center" |✔
|style="background: #F5F5F5; padding: 5px text-align:center" |History of alcohal abuse
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |Clinical assesment and lab findings
|style="background: #F5F5F5; padding: 5px;" |Ophthalmoplegia, confusion
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |CNS abscess
|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 text-align:center" | -
|style="background: #F5F5F5; padding: 5px text-align:center" |History of drug abuse, [[endocarditis]], [[immunosupression]]
|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;" |High grade fever, fatigue,nausea, vomiting
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Drug toxicity
|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 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;" |Drug screen test
|style="background: #F5F5F5; padding: 5px;" |Lithium, Sedatives, phenytoin, carbamazepine
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Conversion disorder
|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 text-align:center" |
|style="background: #F5F5F5; padding: 5px text-align:center" |History of emotional stress
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
|style="background: #F5F5F5; padding: 5px;" |Diagnosis of exclusion
|style="background: #F5F5F5; padding: 5px;" |[[Tremor|Tremors]], [[blindness]], difficulty [[swallowing]]
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |Metabolic disturbances (electrolyte imbalance, hypoglycemia)
|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 text-align:center" |✔
|style="background: #F5F5F5; padding: 5px text-align:center" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |[[Hypoglycemia]], [[Hyponatremia|hypo]] and [[hypernatremia]], [[Hypokalemia|hypo]] and [[hyperkalemia]]
|style="background: #F5F5F5; padding: 5px;" |Depends on the cause
| style="background: #F5F5F5; padding: 5px;" |Confusion, seizures, [[Palpitation|palpitations]], sweating, [[dizziness]], low serum, glucose
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Meningitis or encephalitis
|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 text-align:center" | -
|style="background: #F5F5F5; padding: 5px text-align:center" |History of fever and malaise
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px; text-align:center" |'''↑''' Leukocytes,


'''↑''' Protein
==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]]
↓ Glucose
| 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;" |[[Fever]], neck
rigidity
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Multiple sclerosis exacerbation
|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 text-align:center" |✔
|style="background: #F5F5F5; padding: 5px text-align:center" |History of relapses and remissions
| 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;" |Blurry vision, [[urinary incontinence]], [[fatigue]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Seizure
|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 text-align:center" |✔
|style="background: #F5F5F5; padding: 5px text-align:center" |Previous history of seizures
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |Mass lesion
| 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;" |Confusion, apathy, irritability,
|}
 
==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%.<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>
*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>
*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>
*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>
===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==


==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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