Stroke

Stroke Main page
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Overview
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Classification Hemorrhagic stroke Ischemic stroke
Differentiating Stroke from other Diseases
Epidemiology and Demographics
Diagnosis NIH stroke scale Glasgow coma scale
Epidemiology and Demographics
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Risk calculators and risk factors for Stroke

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]

Differential diagnosis

Diseases	Diagnostic tests				Physical Examination					Symptoms				Past medical history	Other Findings
	Na+, K+, Ca2+	CT /MRI	CSF Findings	Gold standard test	Motor Deficit	Sensory deficit	Speech difficulty	Gait abnormality	Cranial nerves	Headache	LOC	Motor weakness	Abnormal sensations
Brain tumour		✔	Cancer cells	MRI	✔	✔	✔	✔	✔	✔					Cachexia, gradual progression of symptoms
Hemorrhagic stroke		✔	Xanthochromia	CT scan without contrast	✔	✔	✔	✔	✔	✔	✔	✔		Hypertension	Neck stiffness
Subdural hemorrhage		✔		CT scan without contrast	✔	✔	✔	✔	✔	✔	✔	✔		Trauma/fall	Confusion, dizziness, nausea, vomiting
Neurosyphilis		✔	↑ Leukocytes and protein	CSF VDRL-specifc CSF FTA-Ab -sensitive	✔	✔	✔	✔		✔		✔	✔	STIs	Blindness, confusion, depression, Abnormal gait
Complex or atypical migraine				Clinical assesment			✔			✔			✔	Family history of migraine	Presence of aura, nausea, vomiting
Hypertensive encephalopathy		✔		Clinical assesment			✔	✔	✔	✔	✔			History of hypertension	Delirium, cortical blindness, cerebral edema, seizure
Wernicke’s encephalopathy							✔	✔			✔			History of alcohal abuse	Ophthalmoplegia, confusion
CNS abscess		✔	↑ leukocytes, ↓ glucose and ↑ protien	MRI is more sensitive and specific	✔	✔	✔			✔	✔			History of drug abuse, endocarditis, ↓ immune status	High grade fever, fatigue,nausea, vomiting
Drug toxicity							✔	✔			✔				Lithium, Sedatives, phenytoin, carbamazepine
Conversion disorder				Diagnosis of exclusion	✔	✔	✔	✔		✔	✔	✔	✔		Tremors, blindness, difficulty swallowing
Electrolyte disturbance	↓ or ↑			Depends on the cause											Confusion, seizures
Meningitis or encephalitis			↑ Leukocytes, ↑ Protein ↓ Glucose	CSF analysis					✔	✔					Fever, neck rigidity
Multiple sclerosis exacerbation		✔	↑ CSF IgG levels (monoclonal bands)	Clinical assesment and MRI	✔	✔	✔	✔	✔			✔	✔	History of relapses and remissions	Blurry vision, urinary incontinence, fatigue
Seizure	↓ or ↑			Clinical assesment and EEG	✔					✔	✔		✔	Previous history of seizures	Confusion, apathy, irritability,
Hypoglycemia	↓ or ↑			Serum blood glucose HbA1c			✔	✔		✔	✔		✔	History of diabetes	Palpitations, sweating, dizziness, low serum, glucose

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.