Stroke: Difference between revisions
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==Causes== | ==Causes== | ||
The following table lists causes for stroke. | 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> | ||
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! colspan="4" align="center" style="background:#DCDCDC;" |Cause | ! colspan="4" align="center" style="background:#DCDCDC;" |Cause | ||
Revision as of 17:10, 24 March 2017
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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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Stroke On the Web | |
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American Roentgen Ray Society Images of 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]
Overview
Causes
The following table lists causes for stroke.[1][2][3][4][5][6][7][8][9][10]
| Cause | |||
|---|---|---|---|
| Disease | Lethal causes | Common causes | Less common causes |
| Transient ischemic attack (TIA) | Emboli from cardiac source (mostly secondary to AF) | Arterial dissection | |
| Ischemic stroke | |||
| Intracerebral hemorrhage | --- |
| |
| Subarachnoid hemorrhage |
Rupture of an aneurysm
|
Rupture of an aneurysm
|
|
| Subdural hemorrhage | Rupture of bridging vessels | Trauma (motor vehicle accidents, falls, and assaults) |
|
| Epidural hemorrhage | Rupture of middle meningeal arteries | Trauma (motor vehicle accidents, falls, and assaults) | |
| Intraparenchymal hemorrhage | --- | Trauma (motor vehicle accidents, falls, and assaults) | Rupture of an aneurysm
|
| Intraventricular hemorrhage (IVH) | --- |
|
|
Classification
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
| Stroke | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Ischemic | Hemorrhagic | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Large vessel thromboembolism | Cardioembolic | Small vessel or Lacunar infarct | Intra-axial | Extra-axial | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Intracerebral (ICH) | Subarachnoid hemorrhage (SAH) | Subdural Hemorrhage | Epidural Hemorrhage | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Intraparenchymal hemorrhage | Intraventricular hemorrhage (IVH) | Cerebral microbleeds | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Differential diagnosis
| Diseases | Diagnostic tests | Physical Examination | Symptoms | Past medical history | Other Findings | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 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[11] | ✔ | Cancer cells[12] | MRI | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | Cachexia, gradual progression of symptoms | ||||
| Hemorrhagic stroke | ✔ | Xanthochromia[13] | CT scan without contrast[14][15] | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | Hypertension | Neck stiffness | |
| Subdural hemorrhage | ✔ | CT scan without contrast[14][15] | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | Trauma/fall | Confusion, dizziness, nausea, vomiting | ||
| Neurosyphilis[16][17] | ✔ | ↑ Leukocytes and protein | CSF VDRL-specifc
CSF FTA-Ab -sensitive[18] |
✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | 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 | Depends on the cause | Confusion, seizures | ||||||||||||
| Meningitis or encephalitis | ↑ Leukocytes,
↑ Protein ↓ Glucose |
CSF analysis[19] | ✔ | ✔ | Fever, neck
rigidity | |||||||||
| Multiple sclerosis exacerbation | ✔ | ↑ CSF IgG levels
(monoclonal bands) |
Clinical assesment and MRI [20] | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | History of relapses and remissions | Blurry vision, urinary incontinence, fatigue | ||
| Seizure | Clinical assesment and EEG [21] | ✔ | ✔ | ✔ | ✔ | Previous history of seizures | Confusion, apathy, irritability, | |||||||
| Hypoglycemia | Serum blood glucose | ✔ | ✔ | ✔ | ✔ | ✔ | 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%.[22]
- 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[22]
- The incidence of new (610, 000) or recurrent stroke (185, 000) is estimated to be 795000 people annually or 250 cases per 100, 000.[22]
- It is estimated that one incidence of stroke happens every 4 sec with death occuring every 4 min.[22]
- About 87% of all strokes are ischemic strokes[23]
- Stroke costs the United States an estimated $34 billion each year[23]
Worldwide
- According to WHO, the incidence of stroke is estimated to be 15 million people annually, worldwide.[24].
- Out of these, 5 million die and 5 million are left permanently disbaled.[24].
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. [23]
- According to WHO, stroke also occurs in about 8% of children with sickle cell disease.[24].
- In 2009, 34% of people hospitalized for stroke were younger than 65 years[23]
- The incidence of stroke in people aged 18 to 50 years is estimated to be approximately 10%. [22]
The rate of decline in mortality rates of stroke in different age groups is as follows:[22]
- >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.[23]
- Hispanics’ risk for stroke falls between that of whites and blacks [23]
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.[23]
Diagnosis
References
- ↑ Kishimoto M, Arakawa KC (2003). "A patient with wegener granulomatosis and intraventricular hemorrhage". J Clin Rheumatol. 9 (6): 354–8. doi:10.1097/01.rhu.0000089967.51779.d7. PMID 17043443.
- ↑ Challa VR, Richards F, Davis CH (1981). "Intraventricular hemorrhage from pituitary apoplexy". Surg Neurol. 16 (5): 360–1. PMID 7336321.
- ↑ Flint AC, Roebken A, Singh V (2008). "Primary intraventricular hemorrhage: yield of diagnostic angiography and clinical outcome". Neurocrit Care. 8 (3): 330–6. doi:10.1007/s12028-008-9070-2. PMID 18320145.
- ↑ Fukutake T (2011). "Cerebral autosomal recessive arteriopathy with subcortical infarcts and leukoencephalopathy (CARASIL): from discovery to gene identification". J Stroke Cerebrovasc Dis. 20 (2): 85–93. doi:10.1016/j.jstrokecerebrovasdis.2010.11.008. PMID 21215656.
- ↑ Meretoja A, Strbian D, Putaala J, Curtze S, Haapaniemi E, Mustanoja S; et al. (2012). "SMASH-U: a proposal for etiologic classification of intracerebral hemorrhage". Stroke. 43 (10): 2592–7. doi:10.1161/STROKEAHA.112.661603. PMID 22858729.
- ↑ Hart, Robert G., Bradley S. Boop, and David C. Anderson. "Oral anticoagulants and intracranial hemorrhage facts and hypotheses." Stroke 26.8 (1995): 1471-1477.
- ↑ Knudsen, Katherine A., et al. "Clinical diagnosis of cerebral amyloid angiopathy: validation of the Boston criteria." Neurology 56.4 (2001): 537-539.
- ↑ 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.
- ↑ Rümke CL (1975). "Letter: Implications of the statement: No side effects were observed". N Engl J Med. 292 (7): 372–3. PMID 1117973.
- ↑ Hanley DF (2009). "Intraventricular hemorrhage: severity factor and treatment target in spontaneous intracerebral hemorrhage". Stroke. 40 (4): 1533–8. doi:10.1161/STROKEAHA.108.535419. PMC 2744212. PMID 19246695.
- ↑ Morgenstern LB, Frankowski RF (1999). "Brain tumor masquerading as stroke". J Neurooncol. 44 (1): 47–52. PMID 10582668.
- ↑ Weston CL, Glantz MJ, Connor JR (2011). "Detection of cancer cells in the cerebrospinal fluid: current methods and future directions". Fluids Barriers CNS. 8 (1): 14. doi:10.1186/2045-8118-8-14. PMC 3059292. PMID 21371327.
- ↑ Lee MC, Heaney LM, Jacobson RL, Klassen AC (1975). "Cerebrospinal fluid in cerebral hemorrhage and infarction". Stroke. 6 (6): 638–41. PMID 1198628.
- ↑ 14.0 14.1 Birenbaum D, Bancroft LW, Felsberg GJ (2011). "Imaging in acute stroke". West J Emerg Med. 12 (1): 67–76. PMC 3088377. PMID 21694755.
- ↑ 15.0 15.1 DeLaPaz RL, Wippold FJ, Cornelius RS, Amin-Hanjani S, Angtuaco EJ, Broderick DF; et al. (2011). "ACR Appropriateness Criteria® on cerebrovascular disease". J Am Coll Radiol. 8 (8): 532–8. doi:10.1016/j.jacr.2011.05.010. PMID 21807345.
- ↑ Liu LL, Zheng WH, Tong ML, Liu GL, Zhang HL, Fu ZG; et al. (2012). "Ischemic stroke as a primary symptom of neurosyphilis among HIV-negative emergency patients". J Neurol Sci. 317 (1–2): 35–9. doi:10.1016/j.jns.2012.03.003. PMID 22482824.
- ↑ Berger JR, Dean D (2014). "Neurosyphilis". Handb Clin Neurol. 121: 1461–72. doi:10.1016/B978-0-7020-4088-7.00098-5. PMID 24365430.
- ↑ Ho EL, Marra CM (2012). "Treponemal tests for neurosyphilis--less accurate than what we thought?". Sex Transm Dis. 39 (4): 298–9. doi:10.1097/OLQ.0b013e31824ee574. PMC 3746559. PMID 22421697.
- ↑ Carbonnelle E (2009). "[Laboratory diagnosis of bacterial meningitis: usefulness of various tests for the determination of the etiological agent]". Med Mal Infect. 39 (7–8): 581–605. doi:10.1016/j.medmal.2009.02.017. PMID 19398286.
- ↑ Giang DW, Grow VM, Mooney C, Mushlin AI, Goodman AD, Mattson DH; et al. (1994). "Clinical diagnosis of multiple sclerosis. The impact of magnetic resonance imaging and ancillary testing. Rochester-Toronto Magnetic Resonance Study Group". Arch Neurol. 51 (1): 61–6. PMID 8274111.
- ↑ Manford M (2001). "Assessment and investigation of possible epileptic seizures". J Neurol Neurosurg Psychiatry. 70 Suppl 2: II3–8. PMC 1765557. PMID 11385043.
- ↑ 22.0 22.1 22.2 22.3 22.4 22.5 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.
- ↑ 23.0 23.1 23.2 23.3 23.4 23.5 23.6 http://www.cdc.gov/stroke/facts.htm Accessed on November 3, 2016
- ↑ 24.0 24.1 24.2 Mackay, Judith, et al. The atlas of heart disease and stroke. World Health Organization, 2004 Accessed on November 3 2016