Ischemic stroke natural history: Difference between revisions

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| style="padding: 5px 5px; background: #F5F5F5;" |A
| style="padding: 5px 5px; background: #F5F5F5;" |Large size of infarct
| style="padding: 5px 5px; background: #F5F5F5;" |Large size and volume of infarct
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| style="padding: 5px 5px; background: #F5F5F5;" |A
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| style="padding: 5px 5px; background: #F5F5F5;" |A
| style="padding: 5px 5px; background: #F5F5F5;" |A
| style="padding: 5px 5px; background: #F5F5F5;" |Location of the infarct
| style="padding: 5px 5px; background: #F5F5F5;" |Location of the infarct<ref name="pmid19747656">{{cite journal| author=Huttner HB, Schwab S| title=Malignant middle cerebral artery infarction: clinical characteristics, treatment strategies, and future perspectives. | journal=Lancet Neurol | year= 2009 | volume= 8 | issue= 10 | pages= 949-58 | pmid=19747656 | doi=10.1016/S1474-4422(09)70224-8 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19747656  }} </ref><ref name="pmid8929152">{{cite journal| author=Hacke W, Schwab S, Horn M, Spranger M, De Georgia M, von Kummer R| title='Malignant' middle cerebral artery territory infarction: clinical course and prognostic signs. | journal=Arch Neurol | year= 1996 | volume= 53 | issue= 4 | pages= 309-15 | pmid=8929152 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8929152  }} </ref><ref name="pmid20354047">{{cite journal| author=Treadwell SD, Thanvi B| title=Malignant middle cerebral artery (MCA) infarction: pathophysiology, diagnosis and management. | journal=Postgrad Med J | year= 2010 | volume= 86 | issue= 1014 | pages= 235-42 | pmid=20354047 | doi=10.1136/pgmj.2009.094292 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20354047  }} </ref>
|-
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| style="padding: 5px 5px; background: #F5F5F5;" |A
| style="padding: 5px 5px; background: #F5F5F5;" |A
| style="padding: 5px 5px; background: #F5F5F5;" |Presence of fever, cerebral edema, hyperglycemia
| style="padding: 5px 5px; background: #F5F5F5;" |Presence of fever, cerebral edema, hyperglycemia
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| style="padding: 5px 5px; background: #F5F5F5;" |A
| style="padding: 5px 5px; background: #F5F5F5;" |Presence of co morbid conditions
*Anemia
*Myocardial infarction
*Diabetes mellitus
*Atrial fibrillation
*Malnutrition
*Renal dysfunction
*Heart failure
*Cancer
*Coronary artery disease
|-
| style="padding: 5px 5px; background: #F5F5F5;" |A
| style="padding: 5px 5px; background: #F5F5F5;" |Advanced age<ref name="pmid9737218">{{cite journal| author=Wijdicks EF, Diringer MN| title=Middle cerebral artery territory infarction and early brain swelling: progression and effect of age on outcome. | journal=Mayo Clin Proc | year= 1998 | volume= 73 | issue= 9 | pages= 829-36 | pmid=9737218 | doi=10.4065/73.9.829 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9737218  }} </ref>
|-
| style="padding: 5px 5px; background: #F5F5F5;" |A
| style="padding: 5px 5px; background: #F5F5F5;" |Low socioeconomic status
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| style="padding: 5px 5px; background: #F5F5F5;" |A
| style="padding: 5px 5px; background: #F5F5F5;" |African American population
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*Severe neurological deficit  
*Severe neurological deficit  
*Large volume of infarct (supratentorial infarcts)
*Large volume of infarct (supratentorial infarcts)
*Infarct location and vascular supply<ref name="pmid19747656">{{cite journal| author=Huttner HB, Schwab S| title=Malignant middle cerebral artery infarction: clinical characteristics, treatment strategies, and future perspectives. | journal=Lancet Neurol | year= 2009 | volume= 8 | issue= 10 | pages= 949-58 | pmid=19747656 | doi=10.1016/S1474-4422(09)70224-8 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19747656  }} </ref><ref name="pmid8929152">{{cite journal| author=Hacke W, Schwab S, Horn M, Spranger M, De Georgia M, von Kummer R| title='Malignant' middle cerebral artery territory infarction: clinical course and prognostic signs. | journal=Arch Neurol | year= 1996 | volume= 53 | issue= 4 | pages= 309-15 | pmid=8929152 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8929152  }} </ref><ref name="pmid20354047">{{cite journal| author=Treadwell SD, Thanvi B| title=Malignant middle cerebral artery (MCA) infarction: pathophysiology, diagnosis and management. | journal=Postgrad Med J | year= 2010 | volume= 86 | issue= 1014 | pages= 235-42 | pmid=20354047 | doi=10.1136/pgmj.2009.094292 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20354047  }} </ref>
*Infarct location and vascular supply
:*Cervical internal carotid artery  
:*Cervical internal carotid artery  
:*Anterior choroidal artery
:*Anterior choroidal artery

Revision as of 22:44, 10 November 2016

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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]

Overview

Natural History

Complications

Common complications of ischemic stroke may include:[1][2][3][4]

Duration Complications
Early complications

( <7 days )

Late complications

( >7 days )

Prognosis

Prognosis of stroke depends on factors such as:[18][19][20]

  • Age of the patient
  • Location of infarct
  • Size and volume of infarct
  • Extent of neurological damage
  • Time to seek medical help
  • Comorbid conditions such as
  • Intevention such as thrombolysis
  • Quality of rehabilition care
  • Complications
Good Prognostic factors Bad Prognostic factors
A Large size and volume of infarct
A Severe neurological deficit
A Location of the infarct[21][22][23]
A Presence of fever, cerebral edema, hyperglycemia
A Presence of co morbid conditions
  • Anemia
  • Myocardial infarction
  • Diabetes mellitus
  • Atrial fibrillation
  • Malnutrition
  • Renal dysfunction
  • Heart failure
  • Cancer
  • Coronary artery disease
A Advanced age[24]
A Low socioeconomic status
A African American population

Good Prognostic factors

Bad prognostic factors

Infarct size and location
  • Large size of infarct
  • Severe neurological deficit
  • Large volume of infarct (supratentorial infarcts)
  • Infarct location and vascular supply
  • Cervical internal carotid artery
  • Anterior choroidal artery
  • Insular branch of middle cerebral artery
  • Basilar artery
  • Large intracranial artery
Presence of clinical complications
  • Cerebral edema
  • Fever
  • Hyperglycemia >200mg/dl
Presence of other co morbid conditions
  • Anemia
  • Myocardial infarction
  • Diabetes mellitus
  • Atrial fibrillation
  • Malnutrition
  • Renal dysfunction
  • Heart failure
  • Cancer
  • Coronary artery disease
Other
  • Advanced age[24]
  • Low socioeconomic status
  • African American population

References

  1. ↑ Ingeman A, Andersen G, Hundborg HH, Svendsen ML, Johnsen SP (2011). "Processes of care and medical complications in patients with stroke". Stroke. 42 (1): 167–72. doi:10.1161/STROKEAHA.110.599738. PMID 21148436.
  2. ↑ Wira CR, Rivers E, Martinez-Capolino C, Silver B, Iyer G, Sherwin R; et al. (2011). "Cardiac complications in acute ischemic stroke". West J Emerg Med. 12 (4): 414–20. doi:10.5811/westjem.2011.2.1765. PMC 3236132. PMID 22224130.
  3. ↑ 3.0 3.1 3.2 3.3 3.4 Indredavik B, Rohweder G, Naalsund E, Lydersen S (2008). "Medical complications in a comprehensive stroke unit and an early supported discharge service". Stroke. 39 (2): 414–20. doi:10.1161/STROKEAHA.107.489294. PMID 18096834.
  4. ↑ 4.0 4.1 Minet LR, Peterson E, von Koch L, Ytterberg C (2015). "Occurrence and Predictors of Falls in People With Stroke: Six-Year Prospective Study". Stroke. 46 (9): 2688–90. doi:10.1161/STROKEAHA.115.010496. PMID 26243230.
  5. ↑ Ropper AH, Shafran B (1984). "Brain edema after stroke. Clinical syndrome and intracranial pressure". Arch Neurol. 41 (1): 26–9. PMID 6606414.
  6. ↑ Sherman DG, Easton JD (1980). "Cerebral edema in stroke: a common, often fatal complication". Postgrad Med. 68 (1): 107–13, 116, 119–20. PMID 6771748.
  7. ↑ 7.0 7.1 Martino R, Foley N, Bhogal S, Diamant N, Speechley M, Teasell R (2005). "Dysphagia after stroke: incidence, diagnosis, and pulmonary complications". Stroke. 36 (12): 2756–63. doi:10.1161/01.STR.0000190056.76543.eb. PMID 16269630.
  8. ↑ Davenport RJ, Dennis MS, Warlow CP (1996). "Gastrointestinal hemorrhage after acute stroke". Stroke. 27 (3): 421–4. PMID 8610306.
  9. ↑ O'Donnell MJ, Kapral MK, Fang J, Saposnik G, Eikelboom JW, Oczkowski W; et al. (2008). "Gastrointestinal bleeding after acute ischemic stroke". Neurology. 71 (9): 650–5. doi:10.1212/01.wnl.0000319689.48946.25. PMID 18685137.
  10. ↑ Kamran SI, Downey D, Ruff RL (1998). "Pneumatic sequential compression reduces the risk of deep vein thrombosis in stroke patients". Neurology. 50 (6): 1683–8. PMID 9633711.
  11. ↑ Kelly J, Rudd A, Lewis RR, Coshall C, Moody A, Hunt BJ (2004). "Venous thromboembolism after acute ischemic stroke: a prospective study using magnetic resonance direct thrombus imaging". Stroke. 35 (10): 2320–5. doi:10.1161/01.STR.0000140741.13279.4f. PMID 15322298.
  12. ↑ Dennis M, Mordi N, Graham C, Sandercock P, CLOTS trials collaboration (2011). "The timing, extent, progression and regression of deep vein thrombosis in immobile stroke patients: observational data from the CLOTS multicenter randomized trials". J Thromb Haemost. 9 (11): 2193–200. doi:10.1111/j.1538-7836.2011.04486.x. PMID 21883879.
  13. ↑ Amin AN, Lin J, Thompson S, Wiederkehr D (2013). "Rate of deep-vein thrombosis and pulmonary embolism during the care continuum in patients with acute ischemic stroke in the United States". BMC Neurol. 13: 17. doi:10.1186/1471-2377-13-17. PMC 3571887. PMID 23391151.
  14. ↑ 14.0 14.1 Langhorne P, Stott DJ, Robertson L, MacDonald J, Jones L, McAlpine C; et al. (2000). "Medical complications after stroke: a multicenter study". Stroke. 31 (6): 1223–9. PMID 10835436.
  15. ↑ Korpelainen JT, Kauhanen ML, Kemola H, Malinen U, Myllylä VV (1998). "Sexual dysfunction in stroke patients". Acta Neurol Scand. 98 (6): 400–5. PMID 9875618.
  16. ↑ Senelick Richard C., Rossi, Peter W., Dougherty, Karla (1994). Living with Stroke: A Guide For Families. Contemporary Books, Chicago.
  17. ↑ Korpelainen JT, Nieminen P, Myllylä VV (1999). "Sexual functioning among stroke patients and their spouses". Stroke. 30 (4): 715–9. PMID 10187867.
  18. ↑ Faraji F, Ghasami K, Talaie-Zanjani A, Mohammadbeigi A (2013). "Prognostic factors in acute stroke, regarding to stroke severity by Canadian Neurological Stroke Scale: A hospital-based study". Asian J Neurosurg. 8 (2): 78–82. doi:10.4103/1793-5482.116378. PMC 3775186. PMID 24049549.
  19. ↑ Holloway RG, Benesch CG, Burgin WS, Zentner JB (2005). "Prognosis and decision making in severe stroke". JAMA. 294 (6): 725–33. doi:10.1001/jama.294.6.725. PMID 16091575.
  20. ↑ Heinsius T, Bogousslavsky J, Van Melle G (1998). "Large infarcts in the middle cerebral artery territory. Etiology and outcome patterns". Neurology. 50 (2): 341–50. PMID 9484351.
  21. ↑ Huttner HB, Schwab S (2009). "Malignant middle cerebral artery infarction: clinical characteristics, treatment strategies, and future perspectives". Lancet Neurol. 8 (10): 949–58. doi:10.1016/S1474-4422(09)70224-8. PMID 19747656.
  22. ↑ Hacke W, Schwab S, Horn M, Spranger M, De Georgia M, von Kummer R (1996). "'Malignant' middle cerebral artery territory infarction: clinical course and prognostic signs". Arch Neurol. 53 (4): 309–15. PMID 8929152.
  23. ↑ Treadwell SD, Thanvi B (2010). "Malignant middle cerebral artery (MCA) infarction: pathophysiology, diagnosis and management". Postgrad Med J. 86 (1014): 235–42. doi:10.1136/pgmj.2009.094292. PMID 20354047.
  24. ↑ 24.0 24.1 Wijdicks EF, Diringer MN (1998). "Middle cerebral artery territory infarction and early brain swelling: progression and effect of age on outcome". Mayo Clin Proc. 73 (9): 829–36. doi:10.4065/73.9.829. PMID 9737218.

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