Narrative Review: Stroke: Difference between revisions

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|1A
|1A
|Level of consciousness
|Level of consciousness
|0—Alert1—Drowsy2—Obtunded3—Coma/unresponsive
|0—Alert
1—Drowsy
 
2—Obtunded
 
3—Coma/unresponsive
|-
|-
|1B
|1B
| colspan="1" rowspan="1" |Orientation questions (2)
| colspan="1" rowspan="1" |Orientation questions (2)
| colspan="1" rowspan="1" |0—Answers both correctly1—Answers 1 correctly2—Answers neither correctly
| colspan="1" rowspan="1" |0—Answers both correctly
1—Answers 1 correctly
 
2—Answers neither correctly
|-
|-
| colspan="1" rowspan="1" |1C
| colspan="1" rowspan="1" |1C
| colspan="1" rowspan="1" |Response to commands (2)
| colspan="1" rowspan="1" |Response to commands (2)
| colspan="1" rowspan="1" |0—Performs both tasks correctly1—Performs 1 task correctly2—Performs neither
| colspan="1" rowspan="1" |0—Performs both tasks correctly
1—Performs 1 task correctly
 
2—Performs neither
|-
|-
| colspan="1" rowspan="1" |2
| colspan="1" rowspan="1" |2
| colspan="1" rowspan="1" |Gaze
| colspan="1" rowspan="1" |Gaze
| colspan="1" rowspan="1" |0—Normal horizontal movements1—Partial gaze palsy2—Complete gaze palsy
| colspan="1" rowspan="1" |0—Normal horizontal movements
1—Partial gaze palsy
 
2—Complete gaze palsy
|-
|-
| colspan="1" rowspan="1" |3
| colspan="1" rowspan="1" |3
| colspan="1" rowspan="1" |Visual fields
| colspan="1" rowspan="1" |Visual fields
| colspan="1" rowspan="1" |0—No visual field defect1—Partial hemianopia2—Complete hemianopia3—Bilateral hemianopia
| colspan="1" rowspan="1" |0—No visual field defect
1—Partial hemianopia
 
2—Complete hemianopia
 
3—Bilateral hemianopia
|-
|-
| colspan="1" rowspan="1" |4
| colspan="1" rowspan="1" |4
| colspan="1" rowspan="1" |Facial movement
| colspan="1" rowspan="1" |Facial movement
| colspan="1" rowspan="1" |0—Normal1—Minor facial weakness2—Partial facial weakness3—Complete unilateral palsy
| colspan="1" rowspan="1" |0—Normal
1—Minor facial weakness
 
2—Partial facial weakness
 
3—Complete unilateral palsy
|-
|-
| colspan="1" rowspan="1" |5
| colspan="1" rowspan="1" |5
| colspan="1" rowspan="1" |Motor function (arm)a. Leftb. Right
| colspan="1" rowspan="1" |Motor function (arm)a. Leftb. Right
| colspan="1" rowspan="1" |0—No drift1—Drift before 5 seconds2—Falls before 10 seconds3—No effort against gravity4—No movement
| colspan="1" rowspan="1" |0—No drift
1—Drift before 5 seconds
 
2—Falls before 10 seconds
 
3—No effort against gravity
 
4—No movement
|-
|-
| colspan="1" rowspan="1" |6
| colspan="1" rowspan="1" |6
| colspan="1" rowspan="1" |Motor function (leg)a. Leftb. Right
| colspan="1" rowspan="1" |Motor function (leg)a. Leftb. Right
| colspan="1" rowspan="1" |0—No drift1—Drift before 5 seconds2—Falls before 5 seconds3—No effort against gravity4—No movement
| colspan="1" rowspan="1" |0—No drift
1—Drift before 5 seconds
 
2—Falls before 5 seconds
 
3—No effort against gravity
 
4—No movement
|-
|-
| colspan="1" rowspan="1" |7
| colspan="1" rowspan="1" |7
| colspan="1" rowspan="1" |Limb ataxia
| colspan="1" rowspan="1" |Limb ataxia
| colspan="1" rowspan="1" |0—No ataxia1—Ataxia in 1 limb2—Ataxia in 2 limbs
| colspan="1" rowspan="1" |0—No ataxia
1—Ataxia in 1 limb
 
2—Ataxia in 2 limbs
|-
|-
| colspan="1" rowspan="1" |8
| colspan="1" rowspan="1" |8
| colspan="1" rowspan="1" |Sensory
| colspan="1" rowspan="1" |Sensory
| colspan="1" rowspan="1" |0—No sensory loss1—Mild sensory loss2—Severe sensory loss
| colspan="1" rowspan="1" |0—No sensory loss
1—Mild sensory loss
 
2—Severe sensory loss
|-
|-
| colspan="1" rowspan="1" |9
| colspan="1" rowspan="1" |9
| colspan="1" rowspan="1" |Language
| colspan="1" rowspan="1" |Language
| colspan="1" rowspan="1" |0—Normal1—Mild aphasia2—Severe aphasia3—Mute or global aphasia
| colspan="1" rowspan="1" |0—Normal
1—Mild aphasia
 
2—Severe aphasia
 
3—Mute or global aphasia
|-
|-
| colspan="1" rowspan="1" |10
| colspan="1" rowspan="1" |10
| colspan="1" rowspan="1" |Articulation
| colspan="1" rowspan="1" |Articulation
| colspan="1" rowspan="1" |0—Normal1—Mild dysarthria2—Severe dysarthria
| colspan="1" rowspan="1" |0—Normal
1—Mild dysarthria
 
2—Severe dysarthria
|-
|-
| colspan="1" rowspan="1" |11
| colspan="1" rowspan="1" |11
| colspan="1" rowspan="1" |Extinction or inattention
| colspan="1" rowspan="1" |Extinction or inattention
| colspan="1" rowspan="1" |0—Absent1—Mild (loss 1 sensory modality lost)2—Severe (loss 2 modalities lost)
| colspan="1" rowspan="1" |0—Absent
1—Mild (loss 1 sensory modality lost)
 
2—Severe (loss 2 modalities lost)
|}
|}
* '''MM/DD/YYYY at xx:xx on brain MRI''' : [Write the MRI findings, mention the site of stroke here]
* '''MM/DD/YYYY at xx:xx on brain MRI''' : [Write the MRI findings, mention the site of stroke here]

Revision as of 15:30, 26 June 2018

Narrative Review

Narrative Review: Death

Narrative Review: Stroke

Narrative Review: Myocardial Infarction

Narrative Review: Acute Kidney Injury

Narrative Review: Bleeding

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

Site Patient AE Complication Event date AE code
xxx xxx x mm/dd/YYYY xxx

Diagnosis

O Ischemic Stroke O Hemorrhagic Stroke O Undetermined Stroke O TIA

Symptoms:

  • O Loss of consciousness
  • O New focal neurological deficits [scale based on the below table]
  • O Presence of hypoglycemia
  • O Presence of AF (or other arrhythmia)

National Institutes of Health Stroke Scale

Class Title Responses and Scores
1A Level of consciousness 0—Alert

1—Drowsy

2—Obtunded

3—Coma/unresponsive

1B Orientation questions (2) 0—Answers both correctly

1—Answers 1 correctly

2—Answers neither correctly

1C Response to commands (2) 0—Performs both tasks correctly

1—Performs 1 task correctly

2—Performs neither

2 Gaze 0—Normal horizontal movements

1—Partial gaze palsy

2—Complete gaze palsy

3 Visual fields 0—No visual field defect

1—Partial hemianopia

2—Complete hemianopia

3—Bilateral hemianopia

4 Facial movement 0—Normal

1—Minor facial weakness

2—Partial facial weakness

3—Complete unilateral palsy

5 Motor function (arm)a. Leftb. Right 0—No drift

1—Drift before 5 seconds

2—Falls before 10 seconds

3—No effort against gravity

4—No movement

6 Motor function (leg)a. Leftb. Right 0—No drift

1—Drift before 5 seconds

2—Falls before 5 seconds

3—No effort against gravity

4—No movement

7 Limb ataxia 0—No ataxia

1—Ataxia in 1 limb

2—Ataxia in 2 limbs

8 Sensory 0—No sensory loss

1—Mild sensory loss

2—Severe sensory loss

9 Language 0—Normal

1—Mild aphasia

2—Severe aphasia

3—Mute or global aphasia

10 Articulation 0—Normal

1—Mild dysarthria

2—Severe dysarthria

11 Extinction or inattention 0—Absent

1—Mild (loss 1 sensory modality lost)

2—Severe (loss 2 modalities lost)

  • MM/DD/YYYY at xx:xx on brain MRI : [Write the MRI findings, mention the site of stroke here]
  • MM/DD/YYYY at xx:xx on brain CT : [Write the CT findings, mention the site of stroke here]

Event

Addmission date: MM/DD/YYYY

Demographic: [age] year old [gender]

Site Reported Event Onset Date: MM/DD/YYYY

Event summary:

  • Symptoms and sign:
    • Subject presented with [sign and symptom] on MM/DD/YYYY.
    • Important characteristics of the chief complaint such as severity, site, and duration.
    • Other important symptoms related to the chief complaint.
  • Past Medical History: [eg. CAD, Severe mitral stenosis, former tobacco use, dyslipidemia, ...]
  • Past Surgical History: [including date]
  • Medications: [relevant to the event not all]
  • Physical assessment:
    • Vital signs
    • Positive physical examinations or related negative examinations.

Event (2): [If there is more than 1 event]

Stroke/TIA definitions

Stroke:

Duration of a focal or global neurological deficit 24 h OR <24 h if available neuroimaging procedure (CT scan or brain MRI) documents a new intracranial or subarachnoid hemorrhage (hemorrhagic stroke) or central nervous system infarction (ischemic stroke) OR the neurological deficit results in death. Or there is confirmation of a stroke diagnosis by a neurologist or neurosurgical specialist.

Ischemic:

An acute episode of focal cerebral, spinal, or retinal dysfunction caused by infarction of the central nervous system tissue.

Hemorrhagic:

An acute episode of focal or global cerebral or spinal dysfunction caused by intraparenchymal, intraventricular, or subarachnoid hemorrhage.

Undetermined:

If there is insufficient information to allow categorization as ischemic or hemorrhagic.

TIA:

Duration of a focal or global neurological deficit <24 h and neuroimaging procedure (CT scan or brain MRI) does not demonstrate a new hemorrhage or infarct Or there is confirmation of a TIA diagnosis by a neurologist or neurosurgical specialist.

Procedure

  • Index Procedure Date/Time:
    • mm/dd/YYYY at xx:xx [insert date and time]
  • Index Procedure Detail:
    • On mm/dd/YYYY at xx:xx [insert date and time] the subject underwent a [select surgical correction] for [select etiology].
    • Access site details
    • The site reported that there were/were not procedural complication(s). 

Laboratory data

  • Lab studies list: (Date/ name/ value)

Other Diagnostic tests

  • mm/dd/YYYY at xx:xx on MRA
  • mm/dd/YYYY at xx:xx on EEG
  • mm/dd/YYYY at xx:xx on Carotid US
  • mm/dd/YYYY at xx:xx on ECG:
  • mm/dd/YYYY at xx:xx on ECHO:
  • mm/dd/YYYY at xx:xx on Ultrasound:
  • mm/dd/YYYY at xx:xx on Endoscopy:
  • mm/dd/YYYY at xx:xx ... (Other relevant imaging and diagnostic tests)

Consults

  • Date and time of consult
  • Suggested treatments

Clinical course

  • Date and time of events,
  • Patient condition got worse or better.

Treatment and outcome

  • List of relevant medical treatments
  • Outcome [Discharge / Hospice / Death]