Stroke resident survival guide

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

Overview

The term 'stroke' is used to describe pathological conditions caused by brain ischemia or hemorrhage. According to the American Heart Association/American Stroke Association (July, 2013), it is defined as a neurological deficit attributed to an acute focal injury of the central nervous system (CNS) by a vascular cause, including cerebral infarction, intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH). Therefore, by definition, trauma has to be ruled out before stroke can be diagnosed in a patient with a focal neurological deficit.

Stroke vs. Intracranial Hemorrhage

Stroke in the Young

This is a term used to describe stroke seen in individuals between 18 and 45 years of age.

Stroke in the Young

• Cardiac - Congenital heart disease, atrial myxoma, patent foramen ovale, atrial fibrillation, rheumatic heart disease
• Vascular - Extracranial arterial dissection, hypertension, Moyamoya syndrome, migraine, vasospasm following subarachnoid hemorrhage
• Hematologic - Sickle cell disease, protein C deficiency, protein S deficiency, antithrombin III deficiency
• Infectious - Human Immunodeficiency Virus, varicella, bacterial meningitis, syphilis, tuberculosis
• Metabolic - Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy, Fabry disease, mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes
• Drugs - Cocaine, methamphetamine, oral contraceptives

Management

Initial Evaluation

Check vitals Stabilize ABC Brief Hx Rapid physical exam - neuro exam, NIHSS Activate stroke team Stat fingerstick Basic labs, troponin, EKG NPO Obtain stroke protocol

Non-Contrast Enhanced CT (or MRI) to r/o hemorrhage

Bleed Negative

Bleed Positive

Acute Ischemic Stroke

Hemorrhagic Stroke

Intracerebral Hemorrhage

Subarachnoid Hemorrhage