Stroke resident survival guide: Difference between revisions

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==Overview==
==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),<ref name="Sacco-2013">{{Cite journal  | last1 = Sacco | first1 = RL. | last2 = Kasner | first2 = SE. | last3 = Broderick | first3 = JP. | last4 = Caplan | first4 = LR. | last5 = Connors | first5 = JJ. | last6 = Culebras | first6 = A. |last7 = Elkind | first7 = MS. | last8 = George | first8 = MG. | last9 = Hamdan | first9 = AD. | title = An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American Heart Association/American Stroke Association. | journal = Stroke | volume = 44 | issue = 7 |pages = 2064-89 | month = Jul | year = 2013 | doi = 10.1161/STR.0b013e318296aeca | PMID = 23652265 }}</ref>  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.
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),<ref name="Sacco-2013">{{Cite journal  | last1 = Sacco | first1 = RL. | last2 = Kasner | first2 = SE. | last3 = Broderick | first3 = JP. | last4 = Caplan | first4 = LR. | last5 = Connors | first5 = JJ. | last6 = Culebras | first6 = A. |last7 = Elkind | first7 = MS. | last8 = George | first8 = MG. | last9 = Hamdan | first9 = AD. | title = An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American Heart Association/American Stroke Association. | journal = Stroke | volume = 44 | issue = 7 |pages = 2064-89 | month = Jul | year = 2013 | doi = 10.1161/STR.0b013e318296aeca | PMID = 23652265 }}</ref>  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 in the Young===
This is a term used to describe stroke seen in individuals between 18 and 45 years of age.<ref name="Szostak-1988">{{Cite journal  | last1 = Szostak | first1 = C. | last2 = Porter | first2 = L. | last3 = Jakubovic | first3 = A. | last4 = Phillips | first4 = AG. | last5 = Fibiger | first5 = HC. | title = Conditioned circling in rats: bilateral involvement of the mesotelencephalic dopamine system demonstrated following unilateral 6-hydroxydopamine lesions. | journal = Neuroscience | volume = 26 | issue = 2 | pages = 395-401 | month = Aug | year = 1988 | doi =  | PMID = 3140048 }}</ref>
====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 - [[CADASIL|Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy]], [[Fabry disease]], [[mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes]]
* Drugs - [[Cocaine]], [[methamphetamine]], [[oral contraceptive]]s


==Management==
==Management==

Revision as of 15:34, 7 January 2014

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mugilan Poongkunran M.B.B.S [2] Ayokunle Olubaniyi, M.B,B.S [3]

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),[1] 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.

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
 
 

References

  1. ↑ Sacco, RL.; Kasner, SE.; Broderick, JP.; Caplan, LR.; Connors, JJ.; Culebras, A.; Elkind, MS.; George, MG.; Hamdan, AD. (2013). "An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American Heart Association/American Stroke Association". Stroke. 44 (7): 2064–89. doi:10.1161/STR.0b013e318296aeca. PMID 23652265. Unknown parameter |month= ignored (help)

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