Stroke resident survival guide
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.
Stroke in the Young
This is a term used to describe stroke seen in individuals between 18 and 45 years of age.[2]
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 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
References
- ↑ 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) - ↑ Szostak, C.; Porter, L.; Jakubovic, A.; Phillips, AG.; Fibiger, HC. (1988). "Conditioned circling in rats: bilateral involvement of the mesotelencephalic dopamine system demonstrated following unilateral 6-hydroxydopamine lesions". Neuroscience. 26 (2): 395–401. PMID 3140048. Unknown parameter
|month=ignored (help)