Stroke
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Stroke Main page | |
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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]; Tarek Nafee, M.D. [3]; Sara Mehrsefat, M.D. [4]
Overview
Causes
Classification
Differential diagnosis
| Diseases | Diagnostic tests | Physical Examination | Symptoms | Past medical history | Other Findings | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Na+, K+, Ca2+ | CT /MRI | CSF Findings | Gold standard test | Motor Deficit | Sensory deficit | Speech difficulty | Gait abnormality | Cranial nerves | Headache | LOC | Motor weakness | Abnormal sensations | |||
| Brain tumour[1] | ✔ | Cancer cells[2] | MRI | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | Cachexia, gradual progression of symptoms | |||||
| Hemorrhagic stroke | ✔ | Xanthochromia[3] | CT scan without contrast[4][5] | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | Hypertension | Neck stiffness | ||
| Subdural hemorrhage | ✔ | CT scan without contrast[4][5] | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | Trauma/fall | Confusion, dizziness, nausea, vomiting | |||
| Neurosyphilis[6][7] | ✔ | ↑ Leukocytes and protein | CSF VDRL-specifc
CSF FTA-Ab -sensitive[8] |
✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | STIs | Blindness, confusion, depression,
Abnormal gait | |||
| Complex or atypical migraine | Clinical assesment | ✔ | ✔ | ✔ | Family history of migraine | Presence of aura, nausea, vomiting | |||||||||
| Hypertensive encephalopathy | ✔ | Clinical assesment | ✔ | ✔ | ✔ | ✔ | ✔ | History of hypertension | Delirium, cortical blindness, cerebral edema, seizure | ||||||
| Wernicke’s encephalopathy | ✔ | ✔ | ✔ | History of alcohal abuse | Ophthalmoplegia, confusion | ||||||||||
| CNS abscess | ✔ | ↑ leukocytes, ↓ glucose and ↑ protien | MRI is more sensitive and specific | ✔ | ✔ | ✔ | ✔ | ✔ | History of drug abuse, endocarditis, ↓ immune status | High grade fever, fatigue,nausea, vomiting | |||||
| Drug toxicity | ✔ | ✔ | ✔ | Lithium, Sedatives, phenytoin, carbamazepine | |||||||||||
| Conversion disorder | Diagnosis of exclusion | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | Tremors, blindness, difficulty swallowing | |||||
| Electrolyte disturbance | ↓ or ↑ | Depends on the cause | Confusion, seizures | ||||||||||||
| Meningitis or encephalitis | ↑ Leukocytes,
↑ Protein ↓ Glucose |
CSF analysis[9] | ✔ | ✔ | Fever, neck
rigidity | ||||||||||
| Multiple sclerosis exacerbation | ✔ | ↑ CSF IgG levels
(monoclonal bands) |
Clinical assesment and MRI [10] | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | History of relapses and remissions | Blurry vision, urinary incontinence, fatigue | |||
| Seizure | ↓ or ↑ | Clinical assesment and EEG [11] | ✔ | ✔ | ✔ | ✔ | Previous history of seizures | Confusion, apathy, irritability, | |||||||
| Hypoglycemia | ↓ or ↑ | Serum blood glucose | ✔ | ✔ | ✔ | ✔ | ✔ | History of diabetes | Palpitations, sweating, dizziness, low serum, glucose | ||||||
Epidemiology and Demographics
Stroke in USA
- Stroke is a leading cause of serious long-term disability
- In USA, the incidence and mortality rates of stroke has significantly decreased compared to previous years.
- From year 2003 to 2013, the mortality rates due to stroke declined by 18.5%.[12]
- In 2013, stroke became the fifth leading cause of death.
- The case fatality rate of stroke is estimated to be 41.7 deaths per 100, 000 population[12]
- The incidence of new (610, 000) or recurrent stroke (185, 000) is estimated to be 795000 people annually or 250 cases per 100, 000.[12]
- It is estimated that one incidence of stroke happens every 4 sec with death occuring every 4 min.[12]
- About 87% of all strokes are ischemic strokes[13]
- Stroke costs the United States an estimated $34 billion each year[13]
Worldwide
- According to WHO, the incidence of stroke is estimated to be 15 million people annually, worldwide.[14].
- Out of these, 5 million die and 5 million are left permanently disbaled.[14].
Age
- Stroke can occur in all age groups. However, the incidence of stroke is less among individuals age less than 40 years of age and the risk increases with increasing age. [13]
- According to WHO, stroke also occurs in about 8% of children with sickle cell disease.[14].
- In 2009, 34% of people hospitalized for stroke were younger than 65 years[13]
- The incidence of stroke in people aged 18 to 50 years is estimated to be approximately 10%. [12]
The rate of decline in mortality rates of stroke in different age groups is as follows:[12]
- >65 years of age: from 534.1 to 245.2 per 100,000
- 45-65 years of age: from 43.5 to 20.2 per 100,000
- 18 to 44 years of age: from from 3.7 to 2.0 per 100,000
Gender
There is increased incidence of stroke in men as compared to women.
Race
- The risk of incidence of first stroke is twice in african american population as compared to whites with increased mortality rates.[13]
- Hispanics’ risk for stroke falls between that of whites and blacks [13]
Geographical distribution
- There is increased incidence and mortality rates of stroke in developing countries as compared to developed countries due to low socio economic status and heath facilites.
- In USA, the highest death rates from stroke are in the southeastern United States.[13]
Diagnosis
References
- ↑ Morgenstern LB, Frankowski RF (1999). "Brain tumor masquerading as stroke". J Neurooncol. 44 (1): 47–52. PMID 10582668.
- ↑ Weston CL, Glantz MJ, Connor JR (2011). "Detection of cancer cells in the cerebrospinal fluid: current methods and future directions". Fluids Barriers CNS. 8 (1): 14. doi:10.1186/2045-8118-8-14. PMC 3059292. PMID 21371327.
- ↑ Lee MC, Heaney LM, Jacobson RL, Klassen AC (1975). "Cerebrospinal fluid in cerebral hemorrhage and infarction". Stroke. 6 (6): 638–41. PMID 1198628.
- ↑ 4.0 4.1 Birenbaum D, Bancroft LW, Felsberg GJ (2011). "Imaging in acute stroke". West J Emerg Med. 12 (1): 67–76. PMC 3088377. PMID 21694755.
- ↑ 5.0 5.1 DeLaPaz RL, Wippold FJ, Cornelius RS, Amin-Hanjani S, Angtuaco EJ, Broderick DF; et al. (2011). "ACR Appropriateness Criteria® on cerebrovascular disease". J Am Coll Radiol. 8 (8): 532–8. doi:10.1016/j.jacr.2011.05.010. PMID 21807345.
- ↑ Liu LL, Zheng WH, Tong ML, Liu GL, Zhang HL, Fu ZG; et al. (2012). "Ischemic stroke as a primary symptom of neurosyphilis among HIV-negative emergency patients". J Neurol Sci. 317 (1–2): 35–9. doi:10.1016/j.jns.2012.03.003. PMID 22482824.
- ↑ Berger JR, Dean D (2014). "Neurosyphilis". Handb Clin Neurol. 121: 1461–72. doi:10.1016/B978-0-7020-4088-7.00098-5. PMID 24365430.
- ↑ Ho EL, Marra CM (2012). "Treponemal tests for neurosyphilis--less accurate than what we thought?". Sex Transm Dis. 39 (4): 298–9. doi:10.1097/OLQ.0b013e31824ee574. PMC 3746559. PMID 22421697.
- ↑ Carbonnelle E (2009). "[Laboratory diagnosis of bacterial meningitis: usefulness of various tests for the determination of the etiological agent]". Med Mal Infect. 39 (7–8): 581–605. doi:10.1016/j.medmal.2009.02.017. PMID 19398286.
- ↑ Giang DW, Grow VM, Mooney C, Mushlin AI, Goodman AD, Mattson DH; et al. (1994). "Clinical diagnosis of multiple sclerosis. The impact of magnetic resonance imaging and ancillary testing. Rochester-Toronto Magnetic Resonance Study Group". Arch Neurol. 51 (1): 61–6. PMID 8274111.
- ↑ Manford M (2001). "Assessment and investigation of possible epileptic seizures". J Neurol Neurosurg Psychiatry. 70 Suppl 2: II3–8. PMC 1765557. PMID 11385043.
- ↑ 12.0 12.1 12.2 12.3 12.4 12.5 Writing Group Members. Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ; et al. (2016). "Heart Disease and Stroke Statistics-2016 Update: A Report From the American Heart Association". Circulation. 133 (4): e38–360. doi:10.1161/CIR.0000000000000350. PMID 26673558.
- ↑ 13.0 13.1 13.2 13.3 13.4 13.5 13.6 http://www.cdc.gov/stroke/facts.htm Accessed on November 3, 2016
- ↑ 14.0 14.1 14.2 Mackay, Judith, et al. The atlas of heart disease and stroke. World Health Organization, 2004 Accessed on November 3 2016