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Stroke

Stroke Classification: – Ischemic stroke caused by a blood clot leading to brain death. – Hemorrhagic stroke caused by blood leaking into the brain. – […]

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Stroke Classification:
– Ischemic stroke caused by a blood clot leading to brain death.
– Hemorrhagic stroke caused by blood leaking into the brain.
– Ischemic stroke accounts for 87% of cases.
– Hemorrhagic transformation can occur in ischemic stroke.
– Two main types of hemorrhagic stroke: Intracerebral hemorrhage and Subarachnoid hemorrhage.

Definition and Recognition:
– Stroke is defined as a neurological deficit of cerebrovascular cause.
– Stroke persists beyond 24 hours or results in death within 24 hours.
– Alternative terms like brain attack and acute ischemic cerebrovascular syndrome are used.
– FAST mnemonic for early stroke recognition: facial droop, arm weakness, speech difficulty, time to call emergency services.
– Revised mnemonic BE FAST adds balance and eyesight assessment.
– Scales like LAPSS and CPSS aid in prehospital stroke detection.

Symptoms and Subtypes:
– Stroke symptoms start suddenly and depend on the area of the brain affected.
– Associated symptoms of hemorrhagic stroke include loss of consciousness, headache, and vomiting.
– Brain areas affected may cause hemiplegia, muscle weakness, numbness.
– Sentinel headache may precede a stroke.
– Causes of stroke include thrombotic stroke, large vessel disease, small vessel disease, anemia, sickle-cell anemia, and air pollution.

Causes and Diagnosis:
– Causes of stroke include embolism, cerebral hypoperfusion, venous thrombosis, and intracerebral hemorrhage.
– Diagnosis involves neurological examination, CT or MRI scans, Doppler ultrasound, and arteriography.
– Additional studies may be performed to determine the cause of stroke.
– Techniques include ultrasound/doppler study of carotid arteries, ECG, echocardiogram, cerebral angiogram, and blood tests.
– Collateral flow and ischemic cascade play a role in stroke development and progression.

Prevention and Risk Factors:
– Prevention is a crucial public health concern due to the disease burden of stroke.
– Modifiable risk factors for stroke include high blood pressure, atrial fibrillation, high cholesterol levels, diabetes mellitus, and smoking.
– Alcohol use, drug use, lack of physical activity, obesity, and unhealthy diet are also modifiable risk factors.
– High blood pressure accounts for 35–50% of stroke risk.
– Lowering blood pressure can reduce stroke risk by ~40%, with antihypertensive therapy beneficial even for those over 80.

Stroke (Wikipedia)

Stroke (also known as a cerebrovascular accident (CVA) or brain attack) is a medical condition in which poor blood flow to the brain causes cell death. There are two main types of stroke: ischemic, due to lack of blood flow, and hemorrhagic, due to bleeding. Both cause parts of the brain to stop functioning properly.

Stroke
Other namesCerebrovascular accident (CVA), cerebrovascular insult (CVI), brain attack
CT scan of the brain showing a prior right-sided ischemic stroke from blockage of an artery. Changes on a CT may not be visible early on.
SpecialtyNeurology, stroke medicine
SymptomsInability to move or feel on one side of the body, problems understanding or speaking, dizziness, loss of vision to one side
ComplicationsPersistent vegetative state
CausesIschemic (blockage) and hemorrhagic (bleeding)
Risk factorsAge, high blood pressure, tobacco smoking, obesity, high blood cholesterol, diabetes mellitus, previous TIA, end-stage kidney disease, atrial fibrillation
Diagnostic methodBased on symptoms with medical imaging typically used to rule out bleeding
Differential diagnosisLow blood sugar
TreatmentBased on the type
PrognosisAverage life expectancy 1 year
Frequency42.4 million (2015)
Deaths6.3 million (2015)

Signs and symptoms of stroke may include an inability to move or feel on one side of the body, problems understanding or speaking, dizziness, or loss of vision to one side. Signs and symptoms often appear soon after the stroke has occurred. If symptoms last less than one or two hours, the stroke is a transient ischemic attack (TIA), also called a mini-stroke. Hemorrhagic stroke may also be associated with a severe headache. The symptoms of stroke can be permanent. Long-term complications may include pneumonia and loss of bladder control.

The biggest risk factor for stroke is high blood pressure. Other risk factors include high blood cholesterol, tobacco smoking, obesity, diabetes mellitus, a previous TIA, end-stage kidney disease, and atrial fibrillation. Ischemic stroke is typically caused by blockage of a blood vessel, though there are also less common causes. Hemorrhagic stroke is caused by either bleeding directly into the brain or into the space between the brain's membranes. Bleeding may occur due to a ruptured brain aneurysm. Diagnosis is typically based on a physical exam and supported by medical imaging such as a CT scan or MRI scan. A CT scan can rule out bleeding, but may not necessarily rule out ischemia, which early on typically does not show up on a CT scan. Other tests such as an electrocardiogram (ECG) and blood tests are done to determine risk factors and rule out other possible causes. Low blood sugar may cause similar symptoms.

Prevention includes decreasing risk factors, surgery to open up the arteries to the brain in those with problematic carotid narrowing, and warfarin in people with atrial fibrillation. Aspirin or statins may be recommended by physicians for prevention. Stroke is a medical emergency. Ischemic strokes, if detected within three to four-and-a-half hours, may be treatable with medication that can break down the clot, while hemorrhagic strokes sometimes benefit from surgery. Treatment to attempt recovery of lost function is called stroke rehabilitation, and ideally takes place in a stroke unit; however, these are not available in much of the world.

In 2023, 15 million people worldwide had a stroke. In 2015, there were about 42.4 million people who had previously had stroke and were still alive. Between 1990 and 2010 the annual incidence of stroke decreased by approximately 10% in the developed world, but increased by 10% in the developing world. In 2015, stroke was the second most frequent cause of death after coronary artery disease, accounting for 6.3 million deaths (11% of the total). About 3.0 million deaths resulted from ischemic stroke while 3.3 million deaths resulted from hemorrhagic stroke. About half of people who have had stroke live less than one year. Overall, two thirds of cases of stroke occurred in those over 65 years old.

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