STROKE

Stroke Classification Risk Factors Signs and Symptoms Management –Prehospital –In-hospital

Classification of Stroke Ischemic Stroke (75% “Brain Infarct”) –Occlusive: Thrombosis Embolism –Anterior Circulation Occlusion of carotid artery involve cerebral hemispheres –Posterior Circulation Vertebro-basilar artery distribution involve brainstem or cerebellum

Classification of Stroke Hemorrhagic Stroke –Subarachnoid Aneurysm (most common) Arteriovenous malformation –Intracerebral Hypertension (most common) Amyloid angiopathy in elderly

Stroke – Risk Factors Modifiable –Hypertension –Tobacco use –Hx of TIA’s –Heart Disease –Diabetes Mellitus –Hypercoagulopathy Pregnancy, cancer, etc. –Sickle Cell and increased RBC –Hx of carotid Bruit Unmodifiable –Age –Gender –Race –Previous CVA –Heredity

Stroke – Signs and Symptoms Ischemic –Carotid Circulation Unilateral paralysis (opposite side) Numbness (opposite side) Language disturbance –Aphasia – difficult comprehension, nonsense, difficult reading/writing –Dysarthria – slurred speech, abnormal pronunciation. Visual disturbance (opposite side) Monocular blindness (same side)

Stroke – Signs and Symptoms Ischemic –Vertebrobasilar Circulation Vertigo Visual disturbance –Both eyes simultaneously Diplopia –Ocular palsy – inability to move to one side –Dysconjugate gaze – asynchronous movement Paralysis Numbness Dysarthria Ataxia

Netter; Atlas of Human Anatomy

Stroke – Signs and Symptoms Hemorrhagic –Subarachnoid hemorrhage Sudden severe HA Transient LOC Nausea/Vomiting Neck pain Intolerance of noise/light AMS –Intracerebral hemorrhage Focal sx w/ LOC, N/V

Stroke – Signs and Symptoms Differential Diagnosis of Stroke –Head/Cervical trauma –Meningitis/encephalitis –Hypertensive encephalopathy –Intracranial mass Tumor Sub/epi dural hematoma –Todd’s paralysis –Migraine w/ neuro sx –Metabolic Hyper/hypo glycemia Post arrest ischemia Drug OD