The printable version is no longer supported and may have rendering errors. Please update your browser bookmarks and please use the default browser print function instead.
Stroke Types
Background
- Vascular injury that reduces CBF to specific region of brain causing neuro impairment
- Accurate determination of last known time when pt was at baseline is essential
Sensory Homonculus - courtesy AnatomyZone.com
- Thrombotic (80% of ischemic CVA)
- Embolic (20% of ischemic CVA)
- Hypoperfusion
- Cardiac failure resulting in systemic hypotension
- Cryptogenic
- Cryptogenic Stroke (CS) is defined as an Ischemic stroke of obscure or unknown origin. Its causes are unknown. It is transitory or reversible.[1]
Clinical Features
Differential Diagnosis
Diagnosis
- Labs
- POC glucose
- CBC
- Chemistry
- Coags
- Troponin
- T&S
- ECG
- In large ICH or stroke, may see deep TWI and prolong QT, occ ST changes
- Head CT (non-contrast)
- In ischemia stroke CT has sensitivity 42%, specificity 91%[3]
- In acute ICH the sensitivity is 95-100%[4]
- The goal of CTH is to identify stroke mimics (ICH, mass lesions, etc .)[5]
- Also consider:
- CTA brain and neck
- To check for large vessel occlusion for potential thrombectomy
- Determine if there is carotid stenosis that warrants endarterectomy urgently
- Pregnancy test
- CXR (if infection suspected)
- UA (if infection suspected)
- Utox (if ingestion suspected)
MR Imaging (for Rule-Out CVA or TIA)
- MRI Brain with DWI, ADC (without contrast) AND
- Cervical vascular imaging (ACEP Level B in patients with high short-term risk for stroke):[6]
- MRA brain (without contrast) AND
- MRA neck (without contrast)
- May instead use Carotid CTA or US (Carotid US slightly less sensitive than MRA)[7] (ACEP Level C)
Management
Disposition
See Also
External Links
References
- ↑ [Finsterer J. Management of cryptogenic stroke. Acta Neurol Belg. 2010 Jun;110(2):135-47. PMID: 20873443].
- ↑ Itoh Y, Yamada M, Hayakawa M, Otomo E, Miyatake T. Cerebral amyloid angiopathy: a significant cause of cerebellar as well as lobar cerebral hemorrhage in the elderly. J Neurol Sci. 1993 Jun;116(2):135-41.
- ↑ Mullins ME, Schaefer PW, Sorensen AG, Halpern EF, Ay H, He J, Koroshetz WJ, Gonzalez RG. CT and conventional and diffusion-weighted MR imaging in acute stroke: study in 691 patients at presentation to the emergency department. Radiology. 2002 Aug;224(2):353-60.
- ↑ Suarez JI, Tarr RW, Selman WR. Aneurysmal subarachnoid hemorrhage. N Engl J Med. 2006; 354(4):387–396.
- ↑ Douglas VC, Johnston CM, Elkins J, et al. Head computed tomography findings predict short-term stroke risk after transient ischemic attack. Stroke. 2003;34:2894-2899.
- ↑ ACEP Clinical Policy: Suspected Transient Ischemic Attack full text
- ↑ Nederkoorn PJ, Mali WP, Eikelboom BC, et al. Preoperative diagnosis of carotid artery stenosis. Accuracy of noninvasive testing. Stroke. 2002;33:2003-2008.
