Stroke resident survival guide
From Wikidoc - Reading time: 3 min
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Moises Romo M.D., Ayokunle Olubaniyi, M.B,B.S [2]
Synonyms and Keywords: stroke management, stroke workup, stroke approach, approach to stroke, stroke treatment
Overview[edit | edit source]
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.
Causes[edit | edit source]
Life Threatening Causes[edit | edit source]
Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated.
- All strokes can potentialy lead to death or permanent disability within 24 hours if left untreated.
Common Causes[edit | edit source]
- Aneurysms
- Atrial fibrillation
- Eclampsia
- Infective endocarditis
- Myocardial infarction
- Pulmonary embolism
- Arteriovenous malformations
- Atherosclerosis
- Atrial fibrillation
- Embolism
- Hypertension
- Subarachnoid hemorrhage
- Thrombosis
- Transient ischemic attack
- Traumatic brain injury
- Warfarin
Diagnosis[edit | edit source]
Shown below is an algorithm summarizing the diagnosis of stroke according to the American Academy of Neurology guidelines:
Initial Evaluation[edit | edit source]
Characterize the symptoms: ❑ Sudden weakness/paralysis - face, arm or leg ❑ Speech/visual difficulties ❑ Altered/loss of consciousness ❑ Sudden severe headache | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Examine the patient: ❑ Head - trauma, tongue laceration ❑ Neck - bruits, pulses ❑ Limbs - pulses ❑ Heart - murmurs ❑ Skin - color changes ❑ Neurological exam, NIHSS | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Consider alternative diagnosis: ❑ Psychogenic ❑ Seizures ❑ Hypoglycemia ❑ Complicated migraine ❑ Hypertensive encephalopathy ❑ Wernicke encephalopathy ❑ Brain abscess ❑ Brain tumor ❑ Drug toxicity | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
❑ Check vitals ❑ Stabilize ABC ❑ Brief Hx ❑ Activate stroke team ❑ Stat fingerstick ❑ Labs - CBC, serum electrolytes, urea, creatinine, troponin, EKG, PT/PTT/INR ❑ NPO ❑ Obtain stroke protocol | Other labs in selected patients: ❑ Liver function tests ❑ Toxicology screen (drug abuse, stroke in the young) ❑ Blood alcohol level ❑ Arterial blood gas (hypoxia) ❑ Chest radiograph (lung disease) ❑ EEG (seizures) ❑ Lumbar puncture (SAH) ❑ Sepsis profile - urinalysis, blood culture (if fever is present) ❑ Type and cross match FFP (coagulopathy) ❑ Pregnancy test (in women of child-bearing age) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Non-Contrast Enhanced CT (or MRI) to r/o hemorrhage | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Bleed Negative | Bleed Positive | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Acute Ischemic Stroke | Hemorrhagic Stroke | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Intracerebral Hemorrhage | Subarachnoid Hemorrhage | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Treatment[edit | edit source]
The management of stroke will greatly depend on the type of stroke (if it is either hemorrhagic or ischemic).
- To view the specific treatment of hemorrhagic stroke click here.
- To view the specific treatment of ischemic stroke click here.
Do's[edit | edit source]
- Perform tertiary preventive measure to decrease subsecuent episodes, such as using statins and anticoagulants, controling glucose levels and blood pressure.
Don'ts[edit | edit source]
- Do not lower blood pressure in hypertensive patients with ischemic stroke when below
References[edit | edit source]
- ↑ 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)
Original source: https://wikidoc.org/Stroke resident survival guide
Status: article is cached
EncycloReader
is supported by the 
KSF