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| __NOTOC__ | | __NOTOC__ |
| {{Stroke}} | | {{Stroke}} |
| {{CMG}} {{AE}} {{AA}}; {{TarekNafee}}; {{SaraM}}
| | '''For patient information, click [[Stroke (patient information)|here]]''' |
| ==Overview==
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| Stroke is the rapidly developing loss of brain functions due to a disturbance in the blood vessels supplying blood to the brain. This can be due to [[ischemia]] (lack of blood supply) caused by [[thrombosis]] or [[embolism]], or due to a [[hemorrhage]].<ref>{{cite book |author=Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Robbins, Stanley L.; Abbas, Abul K. |title=Robbins and Cotran pathologic basis of disease |publisher=Elsevier Saunders |location=St. Louis, Mo |year=2005 |pages= |isbn=0-7216-0187-1}}</ref>
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| Stroke is a [[medical emergency]] and can cause permanent neurological damage, complications and death if not promptly diagnosed and treated. It is the third leading cause of [[death]] and the leading cause of adult disability in the United States and Europe. It is predicted that stroke will soon become the leading cause of death worldwide.<ref name="feigin2005">{{cite journal |author=Feigin VL |title=Stroke epidemiology in the developing world |journal=Lancet |volume=365 |issue=9478 |pages=2160–1 |year=2005 |pmid=15978910 |doi=10.1016/S0140-6736(05)66755-4}}</ref> [[World Health Organization|WHO]] defines stroke as, a "neurological deficit of cerebrovascular cause that persists beyond 24 hours or is interrupted by death within 24 hours".
| | {{CMG}}; {{AE}} {{MHP}} |
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| Risk factors for stroke include [[Old age|advanced age]], [[hypertension]] (high blood pressure), previous stroke or TIA ([[transient ischaemic attack]]), [[diabetes mellitus]], [[Hypercholesterolemia|high cholesterol]], [[cigarette smoking]], [[atrial fibrillation]], [[migraine]]<ref>[http://headaches.about.com/od/migrainediseas1/a/mx_stroke_risk.htm headaches.about.com]</ref> with aura, and [[thrombophilia]]. In clinical practice, blood pressure is the most important modifiable [[risk factor]] of stroke; however many other risk factors, such as cigarette smoking cessation and treatment of atrial fibrillation with anticoagulant drugs, are important. Treatment of ischemic stroke is occasionally with [[thrombolysis]] ("clot buster"), but usually with supportive care ([[physiotherapy]] and [[occupational therapy]]) and secondary prevention with [[antiplatelet drug]]s ([[aspirin]] and often [[dipyridamole]]), blood pressure control, [[statin]]s and [[Anticoagulant|anticoagulation]] (in selected patients).<ref>{{cite journal |author=Hackam DG, Spence JD |title=Combining multiple approaches for the secondary prevention of vascular events after stroke: a quantitative modeling study |journal=Stroke |volume=38 |issue=6 |pages=1881–5 |year=2007 |pmid=17431209 |doi=10.1161/STROKEAHA.106.475525}}</ref> Hemorrhagic stroke is a medical emergency. Rapid diagnosis and management is crucial because early deterioration is common in the first few hours after ICH onset.<ref name="pmid18007267">{{cite journal| author=Moon JS, Janjua N, Ahmed S, Kirmani JF, Harris-Lane P, Jacob M et al.| title=Prehospital neurologic deterioration in patients with intracerebral hemorrhage. | journal=Crit Care Med | year= 2008 | volume= 36 | issue= 1 | pages= 172-5 | pmid=18007267 | doi=10.1097/01.CCM.0000297876.62464.6B | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18007267 }}</ref>
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| ==Causes== | | ==[[Stroke overview|Overview]]== |
| The following table lists causes for stroke.<ref name="pmid17043443">{{cite journal |vauthors=Kishimoto M, Arakawa KC |title=A patient with wegener granulomatosis and intraventricular hemorrhage |journal=J Clin Rheumatol |volume=9 |issue=6 |pages=354–8 |year=2003 |pmid=17043443 |doi=10.1097/01.rhu.0000089967.51779.d7 |url=}}</ref><ref name="pmid7336321">{{cite journal |vauthors=Challa VR, Richards F, Davis CH |title=Intraventricular hemorrhage from pituitary apoplexy |journal=Surg Neurol |volume=16 |issue=5 |pages=360–1 |year=1981 |pmid=7336321 |doi= |url=}}</ref><ref name="pmid18320145">{{cite journal |vauthors=Flint AC, Roebken A, Singh V |title=Primary intraventricular hemorrhage: yield of diagnostic angiography and clinical outcome |journal=Neurocrit Care |volume=8 |issue=3 |pages=330–6 |year=2008 |pmid=18320145 |doi=10.1007/s12028-008-9070-2 |url=}}</ref><ref name="pmid21215656">{{cite journal |vauthors=Fukutake T |title=Cerebral autosomal recessive arteriopathy with subcortical infarcts and leukoencephalopathy (CARASIL): from discovery to gene identification |journal=J Stroke Cerebrovasc Dis |volume=20 |issue=2 |pages=85–93 |year=2011 |pmid=21215656 |doi=10.1016/j.jstrokecerebrovasdis.2010.11.008 |url=}}</ref><ref name="pmid22858729">{{cite journal| author=Meretoja A, Strbian D, Putaala J, Curtze S, Haapaniemi E, Mustanoja S et al.| title=SMASH-U: a proposal for etiologic classification of intracerebral hemorrhage. | journal=Stroke | year= 2012 | volume= 43 | issue= 10 | pages= 2592-7 | pmid=22858729 | doi=10.1161/STROKEAHA.112.661603 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22858729 }} </ref><ref name=Hart> Hart, Robert G., Bradley S. Boop, and David C. Anderson. "Oral anticoagulants and intracranial hemorrhage facts and hypotheses." Stroke 26.8 (1995): 1471-1477.</ref><ref name=Knudsen> Knudsen, Katherine A., et al. "Clinical diagnosis of cerebral amyloid angiopathy: validation of the Boston criteria." Neurology 56.4 (2001): 537-539. </ref><ref name=Lovelock>Lovelock, C. E., A. J. Molyneux, and P. M. Rothwell. "Change in incidence and aetiology of intracerebral haemorrhage in Oxfordshire, UK, between 1981 and 2006: a population-based study." The Lancet Neurology 6.6 (2007): 487-493. </ref><ref name="pmid1117973">{{cite journal| author=Rümke CL| title=Letter: Implications of the statement: No side effects were observed. | journal=N Engl J Med | year= 1975 | volume= 292 | issue= 7 | pages= 372-3 | pmid=1117973 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1117973 }} </ref><ref name="pmid19246695">{{cite journal |vauthors=Hanley DF |title=Intraventricular hemorrhage: severity factor and treatment target in spontaneous intracerebral hemorrhage |journal=Stroke |volume=40 |issue=4 |pages=1533–8 |year=2009 |pmid=19246695 |pmc=2744212 |doi=10.1161/STROKEAHA.108.535419 |url=}}</ref>
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| {| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
| | ==[[Stroke historical perspective|Historical Perspective]]== |
| ! colspan="4" align="center" style="background:#DCDCDC;" |Cause
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| |-
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| ! align="center" style="background:#DCDCDC;" |Disease
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| ! align="center" style="background:#DCDCDC;" |Lethal causes
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| ! align="center" style="background:#DCDCDC;" |Common causes
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| ! align="center" style="background:#DCDCDC;" |Less common causes
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| |-
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| | align="center" style="background:#DCDCDC;" |[[Transient ischemic attack]] (TIA)
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| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Emboli]] from cardiac source (mostly secondary to [[Atrial fibrillation|AF]])
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| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
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| * [[Atherosclerotic plaque]]
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| * [[Thrombosis]]
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| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Arterial dissection]]
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| |-
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| | align="center" style="background:#DCDCDC;" |[[Ischemic stroke]]
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| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
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| * [[Atrial fibrillation]]
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| * [[Eclampsia]]
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| * [[Infective endocarditis]]
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| * [[Myocardial infarction]]
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| * [[Pulmonary embolism]]
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| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
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| * [[Aneurysm]]
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| * [[Arteriovenous malformations]]
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| * [[Atherosclerosis]]
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| * [[Atrial fibrillation]]
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| * [[Embolism]]
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| * [[Hypertension]]
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| * [[Subarachnoid hemorrhage]]
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| * [[Thrombosis]]
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| * [[Transient ischemic attack]]
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| * [[Traumatic brain injury]]
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| * [[Warfarin]]
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| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
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| * [[Takayasu arteritis]]
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| * [[Vasculitis]]
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| * [[Vasoconstriction]]
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|
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| * [[Infective endocarditis]]
| | ==[[Stroke classification|Classification]]== |
| * [[Lacunar infarcts]]
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| * [[Left atrial myxoma]]
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| |-
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| | align="center" style="background:#DCDCDC;" |[[Intracerebral hemorrhage]]
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| | style="padding: 5px 5px; background: #F5F5F5;" align="left" | ---
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
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| * [[Hypertension|Long-standing hypertension]]
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| * [[Cerebral amyloid angiopathy]]
| | ==[[Stroke pathophysiology|Pathophysiology]]== |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
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| * [[Arteriovenous malformation|Arteriovenous malformations (AVMs)]]
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| * [[Aneurysms]]
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| * [[Cocaine]]
| | ==[[Stroke causes|Causes]]== |
| * [[Amphetamines]]
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| * [[Vasculitis]]
| | ==[[Stroke differential diagnosis|Differentiating Stroke from other Diseases]]== |
|
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| * [[Liver disease]]
| | ==[[Stroke epidemiology and demographics|Epidemiology and Demographics]]== |
| * [[Anticoagulant]] medication
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| * [[Thrombolytic therapy]]
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|
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|
| * [[Tumor|Brain tumor]]
| | ==[[Stroke risk factors|Risk Factors]]== |
| * Hemorrhagic transformation of an [[ischemic stroke]]
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| * [[Moyamoya disease]]
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| * [[Tumor|Tumors]]
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|
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|
| * [[Encephalitis]]
| | ==[[Stroke screening|Screening]]== |
| |-
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| | align="center" style="background:#DCDCDC;" |[[Subarachnoid hemorrhage]]
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| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
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| Rupture of an aneurysm
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| * [[Aneurysm|Saccular aneurysms]] (most common cause)
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| * Fusiform [[Aneurysm|aneurysms]]
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| * Mycotic [[Aneurysm|aneurysms]]
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| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
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| Rupture of an aneurysm
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| * [[Aneurysm|Saccular aneurysms]] (most common cause)
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| * Fusiform [[Aneurysm|aneurysms]]
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| * Mycotic [[Aneurysm|aneurysms]]
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| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
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| * [[Arteriovenous malformation]]
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| * [[Dural arteriovenous fistula]]
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| * [[Perimesencephalic nonaneurysmal subarachnoid hemorrhage|Perimesencephalic]]
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| * [[Arterial dissection|Intracranial arterial dissection]]
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| * [[Amyloid angiopathy]]
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| * Cerebral [[venous thrombosis]]
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| * Cerebral [[vasculitis]]
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| * Reversible vasoconstriction syndrome
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| * Cerebral hyperperfusion syndrome after [[carotid endarterectomy]]
| | ==[[Stroke natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
| * Reversible posterior leukoencephalopathy syndrome
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| * Brain or cervical [[Tumor|tumors]]
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| * Illicit drug use ([[cocaine]], [[amphetamines]])
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| |-
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| | align="center" style="background:#DCDCDC;" |[[Subdural hematoma|Subdural hemorrhage]]
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| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |Rupture of bridging vessels
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| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |Trauma (motor vehicle accidents, falls, and assaults)
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| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
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| * Aneurysmal [[subarachnoid hemorrhage]]
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| * [[Arteriovenous malformation]]
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| * [[Meningioma]]
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| * Dural metastases
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| * [[Coagulopathy]]
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| * Neurosurgical procedures
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| * [[Cocaine abuse]]
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| |-
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| | align="center" style="background:#DCDCDC;" |[[Epidural hemorrhage]]
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| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |Rupture of middle meningeal arteries
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| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |Trauma (motor vehicle accidents, falls, and assaults)
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| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| |
| |-
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| | align="center" style="background:#DCDCDC;" |[[Intraparenchymal hemorrhage]]
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| | style="padding: 5px 5px; background: #F5F5F5;" align="left" | ---
| |
| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |Trauma (motor vehicle accidents, falls, and assaults)
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| | style="padding: 5px 5px; background: #F5F5F5;" align="left" | Rupture of an aneurysm
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| * [[Aneurysm|Saccular aneurysms]] (most common cause)
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| * Fusiform [[Aneurysm|aneurysms]]
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| * Mycotic [[Aneurysm|aneurysms]]
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| [[Arteriovenous malformation]]
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| |-
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| | align="center" style="background:#DCDCDC;" |[[Intraventricular hemorrhage]] (IVH)
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| | style="padding: 5px 5px; background: #F5F5F5;" align="left" | ---
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| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
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| * Secondary to [[intracerebral hemorrhage]]
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| * Trauma (motor vehicle accidents, falls, and assaults)
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| * Vascular malformations (usually [[Arteriovenous malformation|arteriovenous malformations]] or [[Arteriovenous fistula|arteriovenous fistulae]])
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| | style="padding: 5px 5px; background: #F5F5F5;" align="left" |
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| * Intraventricular tumors ([[papilloma]], neurocytoma, [[meningioma]], metastases, [[astrocytoma]], [[ependymoma]])
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| * Intraventricular aneurysms
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| * [[Moyamoya disease]]
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| * [[Pituitary apoplexy]]
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| * [[Vasculitis]]
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| |}
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|
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| ==Classification== | | ==Diagnosis== |
| ===Transient ischemic attack===
| | [[Stroke diagnostic study of choice|Diagnostic study of choice]] | [[Stroke history and symptoms|History and Symptoms]] | [[Stroke physical examination|Physical Examination]] | [[Stroke laboratory findings|Laboratory Findings]] | [[Stroke electrocardiogram|Electrocardiogram]] | [[Stroke x ray|X-Ray Findings]] | [[Stroke echocardiography and ultrasound|Echocardiography and Ultrasound]] | [[Stroke CT scan|CT-Scan Findings]] | [[Stroke MRI|MRI Findings]] | [[Stroke other imaging findings|Other Imaging Findings]] | [[Stroke other diagnostic studies|Other Diagnostic Studies]] |
| *A transient ischemic attack is caused by the temporary disturbance of blood supply to a restricted area of the brain, resulting in brief neurologic dysfunction that usually persists for less than 24 hours.
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| ===Stroke===
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| {{familytree/start |summary=Stroke}}
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| {{familytree | | | | | | | | | | | | | | | | A01 |A01='''Stroke'''}}
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| {{familytree | | | | | |,|-|-|-|-|-|-|-|-|-|-|^|-|-|-|-|-|-|-|-|-|.| | | }}
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| {{familytree | | | | | B01 | | | | | | | | | | | | | | | | | | | B02 | | |B01=[[Ischemic stroke|Ischemic]]|B02=[[Hemorrhagic stroke|Hemorrhagic]]}}
| |
| {{familytree | |,|-|-|-|+|-|-|-|.| | | |,|-|-|-|-|-|-|-|-|-|-|-|-|^|-|-|-|-|-|-|-|.|}}
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| {{familytree | D01 | | D02 | | D03 | | D04 | | | | | | | | | | | | | | | | | | | D05 |D01=Large vessel thromboembolism|D02=Cardioembolic|D03=Small vessel or Lacunar infarct|D04=Intra-axial|D05=Extra-axial}}
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| {{familytree | | | | | | | | | | | | | |!| | | | | | | | | | | | | | | | | | | | |!|}}
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| {{familytree | | | | | | | | | | | | | |)|-|-|-|-|.|,|-|-|-|-|-|-|-|-|v|-|-|-|-|-|^|-|-|-|-|.}}
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| {{familytree | | | | | | | | | | | | | E01 | | | E02 | | | | | | | | E03 | | | | | | | | | E04 |E01=[[Intracerebral hemorrhage|Intracerebral]] (ICH)|E02=[[Subarachnoid hemorrhage]] (SAH)|E03=[[Subdural hematoma|Subdural Hemorrhage]]|E04=[[Epidural hematoma|Epidural Hemorrhage]]}}
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| {{familytree | | | | | | | | | | | | | |!| | | | | | | | |}}
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| {{familytree | | | | | | |,|-|-|-|-|-|-|+|-|-|-|-|-|-|.| }}
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| {{familytree | | | | | | F01 | | | | | F02 | | | | | F03 |F01=[[Intraparenchymal hemorrhage|Intraparenchymal hemorrhage]]|F02=[[Intraventricular hemorrhage]] (IVH)|F03=Cerebral microbleeds
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| }}
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| {{familytree/end}}
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| ==Differential diagnosis==
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| {|
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| |-style="background: #4479BA; color: #FFFFFF; text-align: center;"
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| ! rowspan="2" |<small>Diseases</small>
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| ! colspan="4" |<small>Symptoms
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| ! colspan="5" |<small>Physical Examination</small>
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| ! rowspan="2" |<small>Past medical history</small>
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| ! colspan="3" |<small>Diagnostic tests</small>
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| ! rowspan="2" |<small>Other Findings</small>
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| |- style="background: #4479BA; color: #FFFFFF; text-align: center;" | |
| !<small>Headache</small>
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| !↓<small>LOC</small>
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| !<small>Motor weakness</small>
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| !<small>Abnormal sensory</small>
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| !<small>Motor Deficit</small>
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| !<small>Sensory deficit</small>
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| !<small>Speech difficulty</small>
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| !<small>Gait abnormality</small>
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| !<small>Cranial nerves</small>
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| !<small>CT /MRI</small>
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| !<small>CSF Findings</small>
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| !<small>Gold standard test</small>
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| |-
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| |style="background: #DCDCDC; padding: 5px; text-align: center;" | Brain tumour<ref name="pmid10582668">{{cite journal| author=Morgenstern LB, Frankowski RF| title=Brain tumor masquerading as stroke. | journal=J Neurooncol | year= 1999 | volume= 44 | issue= 1 | pages= 47-52 | pmid=10582668 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10582668 }} </ref>
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| |style="background: #F5F5F5; padding: 5px text-align:center" |✔
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| |style="background: #F5F5F5; padding: 5px text-align:center" | -
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| |style="background: #F5F5F5; padding: 5px text-align:center" | -
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| |style="background: #F5F5F5; padding: 5px text-align:center" | -
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| |style="background: #F5F5F5; padding: 5px text-align:center" |✔
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| |style="background: #F5F5F5; padding: 5px text-align:center" |✔
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| |style="background: #F5F5F5; padding: 5px text-align:center" |✔
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
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| |style="background: #F5F5F5; padding: 5px text-align:center" |✔
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| |style="background: #F5F5F5; padding: 5px text-align:center" |[[Weight loss]], [[fatigue]]
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| |style="background: #F5F5F5; padding: 5px; text-align:center"|✔
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| |style="background: #F5F5F5; padding: 5px text-align:center" |Cancer cells<ref name="pmid21371327">{{cite journal| author=Weston CL, Glantz MJ, Connor JR| title=Detection of cancer cells in the cerebrospinal fluid: current methods and future directions. | journal=Fluids Barriers CNS | year= 2011 | volume= 8 | issue= 1 | pages= 14 | pmid=21371327 | doi=10.1186/2045-8118-8-14 | pmc=3059292 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21371327 }}</ref> | |
| |style="background: #F5F5F5; padding: 5px;" |MRI
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| |style="background: #F5F5F5; padding: 5px;" |[[Cachexia]], gradual progression of symptoms
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| |-
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| |style="background: #DCDCDC; padding: 5px; text-align: center;" |Hemorrhagic stroke
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| |style="background: #F5F5F5; padding: 5px text-align:center" |✔
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| |style="background: #F5F5F5; padding: 5px text-align:center" |✔
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| |style="background: #F5F5F5; padding: 5px text-align:center" |✔
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| |style="background: #F5F5F5; padding: 5px text-align:center" |✔
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| |style="background: #F5F5F5; padding: 5px text-align:center" |✔
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| |style="background: #F5F5F5; padding: 5px text-align:center" |✔
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| |style="background: #F5F5F5; padding: 5px text-align:center" |✔
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| |style="background: #F5F5F5; padding: 5px text-align:center" |✔
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| |style="background: #F5F5F5; padding: 5px text-align:center" | -
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| |style="background: #F5F5F5; padding: 5px text-align:center" |[[Hypertension]]
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| |style="background: #F5F5F5; padding: 5px; text-align:center" |✔
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| | style="background: #F5F5F5; padding: 5px;" | -
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| |style="background: #F5F5F5; padding: 5px;" |CT scan without contrast<ref name="pmid21694755">{{cite journal| author=Birenbaum D, Bancroft LW, Felsberg GJ| title=Imaging in acute stroke. | journal=West J Emerg Med | year= 2011 | volume= 12 | issue= 1 | pages= 67-76 | pmid=21694755 | doi= | pmc=3088377 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21694755 }}</ref><ref name="pmid21807345">{{cite journal| author=DeLaPaz RL, Wippold FJ, Cornelius RS, Amin-Hanjani S, Angtuaco EJ, Broderick DF et al.| title=ACR Appropriateness Criteria® on cerebrovascular disease. | journal=J Am Coll Radiol | year= 2011 | volume= 8 | issue= 8 | pages= 532-8 | pmid=21807345 | doi=10.1016/j.jacr.2011.05.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21807345 }}</ref>
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| |style="background: #F5F5F5; padding: 5px;" |Neck stiffness
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| |-
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| |style="background: #DCDCDC; padding: 5px; text-align: center;" | Subdural hemorrhage
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| |style="background: #F5F5F5; padding: 5px text-align:center" |✔
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| |style="background: #F5F5F5; padding: 5px text-align:center" |✔
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| |style="background: #F5F5F5; padding: 5px text-align:center" |✔
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| |style="background: #F5F5F5; padding: 5px text-align:center" |✔
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |✔
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |✔
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |[[Trauma]], fall
| |
| |style="background: #F5F5F5; padding: 5px; text-align:center" |✔
| |
| |style="background: #F5F5F5; padding: 5px;" |Xanthochromia<ref name="pmid1198628">{{cite journal| author=Lee MC, Heaney LM, Jacobson RL, Klassen AC| title=Cerebrospinal fluid in cerebral hemorrhage and infarction. | journal=Stroke | year= 1975 | volume= 6 | issue= 6 | pages= 638-41 | pmid=1198628 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1198628 }}</ref>
| |
| |style="background: #F5F5F5; padding: 5px;" |CT scan without contrast<ref name="pmid21694755">{{cite journal| author=Birenbaum D, Bancroft LW, Felsberg GJ| title=Imaging in acute stroke. | journal=West J Emerg Med | year= 2011 | volume= 12 | issue= 1 | pages= 67-76 | pmid=21694755 | doi= | pmc=3088377 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21694755 }}</ref><ref name="pmid21807345">{{cite journal| author=DeLaPaz RL, Wippold FJ, Cornelius RS, Amin-Hanjani S, Angtuaco EJ, Broderick DF et al.| title=ACR Appropriateness Criteria® on cerebrovascular disease. | journal=J Am Coll Radiol | year= 2011 | volume= 8 | issue= 8 | pages= 532-8 | pmid=21807345 | doi=10.1016/j.jacr.2011.05.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21807345 }}</ref>
| |
| |style="background: #F5F5F5; padding: 5px;" |Confusion, dizziness, nausea, vomiting
| |
| |-
| |
| |style="background: #DCDCDC; padding: 5px; text-align: center;" |Neurosyphilis<ref name="pmid22482824">{{cite journal| author=Liu LL, Zheng WH, Tong ML, Liu GL, Zhang HL, Fu ZG et al.| title=Ischemic stroke as a primary symptom of neurosyphilis among HIV-negative emergency patients. | journal=J Neurol Sci | year= 2012 | volume= 317 | issue= 1-2 | pages= 35-9 | pmid=22482824 | doi=10.1016/j.jns.2012.03.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22482824 }} </ref><ref name="pmid24365430">{{cite journal |vauthors=Berger JR, Dean D |title=Neurosyphilis |journal=Handb Clin Neurol |volume=121 |issue= |pages=1461–72 |year=2014 |pmid=24365430 |doi=10.1016/B978-0-7020-4088-7.00098-5 |url=}}</ref>
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |✔
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |✔
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |✔
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |✔
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |✔
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |✔
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |[[Sexually transmitted disease|STI]]<nowiki/>s
| |
| |style="background: #F5F5F5; padding: 5px; text-align:center" |✔ | |
| |style="background: #F5F5F5; padding: 5px;" |'''↑''' [[Leukocytes]] and [[protein]]
| |
| |style="background: #F5F5F5; padding: 5px;" |CSF [[VDRL]]-specifc | |
| CSF FTA-Ab -sensitive<ref name="pmid22421697">{{cite journal| author=Ho EL, Marra CM| title=Treponemal tests for neurosyphilis--less accurate than what we thought? | journal=Sex Transm Dis | year= 2012 | volume= 39 | issue= 4 | pages= 298-9 | pmid=22421697 | doi=10.1097/OLQ.0b013e31824ee574 | pmc=3746559 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22421697 }}</ref>
| |
| |style="background: #F5F5F5; padding: 5px;" |Blindness, confusion, [[depression]],
| |
| | |
| Abnormal [[gait]]
| |
| |-
| |
| |style="background: #DCDCDC; padding: 5px; text-align: center;" |Complex or atypical migraine
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |✔
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |✔
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |✔
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |✔
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |Family history of [[migraine]]
| |
| | style="background: #F5F5F5; padding: 5px;" | -
| |
| | style="background: #F5F5F5; padding: 5px;" | -
| |
| |style="background: #F5F5F5; padding: 5px;" |Clinical assesment
| |
| |style="background: #F5F5F5; padding: 5px;" |Presence of aura, [[nausea]], [[vomiting]]
| |
| |-
| |
| |style="background: #DCDCDC; padding: 5px; text-align: center;" |Hypertensive encephalopathy
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |✔
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |✔
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |✔
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |✔
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |[[Hypertension]]
| |
| |style="background: #F5F5F5; padding: 5px;" |✔
| |
| |style="background: #F5F5F5; padding: 5px;" | -
| |
| |style="background: #F5F5F5; padding: 5px;" |Clinical assesment
| |
| |style="background: #F5F5F5; padding: 5px;" |Delirium, cortical blindness, cerebral edema, seizure
| |
| |-
| |
| |style="background: #DCDCDC; padding: 5px; text-align: center;" |Wernicke’s encephalopathy
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |✔
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |✔
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |✔
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |✔
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |✔
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |History of alcohal abuse
| |
| | style="background: #F5F5F5; padding: 5px;" | -
| |
| | style="background: #F5F5F5; padding: 5px;" | -
| |
| | style="background: #F5F5F5; padding: 5px;" |Clinical assesment and lab findings
| |
| |style="background: #F5F5F5; padding: 5px;" |Ophthalmoplegia, confusion | |
| |-
| |
| |style="background: #DCDCDC; padding: 5px; text-align: center;" |CNS abscess
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |✔
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |✔
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |✔
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |✔
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |✔
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |History of drug abuse, [[endocarditis]], [[immunosupression]]
| |
| |style="background: #F5F5F5; padding: 5px;" |✔
| |
| |style="background: #F5F5F5; padding: 5px;" |'''↑''' leukocytes, '''↓''' glucose and '''↑''' protien
| |
| |style="background: #F5F5F5; padding: 5px;" |MRI is more sensitive and specific
| |
| |style="background: #F5F5F5; padding: 5px;" |High grade fever, fatigue,nausea, vomiting
| |
| |-
| |
| |style="background: #DCDCDC; padding: 5px; text-align: center;" |Drug toxicity
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |✔
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |✔
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |✔
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |✔
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |✔
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| | style="background: #F5F5F5; padding: 5px;" | -
| |
| | style="background: #F5F5F5; padding: 5px;" | -
| |
| | style="background: #F5F5F5; padding: 5px;" |Drug screen test
| |
| |style="background: #F5F5F5; padding: 5px;" |Lithium, Sedatives, phenytoin, carbamazepine
| |
| |-
| |
| |style="background: #DCDCDC; padding: 5px; text-align: center;" |Conversion disorder
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |✔
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |✔
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |✔
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |✔
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |✔
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |✔
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |✔
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |✔
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |History of emotional stress
| |
| | style="background: #F5F5F5; padding: 5px;" | -
| |
| | style="background: #F5F5F5; padding: 5px;" | -
| |
| |style="background: #F5F5F5; padding: 5px;" |Diagnosis of exclusion
| |
| |style="background: #F5F5F5; padding: 5px;" |[[Tremor|Tremors]], [[blindness]], difficulty [[swallowing]]
| |
| |-
| |
| |style="background: #DCDCDC; padding: 5px; text-align: center;" |Metabolic disturbances (electrolyte imbalance, hypoglycemia)
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |✔
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |✔
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |✔
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |✔
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |✔
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |✔
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| | style="background: #F5F5F5; padding: 5px;" | -
| |
| | style="background: #F5F5F5; padding: 5px;" |[[Hypoglycemia]], [[Hyponatremia|hypo]] and [[hypernatremia]], [[Hypokalemia|hypo]] and [[hyperkalemia]]
| |
| |style="background: #F5F5F5; padding: 5px;" |Depends on the cause
| |
| | style="background: #F5F5F5; padding: 5px;" |Confusion, seizures, [[Palpitation|palpitations]], sweating, [[dizziness]], low serum, glucose
| |
| |-
| |
| | style="background: #DCDCDC; padding: 5px; text-align: center;" |Meningitis or encephalitis
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |✔
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |✔
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |✔
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |History of fever and malaise
| |
| | style="background: #F5F5F5; padding: 5px;" | -
| |
| | style="background: #F5F5F5; padding: 5px; text-align:center" |'''↑''' Leukocytes,
| |
|
| |
|
| '''↑''' Protein
| | ==Treatment== |
| | | [[Stroke medical therapy|Medical Therapy]] | [[Stroke interventions|Interventions]] | [[Stroke surgery|Surgery]] | [[Stroke primary prevention|Primary Prevention]] | [[Stroke secondary prevention|Secondary Prevention]] | [[Stroke cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Stroke future or investigational therapies|Future or Investigational Therapies]] |
| ↓ Glucose
| |
| | style="background: #F5F5F5; padding: 5px;" |[[CSF analysis]]<ref name="pmid19398286">{{cite journal| author=Carbonnelle E| title=[Laboratory diagnosis of bacterial meningitis: usefulness of various tests for the determination of the etiological agent]. | journal=Med Mal Infect | year= 2009 | volume= 39 | issue= 7-8 | pages= 581-605 | pmid=19398286 | doi=10.1016/j.medmal.2009.02.017 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19398286 }}</ref>
| |
| | style="background: #F5F5F5; padding: 5px;" |[[Fever]], neck
| |
| rigidity
| |
| |-
| |
| | style="background: #DCDCDC; padding: 5px; text-align: center;" |Multiple sclerosis exacerbation
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |✔
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |✔
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |✔
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |✔
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |✔
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |✔
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |History of relapses and remissions
| |
| | style="background: #F5F5F5; padding: 5px; text-align:center" |✔
| |
| | style="background: #F5F5F5; padding: 5px; text-align:center" |'''↑''' CSF IgG levels
| |
| (monoclonal bands)
| |
| | style="background: #F5F5F5; padding: 5px;" |Clinical assesment and [[MRI]] <ref name="pmid8274111">{{cite journal| author=Giang DW, Grow VM, Mooney C, Mushlin AI, Goodman AD, Mattson DH et al.| title=Clinical diagnosis of multiple sclerosis. The impact of magnetic resonance imaging and ancillary testing. Rochester-Toronto Magnetic Resonance Study Group. | journal=Arch Neurol | year= 1994 | volume= 51 | issue= 1 | pages= 61-6 | pmid=8274111 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8274111 }}</ref>
| |
| | style="background: #F5F5F5; padding: 5px;" |Blurry vision, [[urinary incontinence]], [[fatigue]]
| |
| |-
| |
| | style="background: #DCDCDC; padding: 5px; text-align: center;" |Seizure | |
| |style="background: #F5F5F5; padding: 5px text-align:center" |✔
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |✔
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |✔
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |✔
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |✔
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |Previous history of seizures
| |
| | style="background: #F5F5F5; padding: 5px;" | -
| |
| | style="background: #F5F5F5; padding: 5px;" |Mass lesion
| |
| | style="background: #F5F5F5; padding: 5px;" |Clinical assesment and [[EEG]] <ref name="pmid11385043">{{cite journal| author=Manford M| title=Assessment and investigation of possible epileptic seizures. | journal=J Neurol Neurosurg Psychiatry | year= 2001 | volume= 70 Suppl 2 | issue= | pages= II3-8 | pmid=11385043 | doi= | pmc=1765557 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11385043 }}</ref>
| |
| | style="background: #F5F5F5; padding: 5px;" |Confusion, apathy, irritability,
| |
| |}
| |
| | |
| ==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%.<ref name="pmid26673558">{{cite journal| author=Writing Group Members. Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ et al.| title=Heart Disease and Stroke Statistics-2016 Update: A Report From the American Heart Association. | journal=Circulation | year= 2016 | volume= 133 | issue= 4 | pages= e38-360 | pmid=26673558 | doi=10.1161/CIR.0000000000000350 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26673558 }} </ref>
| |
| *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<ref name="pmid26673558">{{cite journal| author=Writing Group Members. Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ et al.| title=Heart Disease and Stroke Statistics-2016 Update: A Report From the American Heart Association. | journal=Circulation | year= 2016 | volume= 133 | issue= 4 | pages= e38-360 | pmid=26673558 | doi=10.1161/CIR.0000000000000350 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26673558 }} </ref>
| |
| *The incidence of new (610, 000) or recurrent stroke (185, 000) is estimated to be 795000 people annually or 250 cases per 100, 000.<ref name="pmid26673558">{{cite journal| author=Writing Group Members. Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ et al.| title=Heart Disease and Stroke Statistics-2016 Update: A Report From the American Heart Association. | journal=Circulation | year= 2016 | volume= 133 | issue= 4 | pages= e38-360 | pmid=26673558 | doi=10.1161/CIR.0000000000000350 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26673558 }} </ref>
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| *It is estimated that one incidence of stroke happens every 4 sec with death occuring every 4 min.<ref name="pmid26673558">{{cite journal| author=Writing Group Members. Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ et al.| title=Heart Disease and Stroke Statistics-2016 Update: A Report From the American Heart Association. | journal=Circulation | year= 2016 | volume= 133 | issue= 4 | pages= e38-360 | pmid=26673558 | doi=10.1161/CIR.0000000000000350 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26673558 }} </ref>
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| *About 87% of all strokes are ischemic strokes<ref name=CDCstroke> http://www.cdc.gov/stroke/facts.htm Accessed on November 3, 2016</ref>
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| *Stroke costs the United States an estimated $34 billion each year<ref name=CDCstroke> http://www.cdc.gov/stroke/facts.htm Accessed on November 3, 2016</ref>
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| ===Worldwide===
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| *According to WHO, the incidence of stroke is estimated to be 15 million people annually, worldwide.<ref name=WHOSTROKE>Mackay, Judith, et al. The atlas of heart disease and stroke. World Health Organization, 2004 Accessed on November 3 2016</ref>.
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| *Out of these, 5 million die and 5 million are left permanently disbaled.<ref name=WHOSTROKE>Mackay, Judith, et al. The atlas of heart disease and stroke. World Health Organization, 2004 Accessed on November 3 2016</ref>.
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| ===Age===
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| *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. <ref name=CDCstroke> http://www.cdc.gov/stroke/facts.htm Accessed on November 3, 2016</ref>
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| *According to WHO, stroke also occurs in about 8% of children with sickle cell disease.<ref name=WHOSTROKE>Mackay, Judith, et al. The atlas of heart disease and stroke. World Health Organization, 2004 Accessed on November 3 2016</ref>.
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| *In 2009, 34% of people hospitalized for stroke were younger than 65 years<ref name=CDCstroke> http://www.cdc.gov/stroke/facts.htm Accessed on November 3, 2016</ref>
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| *The incidence of stroke in people aged 18 to 50 years is estimated to be approximately 10%. <ref name="pmid26673558">{{cite journal| author=Writing Group Members. Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ et al.| title=Heart Disease and Stroke Statistics-2016 Update: A Report From the American Heart Association. | journal=Circulation | year= 2016 | volume= 133 | issue= 4 | pages= e38-360 | pmid=26673558 | doi=10.1161/CIR.0000000000000350 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26673558 }} </ref>
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| The rate of decline in mortality rates of stroke in different age groups is as follows:<ref name="pmid26673558">{{cite journal| author=Writing Group Members. Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ et al.| title=Heart Disease and Stroke Statistics-2016 Update: A Report From the American Heart Association. | journal=Circulation | year= 2016 | volume= 133 | issue= 4 | pages= e38-360 | pmid=26673558 | doi=10.1161/CIR.0000000000000350 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26673558 }} </ref>
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| *>65 years of age: from 534.1 to 245.2 per 100,000
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| *45-65 years of age: from 43.5 to 20.2 per 100,000
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| *18 to 44 years of age: from from 3.7 to 2.0 per 100,000
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| ===Gender===
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| There is increased incidence of stroke in men as compared to women.
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| ===Race===
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| *The risk of incidence of first stroke is twice in african american population as compared to whites with increased mortality rates.<ref name=CDCstroke> http://www.cdc.gov/stroke/facts.htm Accessed on November 3, 2016</ref>
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| *Hispanics’ risk for stroke falls between that of whites and blacks <ref name=CDCstroke> http://www.cdc.gov/stroke/facts.htm Accessed on November 3, 2016</ref>
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| ===Geographical distribution===
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| *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.
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| *In USA, the highest death rates from stroke are in the southeastern United States.<ref name=CDCstroke> http://www.cdc.gov/stroke/facts.htm Accessed on November 3, 2016</ref>
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| ==Diagnosis==
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| *Diagnosis is based on history of symptoms development, physical examination and imaging findings.
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| *CT scan and magnetic resonance imaging (MRI) are both reasonable for initial evaluation.
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| *CT scan without contrast is the initial test performed to diagnose ischemic stroke and rule out hemorrhagic stroke.
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| *CT is very sensitive for identifying acute hemorrhage and is considered the gold standard.
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| *Gradient echo and T2 susceptibility-weighted MRI are as sensitive as CT for detection of acute hemorrhage and are more sensitive for identification of prior hemorrhage.
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| *MR diffusion weighted imaging is the most sensitive and specific test for diagnosing ischemic stroke and may help detect presence of infarction in few minutes of onset of symptoms. It may also help differentiate viable tissue from infarct area if combined with MR perfusion. For diagnosing ischemic stroke in the emergency setting, MRI scan has the sensitivity and specificity of 83% and 98% respectively.<ref name="pmid17258669">{{cite journal |vauthors=Chalela JA, Kidwell CS, Nentwich LM, Luby M, Butman JA, Demchuk AM, Hill MD, Patronas N, Latour L, Warach S |title=Magnetic resonance imaging and computed tomography in emergency assessment of patients with suspected acute stroke: a prospective comparison |journal=Lancet |volume=369 |issue=9558 |pages=293–8 |year=2007 |pmid=17258669 |pmc=1859855 |doi=10.1016/S0140-6736(07)60151-2 |url=}}</ref>
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| *MRI scan is superior to CT scan for being more sensitive and specific in detection of [[Lacunar infarcts|lacunar]] and posterior fossa infarcts, differentiation between acute and chronic stroke and detection of microbleeds. Another additional advantage is absence of [[Ionizing radiation|ionising radiation]] compared to CT scan. Some of the disadvantages of [[MRI scan]] may include lack of availability in acute setting, higher cost, inability to use it in patients with metallic implants. MRI with contrast cannot be used in patients with [[renal failure]].<ref name="pmid23907247">{{cite journal| author=Wintermark M, Sanelli PC, Albers GW, Bello J, Derdeyn C, Hetts SW et al.| title=Imaging recommendations for acute stroke and transient ischemic attack patients: A joint statement by the American Society of Neuroradiology, the American College of Radiology, and the Society of NeuroInterventional Surgery. | journal=AJNR Am J Neuroradiol | year= 2013 | volume= 34 | issue= 11 | pages= E117-27 | pmid=23907247 | doi=10.3174/ajnr.A3690 | pmc=4072500 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23907247 }} </ref><ref name="pmid20974371">{{cite journal| author=Leiva-Salinas C, Wintermark M| title=Imaging of acute ischemic stroke. | journal=Neuroimaging Clin N Am | year= 2010 | volume= 20 | issue= 4 | pages= 455-68 | pmid=20974371 | doi=10.1016/j.nic.2010.07.002 | pmc=2965616 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20974371 }} </ref>
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| ==References== | | ==Case Studies== |
| {{reflist|2}}
| | [[Stroke case study one|Case #1]] |
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