SHM's Clinical Quick Talks-Ischemic Stroke

Pdf Summary

The document provides a comprehensive overview of ischemic stroke, detailing its definition, causes, symptoms, diagnostic algorithm, management, and rehabilitation. <br /><br />**Definition and Symptoms:**<br />Ischemic stroke is an acute condition marked by focal neurological deficits in a vascular territory due to infarctions in the brain, spinal cord, or retina. Symptoms can be identified using the "BEFAST” mnemonic: Balance issues, Eye problems (vision loss), Face asymmetry, Arm or leg weakness, Speech difficulties, and Time sensitivity of treatment.<br /><br />**Etiology:**<br />The causes of ischemic stroke are classified under the TOAST classification system into five categories: cardioembolism, small vessel occlusion, large artery atherosclerosis, strokes of other determined etiology, and undetermined etiology.<br /><br />**Diagnostic Algorithm:**<br />Initial examinations include non-contrast CT head scans to exclude hemorrhages. Depending on specific criteria like time from the last known well (LKW) and CT findings, thrombolytics (TPA/TNK) or thrombectomy may be considered. Further imaging like CT angiograms and MRI are used to detect large vessel occlusions or other abnormalities.<br /><br />**Management:**<br />Patients not receiving thrombolytic therapy are admitted with a focus on maintaining certain health parameters and initiating antithrombotic therapy. Aspirin is used widely, with dual antiplatelet therapy recommended in certain cases. For patients with new onset atrial fibrillation or intracranial atherosclerosis, treatment plans are adjusted accordingly. Diagnosing the stroke's cause requires specific imaging and tests, particularly if no immediate cause is evident.<br /><br />**Rehabilitation and Risk Management:**<br />Rehabilitation involves speech, physiotherapy, and occupational therapy. Patients are also directed towards appropriate stroke units upon discharge. Additional preventive measures include managing hypertension, cholesterol, blood glucose levels, and lifestyle modifications like smoking cessation and monitoring for sleep apnea.<br /><br />This detailed framework is essential for effective stroke treatment and long-term management to improve patient outcomes.

Asset Subtitle

Neeladry Misra, Jingjing Chen

Keywords

ischemic stroke

neurological deficits

BEFAST mnemonic

TOAST classification

thrombolytic therapy

CT head scan

antiplatelet therapy

atrial fibrillation

stroke rehabilitation

risk management