SHM's Clinical Quick Talks-Stroke

Pdf Summary
The document, authored by Dr. Jason Gilbert, focuses on stroke recognition and management, emphasizing the importance of prompt identification and action, even in settings where neurologists might not be immediately available, such as community hospitals. <br /><br />**Key Learning Points:**<br />1. Recognizing a stroke promptly using a neurologic exam.<br />2. Implementing immediate steps upon stroke recognition.<br /><br />**Stroke Overview:**<br />A stroke is defined as an acute neurologic injury due to inadequate brain cell perfusion, categorized into ischemic and hemorrhagic types. Ischemic strokes result from thrombosis, embolism, or systemic hypoperfusion, while hemorrhagic strokes involve intracerebral (ICH) or subarachnoid hemorrhage (SAH).<br /><br />**Risk Factors:**<br />Factors include age, chronic conditions like hypertension, smoking, hyperlipidemia, diabetes, atrial fibrillation, and structural heart problems. Hemorrhagic strokes link to acute hypertension, amyloid angiopathy, and use of blood thinners.<br /><br />**Presentation:**<br />Symptoms include focal neurologic deficits or sudden loss of specific brain functions. Gait testing and use of the NIH Stroke Scale can aid assessment. Alternative diagnoses that mimic strokes include hypoglycemia and migraines.<br /><br />**Initial Workup:**<br />1. Stabilize the patient (ABCDE approach).<br />2. Alert relevant medical teams via a stroke alert.<br />3. Conduct a CT head scan without contrast to rule out hemorrhage.<br />4. Consider reperfusion options within specific time windows, evaluating for contraindications.<br /><br />**Ischemic Stroke Management:**<br />Reperfusion through thrombolysis or thrombectomy, blood pressure management, advanced imaging, and further cardiac evaluations are vital. Secondary prevention includes ASA, statins, and lifestyle modifications.<br /><br />**Hemorrhagic Stroke Management:**<br />Neurosurgical intervention, reversal of anticoagulation, and controlling intracranial pressure are critical measures.<br /><br />**Prognosis:**<br />Recovery mainly occurs in the first three months, demanding intensive rehabilitation (15 hours/week). Chronic disease management and lifestyle adjustments are essential for reducing recurrence risk.<br /><br />Recognizing strokes early and managing them promptly are crucial for positive patient outcomes. The document underlines the importance of distinguishing strokes from other similar conditions and emphasizes preventive measures against recurrent strokes.
Asset Subtitle
Lila Steinberg
Keywords
stroke recognition
stroke management
neurologic exam
ischemic stroke
hemorrhagic stroke
risk factors
NIH Stroke Scale
reperfusion therapy
neurosurgical intervention
stroke prevention