Stroke is an umbrella term for the rapid loss of neurologic function in a particular vascular territory, with symptoms lasting greater than 24 hours.
The causes of stroke are broadly defined as either ischemic or hemorrhagic.
Clinical manifestations depend on the vascular territory affected, with the middle cerebral artery (MCA) being most commonly affected.
Management of stroke involves identifying the onset and duration of symptoms, assessing and maintaining normal vital signs, evaluating whether the patient with acute stroke is a candidate for thrombolysis, and longer-term risk factor management.
For ischemic stroke, the classical determinants of atherosclerosis, such as smoking, poor diet, obesity, hyperlipidemia, and hypertension can increase the risk for stroke, as can the use of certain medications, such as hormone replacement therapy.
Preventive therapies for embolic stroke, specifically Coumadin (warfarin), show replicable associations with interindividual genomic variation. Also, interindividual differences in the susceptibility to serious side effects from statins, used widely in stroke prevention, appear to have a genetic basis.
Diagnostic Criteria and Clinical Characteristics
Stroke is defined as the rapid loss of neurologic function in a particular vascular territory caused by either ischemia or hemorrhage, with symptoms lasting greater than 24 hours. Ischemic strokes can be subdivided according to cause: thrombotic or embolic. Meanwhile, hemorrhagic strokes are subdivided according to location of bleeding: parenchymal (intracerebral hemorrhage [ICH]) or subarachnoid hemorrhage (SAH) (Fig. 17-1). The diagnosis of stroke depends on accurate history and physical examination, and confirmed by appropriate neuroimaging.
Clinical Approach to Strokes.
The exact clinical characteristics of a stroke depend on the vascular territory affected, with the MCA most often affected. See Fig. 17-2 for types of vessels affected and their respective clinical characteristics.
Clinical Characteristics of Stroke Dependent on Vascular Territory Affected.
ACA, anterior cerebral artery; LE, lower extremity; MCA, middle cerebral artery; PCA, posterior ...
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