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Stroke

Updated : December 2, 2022





Background

A stroke or cerebrovascular accident is a sudden disruption of cerebral perfusion or vasculature. Strokes are ischemic in around 85% of cases, and hemorrhagic in the remaining 15%. The main reason for adult disability globally is stroke.

Therefore, it is crucial to identify and treat stroke early to avoid or reduce morbidity and death. The leading causes of stroke are hypertension, clotting disorders, and illicit drug abuse.

Epidemiology

In the US, stroke is the fifth most common cause of death. Every year, there are around 800,000 new cases of stroke. The primary contributor to disability is stroke. Stroke incidence has decreased, but morbidity has increased.

Women have a greater lifetime risk of stroke due to longer life expectancies. Stroke cause at least 5 million fatalities and millions of permanent disabilities worldwide.

Anatomy

Pathophysiology

Ischemia in a specific location of the brain causes a stroke. The ineffective synthesis of adenosine triphosphate (ATP) and malfunction of the aerobic process are the major causes of the Na+/K+ ATPase pumps failing.

Ischemia causes cells to become depolarized, which causes calcium to enter the cells and causes lactic acid to increase acidosis and produce free radicals. Glutamate levels rise due to cell death, triggering an excitotoxic chain reaction.

Etiology

Smoking, obesity, diabetes, hypertension, atrial fibrillation, and drug use are risk factors for stroke. The most frequent modifiable risk factor for a stroke of all the risk factors is hypertension. African Americans are more likely to experience hypertension, which develops earlier in life.

Small vessel strokes mainly affect the internal capsule, pons, thalamus, and cerebellum and are brought on by chronic, uncontrolled hypertension. Lifestyle changes like reducing sodium intake, and following the Mediterranean diet should be incorporated.

In primary prevention, every 10 mm Hg drop in blood pressure is linked to a 1/3 drop in the risk of stroke. In the USA, one-third of individuals have increased levels of low-density lipoprotein (LDL), which causes plaque to develop in the intracerebral vasculature.

Eventually, thrombotic strokes take place as a result of the massive plaque buildup. Atrial fibrillation is responsible for the increased risk of cardioembolic stroke in the elderly.

Genetics

Prognostic Factors

Strokes still have a significant mortality and morbidity rate. The stroke one-year survival rate ranges from 60 to 80%. The chance of having another stroke is significant for individuals who recover completely.

After a stroke, most patients either continue to be incapacitated or suffer partial neurological abnormalities preventing them from participating in the workforce.

Clinical History

Physical Examination

Age group

Associated comorbidity

Associated activity

Acuity of presentation

Differential Diagnoses

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

by Stage

by Modality

Chemotherapy

Radiation Therapy

Surgical Interventions

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

Stem Cell Transplant

Targeted Therapy

Palliative Care

Medication

 

ticlopidine 

250

mg

Orally 

twice a day



nicergoline 

vascular cognitive impairment:

10 mg thrice a day. The duration of therapy should be minimum of 3 months



 
 

Media Gallary

References

https://www.ncbi.nlm.nih.gov/books/NBK430927/

Stroke

Updated : December 2, 2022




A stroke or cerebrovascular accident is a sudden disruption of cerebral perfusion or vasculature. Strokes are ischemic in around 85% of cases, and hemorrhagic in the remaining 15%. The main reason for adult disability globally is stroke.

Therefore, it is crucial to identify and treat stroke early to avoid or reduce morbidity and death. The leading causes of stroke are hypertension, clotting disorders, and illicit drug abuse.

In the US, stroke is the fifth most common cause of death. Every year, there are around 800,000 new cases of stroke. The primary contributor to disability is stroke. Stroke incidence has decreased, but morbidity has increased.

Women have a greater lifetime risk of stroke due to longer life expectancies. Stroke cause at least 5 million fatalities and millions of permanent disabilities worldwide.

Ischemia in a specific location of the brain causes a stroke. The ineffective synthesis of adenosine triphosphate (ATP) and malfunction of the aerobic process are the major causes of the Na+/K+ ATPase pumps failing.

Ischemia causes cells to become depolarized, which causes calcium to enter the cells and causes lactic acid to increase acidosis and produce free radicals. Glutamate levels rise due to cell death, triggering an excitotoxic chain reaction.

Smoking, obesity, diabetes, hypertension, atrial fibrillation, and drug use are risk factors for stroke. The most frequent modifiable risk factor for a stroke of all the risk factors is hypertension. African Americans are more likely to experience hypertension, which develops earlier in life.

Small vessel strokes mainly affect the internal capsule, pons, thalamus, and cerebellum and are brought on by chronic, uncontrolled hypertension. Lifestyle changes like reducing sodium intake, and following the Mediterranean diet should be incorporated.

In primary prevention, every 10 mm Hg drop in blood pressure is linked to a 1/3 drop in the risk of stroke. In the USA, one-third of individuals have increased levels of low-density lipoprotein (LDL), which causes plaque to develop in the intracerebral vasculature.

Eventually, thrombotic strokes take place as a result of the massive plaque buildup. Atrial fibrillation is responsible for the increased risk of cardioembolic stroke in the elderly.

Strokes still have a significant mortality and morbidity rate. The stroke one-year survival rate ranges from 60 to 80%. The chance of having another stroke is significant for individuals who recover completely.

After a stroke, most patients either continue to be incapacitated or suffer partial neurological abnormalities preventing them from participating in the workforce.

ticlopidine 

250

mg

Orally 

twice a day



nicergoline 

vascular cognitive impairment:

10 mg thrice a day. The duration of therapy should be minimum of 3 months



https://www.ncbi.nlm.nih.gov/books/NBK430927/