Ver el código de «Stroke (main)»

==Background==
[[File:23-Sensory-Homonculus.png|thumb|Sensory Homonculus - courtesy AnatomyZone.com]]
*Vascular injury that reduces cerebral blood flow to specific region of brain causing neuro impairment  
*Accurate determination of last known time when patient was at baseline is essential
*In-hospital mortality of 5-10% for ischemic stroke and 40-60% for hemorrhagic stroke
*Only 10% of stroke survivors will recover completely

{{Ischemic Stroke Cause}}
{{Hemorrhagic Stroke Cause}}
{{Stroke types}}

==Clinical Features==
{{Stroke Syndromes}}

==Differential Diagnosis==
{{Stroke DDX}}
{{Weakness DDX}}

==Evaluation==
[[File:StrokeMCA overlay.png|thumb|[[Ischemic stroke]] with CT showing early signs of a middle cerebral artery stroke with loss of definition of the gyri and grey white boundary.]]
[[File:Intracerebral heamorrage.jpg|thumb|[[Hemorrhagic stroke]] (i.e. spontaneous intracranial hemorrhage).]]
[[File:Posterior fossa hemorrhage.jpg|thumb|[[Hemorrhagic stroke]] in the posterior fossa.]]
[[File:Left MCA Stroke.png|thumb|12-lead ECG of a patient with acute stroke, showing large deeply inverted T-waves.]]
'''Always obtain blood glucose, which is commonly overlooked (more embarrassing if you give tPA)'''
Find out last known normal of affected deficit and write it down in chart
{{Stroke workup}}

===Large Vessel Occlusion - Thrombectomy===
*"Cortical strokes" of ICA, MCA, and some ACA occlusions are most likely to benefit from thrombectomy
*CT perfusion study is the key factor in determining brain tissue salvageability from symptom onset to thrombectomy of 6-24 hours<ref>Albers GW, Marks MP, Kemp S, et al. Thrombectomy for Stroke at 6 to 16 Hours with Selection by Perfusion Imaging. N Engl J Med. 2018;378(8):708-718.</ref>
*If CT perfusion unavailable, use ASPECT score<ref>Barber PA, Demchuk AM, Zhang J, Buchan AM. Validity and reliability of a quantitative computed tomography score in predicting outcome of hyperacute stroke before thrombolytic therapy. ASPECTS Study Group. Alberta Stroke Programme Early CT Score. Lancet. 2000;355(9216):1670-4.</ref>

====VAN Score====
*NIHSS score ≥ 6 is nearly 100% sensitive for emergent large vessel occlusion, which may be amenable to thrombectomy<ref>Teleb MS, Ver Hage A, Carter J, et al Stroke vision, aphasia, neglect (VAN) assessment—a novel emergent large vessel occlusion screening tool: pilot study and comparison with current clinical severity indices Journal of NeuroInterventional Surgery 2017;9:122-126.</ref>
*'''VAN''' score is just as sensitive, but also may be more specific (~90%)
**Weakness must be present, plus one or all of the VAN to be VAN positive
***Weakness qualifying findings -- if no weakness, the pt is VAN negative
****Mild (minor drift)
****Moderate (severe drift—touches or nearly touches ground)
****Severe (flaccid or no antigravity)
***'''V'''isual disturbance qualifying findings
****Field cut (which side) (4 quadrants)
****Double vision (ask patient to look to right then left; evaluate for uneven eyes)
****Blind new onset
***'''A'''phasia qualifying findings
****Expressive (inability to speak or paraphasic errors); do not count slurring of words (repeat and name 2 objects)
****Receptive (not understanding or following commands) (close eyes, make fist)
****Mixed
***'''N'''eglect qualifying findings
****Forced gaze or inability to track to one side
****Unable to feel both sides at the same time, or unable to identify own arm
****Ignoring one side
**If VAN positive, CT and CTA of the head should be ordered for consideration of thrombectomy plus/minus tPA

==Management==
*Depends on type
**[[Ischemic stroke|Ischemic]] vs [[Hemorrhagic stroke|Hemorrhagic]]
**Acute vs subacute vs old
**Due to risk for hemorrhagic transformation, there is no role in acute completed stroke for:
***Dual antiplatelet therapy (as opposed in select cases of [[TIA]])
***Anticoagulation, with or without atrial fibrillation

{{BP Goals in Acute Stroke}}

{{Common Medications for BP Control in Acute Stroke}}

==Disposition==
*Admit for acute or subacute stroke

==See Also==
*[[Transient Ischemic Attack (TIA)]]
*[[Thrombolysis in Acute Ischemic Stroke (tPA)]]
*[[CVA (Post-tPA Hemorrhage)]]
*[[Intracerebral Hemorrhage]]
*[[Subarachnoid Hemorrhage (SAH)]]
*[[Cervical Artery Dissection]]
*[[NIH Stroke Scale]]
*[[Cerebellar Stroke]]
*[[Focal neurologic signs]]

==External Links==
*[http://www.mdcalc.com/modified-nih-stroke-scale-score-mnihss/ MDCalc - NIH Stroke Scale/Score]
*[https://emergencymedicinecases.com/ed-stroke-management-endovascular-therapy/ Emergency medicine cases - ED stroke management in the age of endovascular therapy]

==References==
<references/>

[[Category:Neurology]]