S18CkL

Def|n|t|on
An acuLe neurologlcal deflclL lasLlng more Lhan 24 hours and caused by cerebrovascular
aeLlology
O scahemlc sLroke (83) caused by vascular occluslon or sLenosls
O aemorrhaglc sLroke (13) caused by vascular rupLure resulLlng ln lnLra
parenchymal and/or subarachnold haemorrhage
1ranslenL lschaemlc aLLack (1A) a brlef eplsode of neurologlcal dysfuncLlon caused by focal
braln or reLlnal lschaemla wlLh cllnlcal sympLoms lasLlng less Lhan 1 hour and wlLhouL
evldence of acuLe lnfarcLlon

|sk Iactors
O schaemlc sLroke smoklng dlabeLes Al comorbld cardlac condlLlons caroLld
arLery sLenosls slckle cell dlsease
O aemorrhaglc sLroke anLlcoagulaLlon sympaLhomlmeLlc drug abuse vascular
malformaLlons
O 1A Al valvular dlsease caroLld sLenosls Cl 1n uM smoklng alcohol abuse

Assessment
denLlfy alrway breaLhlng and clrculaLory lnsufflclencles requlrlng urgenL LreaLmenL
Ceneral sysLemlc exam Lo ldenLlfy rlsk facLors
neurologlcal assessmenL
O AnLerlor clrculaLlon parLlal or LoLal loss of sLrengLh ln face and upper and/or lower
exLremlLles expresslve and/or recepLlve language dysfuncLlon sensory loss ln face
and upper and/or lower exLremlLles gaze paresls headache
O 9osLerlor clrculaLlon speclflc cranlal nerve deflclLs orner's syndrome vlsual fleld
loss dysarLhrla nausea and/or vomlLlng dlfflculLy wlLh flne moLor coordlnaLlon
and galL dlzzlness verLlgo alLered level of consclousness and coma
O acunar sLrokes pure moLor hemlparesls pure sensory hemlparesls aLaxla mlxed
moLor and sensory slgns dysarLhrla
1he sympLoms of lnLracerebral haemorrhage evolve over seconds or mlnuLes 9resenLlng
slgns depend on Lhe braln reglons lnvolved Selzure someLlmes occurs aL onseL of
haemorrhage aemorrhaglc sLroke ls more frequenLly assoclaLed wlLh reduced level of
consclousness and slgns of lncreased lnLracranlal pressure

Invest|gat|ons
C1 head
O schaemlc hypoaLLenuaLlon of braln parenchyma loss of greywhlLe maLLer
dlfferenLlaLlon and sulcal effacemenL
O aemorrhaglc enhanclng leslon
M8 braln acuLe lschaemlc lnfarcL appears brlghL on uW laLer 12 lmages may show
lncreased slgnal
C1 or M8 anglography or venography
CaroLld ulLrasound
Serum glucose
l8C
LlecLrolyLes
urea and CreaLlnlne
91 and n8
Cardlac enzymes
LCC
S18CkL
,anagement
schaemlc sLroke wlLhouL cerebral venous slnus Lhrombosls
O alLeplase (Llssue plasmlnogen acLlvaLor) lf presenLaLlon wlLhln 3 hours and no
conLralndlcaLlon Lo Lhrombolysls
O asplrln (24 hrs afLer L9A)
schaemlc sLroke wlLh cerebral venous slnus Lhrombosls
O anLlcoagulaLlon
nLraarLerlal reperfuslon Lheraples uslng elLher lnLraarLerlal Lhrombolysls or cloL reLrleval
devlces are used by experlenced cenLres ln selecL cases up Lo 8hrs from sympLom onseL

aemorrhaglc sLroke
O neurosurglcal evaluaLlon (posLerlor fossa bleeds and large lnLracerebral bleeds may
beneflL from surglcal evacuaLlon)
O 8lood pressure conLrol
O CorrecL coagulopaLhy

A|| strokes
supporLlve care admlsslon Lo sLroke unlL alrway proLecLlon asplraLlon precauLlons uv1
prophylaxls (sLocklngs or lowdose heparln ln lschemlc sLroke) referral Lo approprlaLe
consulLanLs for rehablllLaLlons (physloLheraplsL occupaLlonal LheraplsL speech and language
paLhologlsL eLc)

Longterm management
Ceneral vascular rlsk proLecLlon
CaroLld endarcLerecLomy (70 sLenosls)
MulLldlsclpllnary managemenL of home envlronmenL

Comp||cat|ons
uv1 selzure haemorrhaglc LransformaLlon of lschaemlc sLroke braln oedema and elevaLed
lnLracranlal pressure depresslon asplraLlon pneumonla