i am having hard time identifying the cause for stroke
example is it due ti carotid emboli, ischemic, hemorrhagic, lacunar, etc
can some one give me pointers on this
appreciate your help
exam soon
most of strokes are ischemic, hints: AF-->cardiac source, carotid bruit-->carotid source,
the lacunar strokes have no focal signs, usually cognitive (dementia),
the hemorrhagic strokes usually associated with v. high BP, also level of conciousness is usually deteriorated>ischemic counterpart
any stroke, only CT w/o contrast confirms either ishchemic or hemorr... but some clues are...
carotid emboli : usually they mention riskfactors like hypercholes...carotid bruise etc...
ischemic : usually slow ,progressive, w/o headache, ...
hemorrhagic : HTN, h/o headche, sudden neuro sx...usually vast area.
lacunar": compulsory h/o HTN +/- DM, usually affecting small area of brain with classic presentations of pure motor/sensory/ataxia hemiplegia/dysarthria clumsy hand...
any body add more...
Sure lets add some more even though you guys pretty much summed it up already
Strokes are divided into two classes/types; (1) ischemic and (2) hemorrhagic.
the causes of the two have previuosly been outlined by successor and toha. but what does it mean. It means the only difference between the two is how are we going to manage our patient.
If its ischemic (only way we can be POSITIVE is non contrast CT) as always ABC's then we give thrombolytics if inside the therapeutic window (3 hours). The criteria for thrombolytics is the onset of symptoms must be witnessed by another person before thrombolytics can be administered. contraindications are uncontrolled HTN, bleeding disorder, and Hx of recent trauma or surgery. Of course we need to give aspirin for life and plavix for at least six months. Management of whatever the primary cause of the stroke is also indicated. Ischemic strokes can turn into hemorrhagic stokes if they go untreated.
Hemorrhagic stroke identified by non contrast CT has a worse prognosis. 50% die in 30 days. Again ABC's, ICU admit, Mainstay of treatment is intensive BP control but reduce it gradually. If there are signs of increased ICP we give mannitol. Never steroids. If they make it HTN control is mandatory.