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| '''For patient information click [[{{PAGENAME}} (patient information)|here]]'''
| | __NOTOC__ |
| {{Infobox_Disease | | {| class="infobox" style="float:right;" |
| | Name = Stroke
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| | Image = MCA-Stroke-Brain-Human-2.JPG
| | | [[File:Siren.gif|30px|link=Stroke resident survival guide]]|| <br> || <br> |
| | Caption = A slice of brain from the autopsy of a person who suffered an acute MCA stroke
| | | [[Stroke resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']] |
| | DiseasesDB = 2247
| | |} |
| | ICD10 = {{ICD10|I|61||i|60}}-{{ICD10|I|64||i|60}}
| | {{Ischemic stroke}} |
| | ICD9 = {{ICD9|434}}
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| | ICDO =
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| | OMIM = 601367
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| | MedlinePlus = 000726
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| | eMedicineSubj =
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| | eMedicineTopic =
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| | eMedicine_mult =
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| | MeshID = D020521
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| }}
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| {{Stroke}} | |
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| {{CMG}} | | {{CMG}} {{AE}}{{AAA}} |
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| | {{SK}} Cerebrovascular accident; cerebrovascular event; CVA; cerebral emboli; brain attack; ischemic stroke |
| ==[[Stroke overview|Overview]]== | | ==[[Stroke overview|Overview]]== |
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| ==[[Stroke definition|Definition]]== | | ==[[Ischemic stroke historical perspective|Historical Perspective]]== |
| | ==[[Ischemic stroke classification|Classification]]== |
| | ==[[Ischemic stroke pathophysiology|Pathophysiology]]== |
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| ==[[Stroke historical perspective|Historical Perspective]]== | | ==[[Stroke causes|Causes]]== |
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| ==[[Stroke epidemiology and demographics|Epidemiology & Demographics]]== | | ==[[Ischemic stroke differential diagnosis|Differentiating Stroke from other Diseases]]== |
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| ==[[Stroke risk factors|Risk Factors]]== | | ==[[Ischemic stroke epidemiology and demographics|Epidemiology and Demographics]]== |
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| ==[[Stroke natural history|Prognosis]]== | | ==[[Ischemic stroke risk factors|Risk Factors]]== |
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| ==[[Stroke classification|Classification]]== | | ==[[Stroke natural history|Natural History, Complications and Prognosis]]== |
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| ==[[Stroke pathophysiology|Pathophysiology]]==
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| ==Diagnosis== | | ==Diagnosis== |
| [[Stroke history and symptoms|History & Symptoms]] | [[Stroke physical examination|Physical Examination]] | | [[Ischemic stroke history and symptoms|History and Symptoms]] | [[Ischemic stroke physical examination|Physical Examination]] | [[Ischemic stroke laboratory findings|Laboratory Findings]] | [[Ischemic stroke electrocardiogram|Electrocardiogram]] | [[Ischemic stroke CT|CT]] | [[Ischemic stroke MRI|MRI]] | [[Ischemic stroke echocardiography|Echocardiography]] | [[Ischemic stroke ultrasound|Ultrasound]] | [[Ischemic stroke other imaging findings|Other Imaging Findings]] |
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| ===Imaging===
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| For diagnosing ischemic stroke in the emergency setting:<ref name="pmid17258669">{{cite journal | last=Chalela | first=J | coauthors=Kidwell C, Nentwich L et al. | title=Magnetic resonance imaging and computed tomography in emergency assessment of patients with suspected acute stroke: a prospective comparison | journal=Lancet | volume=369 | issue=9558 | pages=293-8 | year=2007 | url=http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=17258669 | pmid=17258669 | accessdate=2008-01-22 }}</ref>
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| * [[CT scan]]s (''without'' contrast enhancements)
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| : [[sensitivity (tests)|sensitivity]]= 16%
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| : [[specificity (tests)|specificity]]= 96%
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| * [[MRI scan]]
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| : sensitivity= 83%
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| : specificity= 98%
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| For diagnosing hemorrhagic stroke in the emergency setting:
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| * CT scans (''without'' contrast enhancements)
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| : sensitivity= 89%
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| : specificity= 100%
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| * MRI scan
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| : sensitivity= 81%
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| : specificity= 100%
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| For detecting chronic hemorrhages, MRI scan is more sensitive.<ref name="pmid15494579">{{cite journal | last=Kidwell | first=C | coauthors=Chalela J, Saver J et al. | title=Comparison of MRI and CT for detection of acute intracerebral hemorrhage | journal=JAMA | volume=292 | issue=15 | pages=1823–30 | year=2004 | url=http://jama.ama-assn.org/cgi/content/full/292/15/1823 | pmid=15494579 | accessdate=2008-01-22 }}</ref>
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| For the assessment of stable stroke, nuclear medicine scans SPECT and PET/CT may be helpful. SPECT documents cerebral blood flow and PET with FDG isotope the metabolic activity of the neurons.
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| ===Underlying etiology===
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| When a stroke has been diagnosed, various other studies may be performed to determine the underlying etiology. With the current treatment and diagnosis options available, it is of particular importance to determine whether there is a peripheral source of [[embolus|emboli]]. Test selection may vary, since the cause of stroke varies with age, [[comorbidity]] and the clinical presentation. Commonly used techniques include:
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| * an [[medical ultrasonography|ultrasound/doppler study]] of the [[carotid artery|carotid arteries]] (to detect [[carotid stenosis]]) or [[carotid artery dissection|dissection of the precerebral artieries]]
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| * an [[electrocardiogram]] (ECG) and [[echocardiogram]] (to identify [[cardiac arrhythmia|arrhythmias]] and resultant clots in the heart which may spread to the brain vessels through the bloodstream)
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| * a [[Holter monitor]] study to identify intermittent arrhythmias
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| * an [[angiogram]] of the cerebral vasculature (if a bleed is thought to have originated from an [[aneurysm]] or [[arteriovenous malformation]])
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| * blood tests to determine [[hypercholesterolemia]], [[bleeding diathesis]] and some rarer causes such as [[homocysteinuria]]
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| ==Treatment== | | ==Treatment== |
| [[Stroke early assessment|Early assessment]] | [[Stroke ischemic treatment|Ischemic Stroke]] | [[Stroke hemorrhagic treatment|Hemorrhagic stroke]] | | [[Stroke early assessment|Early assessment]] | [[Stroke medical therapy|Medical Therapy]] | [[Stroke surgery|Surgery]] | [[Stroke rehabilitation|Rehabilitation]] | [[Ischemic stroke primary prevention|Primary prevention]] | [[Ischemic stroke secondary prevention|Secondary prevention]] | [[Stroke cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Stroke future or investigational therapies|Future or Investigational Therapies]] |
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| ==[[Stroke rehabilitation|Care and rehabilitation]]==
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| ==[[Stroke prevention|Prevention]]==
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| ==[[Stroke ACC/AHA guidelines|ACC/AHA Guidelines]]==
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| ==Sources==
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| *The 2004 ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction <ref name="pmid15339869">{{cite journal |author=Antman EM, Anbe DT, Armstrong PW, Bates ER, Green LA, Hand M, Hochman JS, Krumholz HM, Kushner FG, Lamas GA, Mullany CJ, Ornato JP, Pearle DL, Sloan MA, Smith SC, Alpert JS, Anderson JL, Faxon DP, Fuster V, Gibbons RJ, Gregoratos G, Halperin JL, Hiratzka LF, Hunt SA, Jacobs AK |title=ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines for the Management of Patients with Acute Myocardial Infarction) |journal=Circulation |volume=110 |issue=9 |pages=e82–292 |year=2004 |month=August |pmid=15339869 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=15339869}}</ref>
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| *The 2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients with ST-Elevation Myocardial Infarction <ref name="pmid18071078">{{cite journal |author=Antman EM, Hand M, Armstrong PW, ''et al'' |title=2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: developed in collaboration With the Canadian Cardiovascular Society endorsed by the American Academy of Family Physicians: 2007 Writing Group to Review New Evidence and Update the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction, Writing on Behalf of the 2004 Writing Committee |journal=Circulation |volume=117 |issue=2 |pages=296–329 |year=2008 |month=January |pmid=18071078 |doi=10.1161/CIRCULATIONAHA.107.188209 |url=}}</ref>
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| ==References== | | == Case Studies == |
| {{reflist|2}}
| | [[Stroke case study one|Case #1]] |
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| {{Circulatory system pathology}} | | {{Circulatory system pathology}} |
| {{SIB}}
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| [[Category:Aging-associated diseases]]
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| [[Category:Cardiovascular diseases]]
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| [[Category:Neurological disorders]]
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| [[Category:Emergency medicine]]
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| [[Category:Cardiology]]
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| [[Category:Neurosurgery]]
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| [[Category:Mature chapter]]
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| [[Category:Disease state]]
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| [[ar:سكتة]] | | [[ar:سكتة]] |
| [[zh-min-nan:Tiòng-hong]] | | [[zh-min-nan:Tiòng-hong]] |
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| | [[Category:Aging-associated diseases]] |
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