Ischemic stroke

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Stroke
A slice of brain from the autopsy of a person who suffered an acute MCA stroke
ICD-10	I61-I64
ICD-9	434
OMIM	601367
DiseasesDB	2247
MedlinePlus	000726
MeSH	D020521

Stroke Main page
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Overview
Causes
Classification Hemorrhagic stroke Ischemic stroke
Differentiating Stroke from other Diseases
Epidemiology and Demographics
Diagnosis NIH stroke scale Glasgow coma scale
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
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History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
X-ray
Echocardiography and Ultrasound
CT scan
MRI
Other Imaging Findings
Other Diagnostic Studies
Treatment
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Risk calculators and risk factors for Ischemic stroke

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Diagnosis

History & Symptoms | Physical Examination

Imaging

For diagnosing ischemic stroke in the emergency setting:

• CT scans (without contrast enhancements)

sensitivity= 16%

specificity= 96%

• MRI scan

sensitivity= 83%

specificity= 98%

For diagnosing hemorrhagic stroke in the emergency setting:

• CT scans (without contrast enhancements)

sensitivity= 89%

specificity= 100%

• MRI scan

sensitivity= 81%

specificity= 100%

For detecting chronic hemorrhages, MRI scan is more sensitive.

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.

Underlying etiology

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 emboli. Test selection may vary, since the cause of stroke varies with age, comorbidity and the clinical presentation. Commonly used techniques include:

• an ultrasound/doppler study of the carotid arteries (to detect carotid stenosis) or dissection of the precerebral artieries
• an electrocardiogram (ECG) and echocardiogram (to identify arrhythmias and resultant clots in the heart which may spread to the brain vessels through the bloodstream)
• a Holter monitor study to identify intermittent arrhythmias
• an angiogram of the cerebral vasculature (if a bleed is thought to have originated from an aneurysm or arteriovenous malformation)
• blood tests to determine hypercholesterolemia, bleeding diathesis and some rarer causes such as homocysteinuria

Treatment

Early assessment | Ischemic Stroke | Hemorrhagic stroke

Sources

• The 2004 ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction

• The 2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients with ST-Elevation Myocardial Infarction

References

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