Sandbox:MP

Jump to navigation Jump to search

Mehdi's sanbox

Stroke Main page

Patient Information

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

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-ray

Echocardiography and Ultrasound

CT scan

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Interventions

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Sandbox:MP On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Sandbox:MP

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Sandbox:MP

CDC on Sandbox:MP

Sandbox:MP in the news

Blogs on Sandbox:MP

Directions to Hospitals Treating Psoriasis

Risk calculators and risk factors for Sandbox:MP

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Aysha Anwar, M.B.B.S[2]; Tarek Nafee, M.D. [3]; Sara Mehrsefat, M.D. [4]

Overview

 
 
 
 
 
 
 
 
 
 
 
 
 
Stroke
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Ischemic stoke (85%)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Hemorrhagic stroke (15%)Ischemic stoke (85%)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Based on duration of onset of symptoms
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Based on cause
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Transient Ischemic stroke
(symptoms lasts <24 hrs)
 
Acute Ischemic stroke
(symptoms lasts >24 hrs)
 
 
Chronic ischemic stroke
 
 
 
 
 
 
 
Thrombotic
 
 
Embolic[1]

1.Atrial fibrillation
2.Fat
3.Septic
4.Air

5.Cancer
 
 
 
Vasculitic

Giant cell arteritis

Takayasu arteritis
 
 
Systemic hypoperfusion

1.Myocardial infarction
2.Pulmonary embolism
3.Pericardial effusion

4.Bleeding
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
TOAST classification[2]

1.Large artery atherosclerosis
2.Cardioembolism
3.Small vessel occlusion
4.Stroke of determined etiology

5.Stroke of undetermined etiology
 
 
 
 
 
 
 
 
 
Arterial thrombosis 1.Carotid artery
2.Vertebral artery
3.Circle of Willis
4.Middle cerbral artery
 
 
 
Venous thrombosis Central venous thrombosis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Large vessel involvement

1.Atherosclerosis
2.Vasculitis
3.Noninflammatory vasculopathy

4.Fibromuscular dysplasia
 
 
 
 
Small vessel involvement

1.Fibrinoid degeneration
2.Lipohyalinosis

3.Microatheroma
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Historical Perspective

  • Hippocrates (460 to 370 BC) was first to describe the phenomenon of sudden paralysis.
  • Apoplexy, from the Greek word meaning "struck down with violence,” first appeared in Hippocratic writings to describe this phenomenon.[3]
  • The word stroke was used as a synonym for apoplectic seizure as early as 1599,[4] and is a fairly literal translation of the Greek term.
  • In 1658, in his Apoplexia, Johann Jacob Wepfer (1620–1695) identified the cause of hemorrhagic stroke when he suggested that people who had died of apoplexy had bleeding in their brains.[3]
  • Wepfer also identified the main arteries supplying the brain, the vertebral and carotid arteries, and identified the cause of ischemic stroke when he suggested that apoplexy might be caused by a blockage to those vessels.

Synopsis

Diseases Laboratory Findings Physical Examination History and Symptoms Other Findings
Lab Test 1 Lab Test 2 Lab Test 3 Lab Test 4 Physical Finding 1 Physical Finding 2 Physical Finding 3 Physical Finding 4 Finding 1 Finding 2 Finding 3 Finding 4
Differential Diagnosis 1 +
Differential Diagnosis 2
Differential Diagnosis 3
Differential Diagnosis 4
Differential Diagnosis 5

Imaging Studies

Types of Stroke Imaging Findings
CT MRI
Sensitivity Specificity Sensitivity Specificity
TIA
Ischemic Stroke
Hemorrhagic Stroke

Prevention

Epidemiology and Demographics

Stroke in USA

  • Stroke is a leading cause of serious long-term disability
  • In USA, the incidence and mortality rates of stroke has significantly decreased compared to previous years.
  • From year 2003 to 2013, the mortality rates due to stroke declined by 18.5%.[5]
  • In 2013, stroke became the fifth leading cause of death.
  • The case fatality rate of stroke is estimated to be 41.7 deaths per 100, 000 population[5]
  • The incidence of new (610, 000) or recurrent stroke (185, 000) is estimated to be 795000 people annually or 250 cases per 100, 000.[5]
  • It is estimated that one incidence of stroke happens every 4 sec with death occuring every 4 min.[5]
  • About 87% of all strokes are ischemic strokes[6]
  • Stroke costs the United States an estimated $34 billion each year[6]

Worldwide

  • According to WHO, the incidence of stroke is estimated to be 15 million people annually, worldwide.[7].
  • Out of these, 5 million die and 5 million are left permanently disbaled.[7].

Age

  • Stroke can occur in all age groups. However, the incidence of stroke is less among individuals age less than 40 years of age and the risk increases with increasing age. [6]
  • According to WHO, stroke also occurs in about 8% of children with sickle cell disease.[7].
  • In 2009, 34% of people hospitalized for stroke were younger than 65 years[6]
  • The incidence of stroke in people aged 18 to 50 years is estimated to be approximately 10%. [5]

The rate of decline in mortality rates of stroke in different age groups is as follows:[5]

  • >65 years of age: from 534.1 to 245.2 per 100,000
  • 45-65 years of age: from 43.5 to 20.2 per 100,000
  • 18 to 44 years of age: from from 3.7 to 2.0 per 100,000

Gender

There is increased incidence of stroke in men as compared to women.

Race

  • The risk of incidence of first stroke is twice in african american population as compared to whites with increased mortality rates.[6]
  • Hispanics’ risk for stroke falls between that of whites and blacks [6]

Geographical distribution

  • There is increased incidence and mortality rates of stroke in developing countries as compared to developed countries due to low socio economic status and heath facilites.
  • In USA, the highest death rates from stroke are in the southeastern United States.[6]

References

  1. Montanaro VV, da Silva CM, de Viana Santos CV, Lima MI, Negrão EM, de Freitas GR (2016). "Ischemic stroke classification and risk of embolism in patients with Chagas disease". J Neurol. doi:10.1007/s00415-016-8275-0. PMID 27624118 : 27624118 Check |pmid= value (help).
  2. Adams HP, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL; et al. (1993). "Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment". Stroke. 24 (1): 35–41. PMID 7678184.
  3. 3.0 3.1 Thompson JE (1996). "The evolution of surgery for the treatment and prevention of stroke. The Willis Lecture". Stroke. 27 (8): 1427–34. PMID 8711815.
  4. R. Barnhart, ed. The Barnhart Concise Dictionary of Etymology (1995)
  5. 5.0 5.1 5.2 5.3 5.4 5.5 Writing Group Members. Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ; et al. (2016). "Heart Disease and Stroke Statistics-2016 Update: A Report From the American Heart Association". Circulation. 133 (4): e38–360. doi:10.1161/CIR.0000000000000350. PMID 26673558.
  6. 6.0 6.1 6.2 6.3 6.4 6.5 6.6 http://www.cdc.gov/stroke/facts.htm Accessed on November 3, 2016
  7. 7.0 7.1 7.2 Mackay, Judith, et al. The atlas of heart disease and stroke. World Health Organization, 2004 Accessed on November 3 2016

Template:WS Template:WH