Narrative Review: Stroke

Narrative Review
Narrative Review: Death
Narrative Review: Stroke
Narrative Review: Myocardial Infarction
Narrative Review: Acute Kidney Injury
Narrative Review: Bleeding

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mehrian Jafarizade, M.D [2]

Site	Patient	AE	Complication	Event date	AE code
xxx	xxx	x		mm/dd/YYYY	xxx

Diagnosis

Symptoms:

• O Loss of consciousness
• O New focal neurological deficits [scale based on the below table]
• O Presence of hypoglycemia
• O Presence of AF (or other arrhythmia)

National Institutes of Health Stroke Scale

Class	Title	Responses and Scores
1A	Level of consciousness	0—Alert 1—Drowsy 2—Obtunded 3—Coma/unresponsive
1B	Orientation questions (2)	0—Answers both correctly 1—Answers 1 correctly 2—Answers neither correctly
1C	Response to commands (2)	0—Performs both tasks correctly 1—Performs 1 task correctly 2—Performs neither
2	Gaze	0—Normal horizontal movements 1—Partial gaze palsy 2—Complete gaze palsy
3	Visual fields	0—No visual field defect 1—Partial hemianopia 2—Complete hemianopia 3—Bilateral hemianopia
4	Facial movement	0—Normal 1—Minor facial weakness 2—Partial facial weakness 3—Complete unilateral palsy
5	Motor function (arm)a. Leftb. Right	0—No drift 1—Drift before 5 seconds 2—Falls before 10 seconds 3—No effort against gravity 4—No movement
6	Motor function (leg)a. Leftb. Right	0—No drift 1—Drift before 5 seconds 2—Falls before 5 seconds 3—No effort against gravity 4—No movement
7	Limb ataxia	0—No ataxia 1—Ataxia in 1 limb 2—Ataxia in 2 limbs
8	Sensory	0—No sensory loss 1—Mild sensory loss 2—Severe sensory loss
9	Language	0—Normal 1—Mild aphasia 2—Severe aphasia 3—Mute or global aphasia
10	Articulation	0—Normal 1—Mild dysarthria 2—Severe dysarthria
11	Extinction or inattention	0—Absent 1—Mild (loss 1 sensory modality lost) 2—Severe (loss 2 modalities lost)

• MM/DD/YYYY at xx:xx on brain MRI : [Write the MRI findings, mention the site of stroke here]
• MM/DD/YYYY at xx:xx on brain CT : [Write the CT findings, mention the site of stroke here]

Event

Addmission date: MM/DD/YYYY

Demographic: [age] year old [gender]

Site Reported Event Onset Date: MM/DD/YYYY

Event summary:

• Symptoms and sign:
  • Subject presented with [sign and symptom] on MM/DD/YYYY.
  • Important characteristics of the chief complaint such as severity, site, and duration.
  • Other important symptoms related to the chief complaint.

• Past Medical History: [eg. CAD, Severe mitral stenosis, former tobacco use, dyslipidemia, ...]
• Past Surgical History: [including date]
• Medications: [relevant to the event not all]
• Physical assessment:
  • Vital signs
  • Positive physical examinations or related negative examinations.

Event (2): [If there is more than 1 event]

Stroke/TIA definitions

Stroke:

Duration of a focal or global neurological deficit 24 h OR <24 h if available neuroimaging procedure (CT scan or brain MRI) documents a new intracranial or subarachnoid hemorrhage (hemorrhagic stroke) or central nervous system infarction (ischemic stroke) OR the neurological deficit results in death. Or there is confirmation of a stroke diagnosis by a neurologist or neurosurgical specialist.

Ischemic:

An acute episode of focal cerebral, spinal, or retinal dysfunction caused by infarction of the central nervous system tissue.

Hemorrhagic:

An acute episode of focal or global cerebral or spinal dysfunction caused by intraparenchymal, intraventricular, or subarachnoid hemorrhage.

Undetermined:

If there is insufficient information to allow categorization as ischemic or hemorrhagic.

TIA:

Duration of a focal or global neurological deficit <24 h and neuroimaging procedure (CT scan or brain MRI) does not demonstrate a new hemorrhage or infarct Or there is confirmation of a TIA diagnosis by a neurologist or neurosurgical specialist.

Procedure

• Index Procedure Date/Time:
  • mm/dd/YYYY at xx:xx [insert date and time]
• Index Procedure Detail:
  • On mm/dd/YYYY at xx:xx [insert date and time] the subject underwent a [select surgical correction] for [select etiology].
  • Access site details
  • The site reported that there were/were not procedural complication(s). 

Laboratory data

• Lab studies list: (Date/ name/ value)

Other Diagnostic tests

• mm/dd/YYYY at xx:xx on MRA
• mm/dd/YYYY at xx:xx on EEG
• mm/dd/YYYY at xx:xx on Carotid US
• mm/dd/YYYY at xx:xx on ECG:

• mm/dd/YYYY at xx:xx on ECHO:
• mm/dd/YYYY at xx:xx on Ultrasound:
• mm/dd/YYYY at xx:xx on Endoscopy:
• mm/dd/YYYY at xx:xx ... (Other relevant imaging and diagnostic tests)

Consults

• Date and time of consult
• Suggested treatments

Clinical course

• Date and time of events,
• Patient condition got worse or better.

Treatment and outcome

• List of relevant medical treatments
• Outcome [Discharge / Hospice / Death]