Approach to Acute Stroke in the Emergency Department
[Pages:59]Approach to Acute Stroke in the Emergency Department
Dr Julia Hopyan
Objectives
Types of stroke Differentiating hemorrhagic and ischemic strokes:
Clinically and radiologically
Stroke syndromes
Anterior circulation:
Middle cerebral artery Anterior cerebral artery
Posterior circulation:
Posterior cerebral artery Basilar artery
Case examples
Types of Stroke
Ischemic 85%
Hemorrhagic 15%
Large vessel Cardioembolic
35%
25%
Lacunar 20%
Other 5%
ICH 10%
SAH 5%
Differentiation Between Ischemic versus Hemorrhagic Strokes
Clinical Clues for Detecting Hemorrhagic Stroke
Historical Headache Sudden onset but
gradually worsening Nausea and vomiting
Examination Findings Decreased level of
consciousness Hypertension Bradycardia Seizures Meningism Fever
Patients with hemorrhagic stroke present with similar focal neurologic deficits but tend to be more ill than patients with ischemic stroke
Other Clinical Clues
Causes: Uncontrolled hypertension Anticoagulants Coagulopathies
Known bleeding diathesis Advanced liver disease
Elderly with poor cognition (cerebral amyloid angiopathy)
Known vascular malformations or aneurysms Brain tumours
Radiological Hallmarks
Urgent Non-contrast CT scan of the Brain Blood looks bright white
Don't confuse this with cerebral calcification
Parenchymal versus subarachnoid Location
Deep versus lobar
Volume Ventricular extension Hydrocephalus
Location of Bleeds
Deep 50% Lobar 35% Cerebellum 10% Brainstem 5%
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