Approach to Acute Stroke in the Emergency Department
Approach to Acute Stroke in
the Emergency Department
Dr Julia Hopyan
Objectives
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Types of stroke
Differentiating hemorrhagic and ischemic strokes:
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Stroke syndromes
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Clinically and radiologically
Anterior circulation:
? Middle cerebral artery
? Anterior cerebral artery
Posterior circulation:
? Posterior cerebral artery
? Basilar artery
Case examples
Types of Stroke
Ischemic
85%
Large vessel
35%
Cardioembolic
25%
Lacunar
20%
Hemorrhagic
15%
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
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