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Stroke for Interns 05 November 2004 Is
it a stroke? Onset:
sudden Distribution:
hemibody disturbance as majority are nonbrainstem events Beware
of syncope, hypoglycemia, and Todd’s palsy STROKES
DO NOT CAUSE LOC (UNLESS LARGE BRAINSTEM) BUT CAUSE ALTERED CONSCIOUS STATES OR
A FALL DUE TO WEAKNESS Risk
factors: previous strokes
Hypertension Diabetes Smoking AF IHD
/ cardiomyopathy Cholesterol
& FHx are not that useful Is
the patient compliant or on aspirin or warfarin or clopidogrel Do
the signs make sense? Brainstem
vs nonbrainstem In
nonbrainstem, lacune vs cortical Dysarthria
(articulation) vs dysphasia (language) Signs
of risk factors: AF, bruits CT ECG CXR What
you should say Age
& premorbid status
(independent, working, nursing home) Time
of onset Distribution Risk
factors Examination
which should make sense & grade deficit CT ECG THEN
AWAIT INSTRUCTIONS Lesion localization Brainstem Why
important: because they can be devastating or fatal Nausea,
vomiting Vertigo
(true vertigo) Diplopia Nystagmus Cortical Why
important:
because they are carotid or cardioembolic in origin
That is we can do something (endarterectomy, anticoagulate) Face
> arm > leg or variations thereof Dysphasia
(beware of left handers) hemianopia Neglect Lacunar Why
important:
because they have good prognosis, few interventions available
& do not mistake for cortical Remember
your five syndromes: (MAJORITY
ARE HEMIBODY DISTURBANCES)
Pure motor
Pure sensory
Mixed motor /sensory
Ataxic hemiparesis & clumsy hand – dysarthria are rare There
is never neglect ie patient is aware of deficit There
is never dysphasia but can have dysarthria TIA If
more than 24 hrs old, it is a stroke & require admission Use
the stroke paradigms to come to a conclusion: is it a TIA? Beware
of syncope, hypoglycemia TIA
most often cortical than brainstem TIA
that occurred more than 48 hrs ago, safe to send home with aspirin and
outpatient Doppler & preferably CT whilst inpatient / A&E; unless
patient has AF, in which case warfarin Who goes where HEMORRHAGE
ISCHEMIC
STROKES
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