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Stroke

Clinical

History: Sudden onset of focal neurological deficit for > 24h.
Risk factors: CVS risk factors
ΔΔ: TIA, hypoglycaemia, migraine, extradural/subdural (trauma, alcohol abuse), subdural/tumour (progressive onset), meningitis/encephalitis (fever, neck stiffness), Todd's paresis & cerebral vasculitis
Pathology: 80% are infarcts and 20% haemorrhages

Investigations

Location

TACI (Total anterior cerebral Infarct)

Middle/anterior cerebral artery. 60% die in a year. All of:
  1. Ipsilateral hemiparesis w 2 of 3 body parts (face, arms, legs)
  2. Homonymous hemianpoia
  3. New cerebral dysfunction: dysphagia, neglect, visuospatial

PACI (Partial anterior cerebral Infarct)

Same territory. Either of:
  1. 2 out of 3 TACI
  2. New higher cerebral alone
  3. Motor/sensory deficit more restricted than TACI

POCI (Posterior circulation Infarct)

Brainstem/cerebellar signs:

LACI (Lacunar Infarct)

Commonly asymptomatic. Pure motor/sensory/sensorimotor deficit/ataxic hemiparesis/dysarthria & clumsy hand. Excluded by higher cortical involvement or disturbance of consciousness.

Prognosis

Bad for TACI. 1 year mortality is 10-20% for the rest.

Treatment

The gold standard is to treat in a specialied stroke unit.

Initial treatment

See also the emergency page.

Continuing management

Prognosis

Recurrence: In the week following the stroke 10% recur. At one month 20% recur.
Mortality: 10%
Negative prognostic signs: unsafe swallow (leads to aspiration pneumonia), loss of consciousness (80% mortality), incontinence, pyrexia, hyperglycaemica
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