ischemic%20stroke
ISCHEMIC STROKE
Ischemic stroke occurs when a blood vessel supplying the brain is obstructed.
Consider stroke in any patient presenting with sudden focal neurological deficit or any alteration in level of consciousness.
Rapid evaluation is essential for sure of time-sensitive treatments.
Determine if patient's symptoms are due to stroke and exclude stroke mimics (eg migraine, hypertensive encephalopathy, hypoglycemia, seizures or post-ictal paresis); identify other conditions requiring immediate intervention and determine the potential causes of stroke.

Ischemic%20stroke Signs and Symptoms

Introduction

  • Stroke or cerebrovascular disease is defined as a sudden onset of focal neurological deficit or any alteration in level of consciousness due to an underlying vascular pathology
  • Ischemic stroke is a type of stroke characterized by the sudden absence of blood supply to an area of the brain, spinal cord or retina secondary to a thrombus or emboli
  • Rapid evaluation is essential for use of time-sensitive treatments and to prevent further brain damage

Signs and Symptoms

Common Presentation of Patients with Acute Ischemic Stroke

Left (dominant) hemisphere

  • Left gaze preference
  • Right visual field deficit
  • Right hemiparesis
  • Right hemisensory loss
  • Dysarthria
  • Aphasia (Broca’s, Wernicke’s, Global)
  • Apraxia 
  • Visual agnosia

Right (non-dominant) hemisphere

  • Right gaze preference
  • Left visual field deficit
  • Left hemiparesis
  • Left hemisensory loss (hemi-inattention)
  • Neglect of left side
  • Dysarthria

Brainstem

  • Nausea/vomiting
  • Diplopia, dysconjugate gaze, gaze palsy, nystagmus, visual agnosia
  • Homonymous hemianopsia due to 3rd nerve palsy paralysis
  • Dysarthria, dysphagia
  • Vertigo, syncope
  • Hemiparesis or quadriplegia
  • Sensory loss in hemibody or all 4 limbs
  • Decreased consciousness
  • Hiccups, abnormal respirations
  • Alexia or inability to understand words written

Cerebellum

  • Truncal/gait ataxia, limb ataxia
  • Dysarthria
  • Vertigo, nystagmus
Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Cardiology - Malaysia digital copy today!
Sign In To Download
Editor's Recommendations
Most Read Articles
29 Mar 2020
Targeting a low-density lipoprotein cholesterol level <70 mg/dL following an ischaemic stroke of atherosclerotic origin helps to avoid one in four subsequent major vascular events without increasing the risk of intracranial haemorrhage over about 5 years of follow-up, according to data from the Treat Stroke to Target trial.
Pearl Toh, 12 Sep 2020
Early initiation of rhythm-control therapy led to a significantly reduced risk of major adverse cardiovascular (CV) outcomes compared with usual care (typically rate control) in patients with newly diagnosed atrial fibrillation (AF) at risk of stroke, reveals the EAST-AFNET 4* trial presented at ESC 2020.
Audrey Abella, 16 Sep 2020
The final results of EVAPORATE* reinforce the plaque-regressing potential of icosapent ethyl (IPE) in patients on statins for elevated triglycerides.
01 Feb 2020
High-intensity statin therapy appears to be seeing increased use in patients with acute coronary syndrome and leads to better lipid control, according to a recent Thailand study.