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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.

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
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