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
Editor's Recommendations
Most Read Articles
Pearl Toh, 29 Jun 2020
Having migraine during midlife appears to be associated with a higher risk of developing dementia in later life, according to a large population-based longitudinal Danish study presented at the AHS* 2020 Virtual Meeting, indicating that migraine may be a risk factor for dementia.
Pearl Toh, 4 days ago
After treatment with fremanezumab, a difficult-to-treat patient population with treatment-resistant episodic or chronic migraine saw sustained benefits across a broad range of measures, according to multiple analyses of the FOCUS study released during the AHS 2020 Virtual Meeting.
Pearl Toh, 24 Jun 2020
While aducanumab significantly reduced clinical decline in individuals with early Alzheimer's disease (AD) in one randomized trial, no changes were seen in another identical study — rendering the role of aducanumab in AD inconclusive.
Roshini Claire Anthony, 13 Aug 2019

An active lifestyle, regardless of vascular risk, may delay the progression of Alzheimer’s disease (AD) by slowing down cognitive decline and neurodegeneration, according to a study presented at the Alzheimer’s Association International Conference (AAIC 2019).