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
    • Brain involvement is evident clinically or as documented in imaging studies based on the onset of symptoms
  • 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, emboli, or intracranial small vessel disease
  • Most common risk factors include hypertension and diabetes mellitus (DM)
  • 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
  • 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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