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stroke

Stroke

Journal

Definition

Permanent death of neurons caused by inadecuate perfusion of a region of brain or brainstem.

Classification

This disturbance is due to either ischemia (lack of blood flow) or hemorrhage.

Ischemic stroke.

Hemorrhagic stroke

The term major stroke is used to distinguish a full-blown stroke from a minor stroke, or transient ischemic attack (TIA).

Epidemiology

Etiology

Extra cranial carotid artery dissection and vertebral artery dissection is an important cause of stroke, especially in young people.

Stroke etiology was classified as cardioembolism in 22 patients (59.4%), large-artery atherosclerosis in 8 (21.6%), and undetermined in 7 (18.9%). The clots from cardioembolism had a significantly higher proportion of red blood cells (37.8% versus 16.9%, P = .031) and a lower proportion of fibrin (32.3% versus 48.5%, P = .044) compared with those from large artery atherosclerosis. The proportion of red blood cells was significantly higher in clots with a susceptibility vessel sign than in those without it (48.0% versus 1.9%, P < .001), whereas the proportions of fibrin (26.4% versus 57.0%, P < .001) and platelets (22.6% versus 36.9%, P = .011) were significantly higher in clots without a susceptibility vessel sign than those with it.

The histologic composition of clots retrieved from cerebral arteries in patients with acute stroke differs between those with cardioembolism and large-artery atherosclerosis. In addition, a susceptibility vessel sign on gradient echo sequence is strongly associated with a high proportion of red blood cells and a low proportion of fibrin and platelets in retrieved clots 1).


There is conflicting evidence for whether or not the incidence of stroke is influenced by the daily temperature.

The daily temperature had measurable and different associations with the number of strokes and strokes subtypes in Seoul, Korea 2).

Pathophysiology

Pathophysiology and Neuroprotective Strategies in Hypoxic-Ischemic Brain Injury and Stroke 3).

Syndromes

Diagnosis

A rapid and reliable diagnostic test to distinguish ischemic from hemorrhagic stroke in patients presenting with stroke-like symptoms is essential to optimize management and triage for thrombolytic therapy.

Stroke has been extensively studied in clinical practice and experimental research by means of MR images with ever-emerging new technologies, such as DWI, PWI, and ADC maps. More recently, different PWI-derived parameters, such as the rCBV), the relative cerebral blood flow (rCBF), the relative MTT, and the time to peak (TTP) have been applied to quantify the perfusion deficit and to evaluate the temporal infarct growth in acute stroke either in patients or in small animals with high field strength MR spectrometers 4).

Differential diagnosis

Outcome

A bursting inflammation has been observed that compromises neurologic function in patients who experience stroke.

A common complication after stroke is development of cognitive impairment and dementia.

Stroke is deemed a worldwide leading cause of neurological disability and death.

Stroke causes life long disabilities where few therapeutic options are available. Using electrical and magnetic stimulation of the brain and physical rehabilitation, recovery of brain function can be enhanced even late after stroke.

see Stroke biomarker.

Prevention

Effective strategies for reducing the risk of developing problems after stroke remain undefined. Potential strategies include intensive lowering of blood pressure (BP) and/or lipids.

Treatment

Case series

611 ischemic and 805 hemorrhagic stroke patients who were admitted within 24 h after the symptom onset. Data were analyzed with independent t test and Chi square test, and then with multivariate logistic regression analysis.

In ischemic stroke, National Institutes of Health Stroke Scale (NIHSS) score (OR 1.08; 95 % CI 1.06-1.11; P < 0.01), white blood cell count (OR 1.11; 95 % CI 1.05-1.18; P < 0.01), systolic blood pressure (BP) (OR 0.49; 95 % CI 0.26-0.90; P = 0.02) and age (OR 1.03; 95 % CI 1.00-1.05; P = 0.03) were associated with in-hospital mortality. In hemorrhagic stroke, NIHSS score (OR 1.12; 95 % CI 1.09-1.14; P < 0.01), systolic BP (OR 0.25; 95 % CI 0.15-0.41; P < 0.01), heart disease (OR 1.94; 95 % CI 1.11-3.39; P = 0.02) and creatinine (OR 1.16; 95 % CI 1.01-1.34; P = 0.04) were related to in-hospital mortality. Nomograms using these significant predictors were constructed for easy and quick evaluation of in-hospital mortality.

Variables in acute stroke can predict in-hospital mortality and help decision-making in clinical practice using nomogram 5).

1)
Kim SK, Yoon W, Kim TS, Kim HS, Heo TW, Park MS. Histologic Analysis of Retrieved Clots in Acute Ischemic Stroke: Correlation with Stroke Etiology and Gradient-Echo MRI. AJNR Am J Neuroradiol. 2015 Jul 9. [Epub ahead of print] PubMed PMID: 26159515.
2)
Shin DW, Yoon JE, Hwang HW, Kim JS, Park SQ, Roh H, Ahn MY, Lee KB. Numbers of Stroke Patients and Stroke Subtypes According to Highest and Lowest Daily Temperatures in Seoul. J Clin Neurol. 2016 Oct;12(4):476-481. doi: 10.3988/jcn.2016.12.4.476. PubMed PMID: 27819418.
3)
Meloni BP. Pathophysiology and Neuroprotective Strategies in Hypoxic-Ischemic Brain Injury and Stroke. Brain Sci. 2017 Aug 22;7(8). pii: E110. doi: 10.3390/brainsci7080110. PubMed PMID: 28829350.
4)
Park JW, Kim HJ, Song GS, Han HS. Blood-brain barrier experiments with clinical magnetic resonance imaging and an immunohistochemical study. J Korean Neurosurg Soc. 2010 Mar;47(3):203-9. doi: 10.3340/jkns.2010.47.3.203. Epub 2010 Mar 31. PubMed PMID: 20379473; PubMed Central PMCID: PMC2851093.
5)
Ho WM, Lin JR, Wang HH, Liou CW, Chang KC, Lee JD, Peng TY, Yang JT, Chang YJ, Chang CH, Lee TH. Prediction of in-hospital stroke mortality in critical care unit. Springerplus. 2016 Jul 11;5(1):1051. doi: 10.1186/s40064-016-2687-2. eCollection 2016. PubMed PMID: 27462499.
stroke.txt · Last modified: 2018/09/23 11:39 by administrador