The patient with an acute stroke
Andrew Stewart in Pocket On Call, 2015
Patients with established cerebrovascular accidents (CVA) are usually cared for on designated stroke units, which provide specialist medical, nursing, and therapy input. Strokes, or CVAs, represent a significant cause of morbidity and mortality with an average incidence of 1/100 in those aged greater than 75. Thrombolysis with alteplase is considered for patients with acute ischaemic stroke, with no evidence of haemorrhage, who present within a 4.5-hour window from symptom onset. These account for 80% of all strokes and are the result of either a thrombosis superimposed upon an atherosclerotic plaque within a cerebral artery or an embolic event. In theory, a true embolic stroke will produce a very acute onset of symptoms with maximal neurological deficit seen immediately, whereas an infarct caused by thrombosis in situ tends to develop over minutes to hours. In the context of acute stroke, imaging should be obtained.
Introduction
Christos Tziotzios, Jesse Dawson, Matthew Walters, Kennedy R Lees in Stroke in Practice, 2017
The onset of stroke is sudden and can be either haemorrhagic or ischemic. This chapter reviews the essential neuroanatomy and pathophysiology before considering stroke classification systems. It discusses Stroke syndromes, assessment of the suspected stroke patient, evidence-based management strategies, stroke mimics, stroke in the young adult, transient ischemic attacks, and the role of different imaging strategies. In haemorrhagic stroke, bleeding into the brain parenchyma occurs and causes neuronal damage via several mechanisms. Stroke and transient ischaemic attack should best be thought of as a continuum, as the same risk factors underpin both disease processes and the latter heralds the former. The incidence of stroke varies among countries and increases exponentially with age, as does the likelihood of a poor outcome after a cerebrovascular event. Focal cerebral ischemia due to arterial occlusion accounts for the majority of strokes with some 80% of strokes in Western societies being of ischemic aetiology, whereas haemorrhages account for the remaining 20%.
Stroke Clients' Perceptions of Disability and Treatment
Laura H. Krefting in Occupational Therapy Approaches to Traumatic Brain Injury, 2013
SUMMARY. Twenty subjects who had experienced a stroke and were serving as a control group in a larger research project, were interviewed regarding the effect the stroke had had on their lives and their perceptions of the occupational therapy they had received. The majority of the subjects had very little understanding of the nature of a stroke but were well able to articulate the effect the stroke had had on their lives. How each person experienced a stroke was very different, yet the losses each felt related to North American values of independence, mobility, individual control and coping. Treatment received in occupational therapy was most commonly described in terms of games; very few people had grasped the notion that the central purpose of occupational therapy was to help them to perform daily living tasks independently. Therapists should consequently consider the use of more functionally oriented treatment.
Stroke Due to Cerebral Vasculitis in a Patient with Relentless Placoid Chorioretinitis
Published in Ocular Immunology and Inflammation, 2018
Eileen S. Hwang, James E. Bell, Edward P. Quigley, Robert E. Hoesch, Akbar Shakoor
Purpose: To report the first case of stroke in a patient with relentless placoid chorioretinitis. Methods: Observational case report. Results: A 20-year-old female with newly diagnosed relentless placoid chorioretinitis was urgently evaluated for unilateral paresthesias. She was found to have acute bilateral pontine strokes and cerebral vasculitis on magnetic resonance imaging of the brain and cerebral angiography. Conclusions: We report the first case of stroke due to cerebral vasculitis in a patient with relentless placoid chorioretinitis. This case emphasizes the need for timely evaluation of neurological symptoms in patients with this ocular diagnosis.
Role of hospitalists in the diagnosis of atrial fibrillation for the management of cryptogenic stroke patients
Published in Hospital Practice, 2016
Cryptogenic strokes are responsible for significant morbidity and mortality. Identifying the underlying cause of cryptogenic stroke is imperative for appropriate short and long-term management of these patients. In particular, detecting atrial fibrillation in cryptogenic stroke patients may shed insight into the cause of the index stroke, but is also important to identify an important cause of secondary stroke. There is accumulating evidence indicating that monitoring for durations beyond the guideline recommended 30 day-period results in greater atrial fibrillation yield. This article reviews current guidelines and practices for the diagnosis of cryptogenic stroke, as well as outpatient cardiac monitoring options available, and focuses on the role that hospitalists have to play in the care of these patients.
The next revolution in stroke care
Published in Expert Review of Neurotherapeutics, 2014
Robert Teasell, Danielle Rice, Marina Richardson, Nerissa Campbell, Mona Madady, Norhayati Hussein, Manuel Murie-Fernandez, Stephen Page
Stroke is the second leading cause of death and disability worldwide. Initiatives to decrease the burden of stroke have largely focused on prevention and acute care strategies. Despite considerable resources and attention, the focus on prevention and acute care has not been successful in changing the clinical trajectory for the majority of stroke patients. While efforts to prevent strokes will continue to have an impact, the total burden of stroke will increase due to the aging population and decreased mortality rates. There is strong evidence for the effectiveness of rehabilitation in better managing stroke and its related disabilities. The time has come to shift the attention in stroke care and research from prevention and cure to a greater focus and investment in the rehabilitation and quality of life of stroke survivors. The rebalancing of stroke care and research initiatives requires a reinvestment in rehabilitation and community reintegration of stroke survivors.
Related Knowledge Centers
- Brain
- Circulatory System
- Hemiplegia
- Ischemia
- Thrombosis
- Arterial Embolism
- Internal Bleeding
Current Research
- Clinical Trials (United States)
- Clinical Trials (Europe)
- Clinical Trials (Australia/New Zealand)
- Clinical Trials (India)
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