Stroke (summary)

Stroke is a clinical diagnosis where an acute neurological deficit follows a cerebrovascular insult. There are two main groups of stroke: ischaemic (>80%) or haemorrhagic (<20%) 1.

Reference article

This is a summary article; read more in our article on stroke.

Summary

  • epidemiology
    • common
    • leading cause of disability
    • third highest cause of mortality in the UK 2,3
  • presentation
    • sudden neurological deficit
    • manifest symptoms depend on the vascular territories involved
    • time of onset is important when considering treatment
  • pathophysiology
    • brain parenchyma is deprived of blood flow and therefore oxygen
    • ischaemic
      • arteries occluded by thrombus or embolus
      • temporary loss of blood flow may occur (TIA)
    • cell death results in oedema and swelling
  • investigation
    • non-contrast CT head in the first instance
      • exclude haemorrhage or other cause
      • may show hyperdense vessel or evidence of infarction
    • CT angiography
      • some centres use this to identify blockages and assess collaterals when planning clot retrieval
    • MRI
      • less commonly used for acute events, but good for identifying infarcts (especially using DWI sequences)
    • ultrasound
      • carotid Doppler ultrasound in the peri-stroke period to select patients who may benefit from endarerectomy
  • treatment
    • thrombolysis or thrombectomy
      • ischaemic strokes less than 4.5 hours old
      • depends on the local protocol
      • should be discussed with an acute stroke service
    • stroke patients should be managed in a stroke centre
    • medical management of hypertension and risk factor reduction
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Article information

rID: 34332
Synonyms or Alternate Spellings:
  • Ischaemic stroke (summary)
  • Haemorrhagic stroke (summary)
  • Ischemic stroke (summary)

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Cases and figures

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    Figure 1: diagram of cerebral vascular territories
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    Case 1: loss of grey/white differentiation (left MCA)
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    Case 1: some hours later - hypodensity (left MCA)
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    Case 1: after one day - high signal DWI (left MCA)
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    Case 1: follow-up, gliosis (left MCA)
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    Case 2: Hyperdense collection in left basal ganglia with extension into ventricular system
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    Case 3: Hypodensity in left PCA territory (ischaemic stroke)
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    Case 4: Hyperdense right MCA
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    Case 4: Hypodensity in right MCA territory
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