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  • Approach To Stroke Patient

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    NEuRoLoGisT CoFFeeCuP
    1K vues16 pages
    Stroke is the most common cause of neurological disability in the u.s. Stroke is the leading cause of death in the united states. The most common causes of Stroke are Ischemic Stroke and myocardial infarction.

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    Approach to Stroke Patient

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    Stroke is the most common cause of neurological disability in the u.s. Stroke is the leading cause of death in the united states. The most common causes of Stroke are Ischemic Stroke and myocardial infarction.

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    1K vues16 pages

    Approach To Stroke Patient

    Transféré par

    NEuRoLoGisT CoFFeeCuP
    Stroke is the most common cause of neurological disability in the u.s. Stroke is the leading cause of death in the united states. The most common causes of Stroke are Ischemic Stroke and myocardial infarction.

    Droits d'auteur :

    Attribution Non-Commercial (BY-NC)
    Téléchargez comme PDF ou lisez en ligne sur Scribd
    Signaler comme contenu inapproprié
    sur 16

    Approach
to
stroke
pa-ent!

    Surat
Tanprawate,
MD,
FRCPT(T)

    Northern
Neuroscience
Center

    Chiangmai
University!

    www.neurologycoffeecup.com
    Outline
approach
to
pa-ent!
    Sudden
onset
of

    Localiza-on
of
lesion! neurological
deficit! Suspected
stroke!

    Stroke
mimicker

    Stroke
VS
Stroke
 Tumor

    mimicker!
    Infec-on
!

    Stroke
type!

    Ischemic
stroke! Hemorrhagic
stroke!

    Stroke
subtype
by
 Primary
VS

    TOAST
 Secondary

    classifica-on
 Hemorrhagic
stroke!
    Stroke
mimicker!
    Unrecognized
 Confusion
state! Syncope
!
    seizure!

    13%
ini-ally
diagnos-c

    stroke

    
was
stroke
mimicker


    Toxic
and
 Subdural

    hematoma! Tumor
!
    metabolic

    disorder!

    Misdiagnosis
of
stroke:
Lancet,
1982;1:328‐331!
    “stroke
localiza.on:

    vascular
distribu.on
of

    the
ischemic
lesion”!

    Anterior
VS
posterior
circula-o
stroke!
    Anterior
circula-on
stroke!
    Posterior

    circula-on

    stroke!
    Infarc-on
VS
Hemorrhage!
    •  Some
clues
from
Hx.
And
PE

    •  ICH

    – Coma
on
arrival

    – Vomi-ng

    – Severe
headache

    – Current
warfarin
therapy

    – SBP>220
mmHg

    – Glucose
level>170
mg/dL
in
non‐diabe-c
pa-ent

    Stroke
1981;12:
288‐293

    Arch
Intern
Med
1985;145:1800‐1803!
    Classifica-on
of
ischemic
stroke

    “TOAST
classifica-on”!
    1. Large
artery
atherosclerosis

    2. Cardioembolism

    3. Small
vessel
occlusion

    4. Stroke
of
other
determined
e-ology

    5. Stroke
of
undetermined
e-ology!
    Problem list

    1.  Acute onset quadriparesis with urinary incontinence


    2.  Previous episode of transient right hemiparesis
    3.  Decreased bilateral carotid pulsations
    4.  Bilateral frontal lobe signs
    5.  Left parietal cortical impairement
    (astereognosis, agraphia)
    6.  Right UMN VII
    7.  Bilateral pyramidal weakness
    8.  Bilateral babinski response
    Old R frontal lobe infarction Anterior watershed infarction at
    left frontal and parietal lobes
    Normal

    Border-zone ischemia

    Ischemia at center of bl supply

    Anterior watershed

    Subcortical watershed

    Posterior watershed
    Anterior Watershed Infarction
    Moyamoya-“like” disease = “Puff-Of-Smoke”!
    Bilateral occlusion of internal carotid arteries
    ⇒  Fine collateral arteries

    Children ⇒ Alternating hemiplegia


    Adults ⇒ Subarachnod haemorrhage !
    Thank
you
for
your
aden-on


    www.neurologycoffeecup.com


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