A cerebrovascular accident, more commonly known as a stroke, occurs when the blood supply to determined parts of the brain suddenly ceases. This may be due to the occlusion of a cerebral vessel, in which case the patient suffers an ischemic infarction, or due to the rupture of a blood vessel. The latter leads causes a hemorrhagic stroke. Ischemic strokes are much more common than hemorrhagic ones, but mortality is significantly higher after an intracranial hemorrhage.
Presentation
Both the occlusion of a blood vessel supplying the brain and the rupture of a cerebral vessel occur suddenly and mostly unexpectedly. Neurons are unable to tolerate oxygen and glucose deficiency for prolonged periods of time and neuronal death ensues shortly afterwards. Thus, symptom onset in stroke patients is acute. In general, a cerebrovascular accident may cause any type of neurological deficits, ranging from motor and sensory loss to cognitive impairment and decreased levels of consciousness. The type of deficits to be observed in an individual case largely depends on the location and the extent of the infarction. To some extent, on the basis of clinical symptoms, neurologists may deduce which part of the patient's brain is affected. Commonly observed neurological deficits include:
- Unilateral motor deficits, e.g., face drooping, hemiparesis/hemiplegia, inability to lift ipsilateral arm or abnormal gait
- Contralateral sensory loss
- Contralateral homonymous hemianopia
- Dysphasia
- Dysphagia
- Disturbance of consciousness
- Confusion
- Headache
- Nausea and vomiting
Space-occupying brain edema is a serious and potentially fatal complication of cerebrovascular accidents. It usually occurs between the second and fourth day after the onset of stroke symptoms [6] and possibly involves an exacerbation of neurological deficits. Brain edema is accompanied by an increase of intracranial pressure and thus, edema-mediated brain damage is not necessarily restricted to those brain regions originally affected by the cerebrovascular accident. Decreased levels of consciousness, hypertension, bradycardia and anisocoria may indicate a pathological rise of intracranial pressure due to cerebral edema.
Another possible source of delayed aggravation is reperfusion injury. Despite the fact that stroke therapy aims at recanalization and restoration of blood flow to affected brain regions, it can't currently be excluded that tissue reperfusion contributes to neuroinflammation and neuronal death. Although molecular and cellular events following tissue reperfusion are well described, evidence regarding possibly detrimental effects of reperfusion in stroke patients is still scarce [7].
Entire Body System
- Weakness
[…] had uniform finger weakness. [ncbi.nlm.nih.gov]
In the video, The Village People's iconic 1970's hit "Y.M.C.A." refreshes its lyrics to“F.A.S.T.,” a memory aid that stands for face drooping, arm weakness, speech difficulty, and time to call 911. [strokeassociation.org]
- Epilepsy
Our primary aim was to evaluate whether early EEG abnormalities can predict poststroke epilepsy. [onlinelibrary.wiley.com]
Patients with a history of epilepsy before the stroke (n=19) or who died in the first day after the stroke (n=17) were excluded from these analyses. [doi.org]
Seizure Disorders and Epilepsy Abnormal electrical activity in the brain can cause seizures. When a person has repeated seizures, this condition is called epilepsy. [urmc.rochester.edu]
[…] and clinical trials for epilepsy. [henryford.com]
- Unconsciousness
Other symptoms include: confusion, difficulty speaking or understanding speech; difficulty seeing with one or both eyes; difficulty walking, dizziness, loss of balance or coordination; severe headache with no known cause; fainting or unconsciousness. [who.int]
Depending on which area of the brain is affected, a stroke can cause speech impairments, paralysis, unconsciousness, or even death. [msdmanuals.com]
* An episode of unconsciousness or convulsions. More information eMedicine Health: Stroke Consumer health resource center, providing information on the causes, symptoms, and urgent treatment of stroke. [curlie.org]
Symptoms of brain ischemia can include unconsciousness, blindness, problems with coordination, and weakness in the body. Other effects that may result from brain ischemia are stroke, cardiorespiratory arrest, and irreversible brain damage. [en.wikipedia.org]
- Hypothermia
Olsen TS, Weber UJ, Kammersgaard LP: Therapeutic hypothermia for acute stroke. Lancet Neurol 2003, 2 :410–416. PubMed CrossRef Google Scholar 23. [doi.org]
Evidence supporting the use of therapeutic hypothermia after brain ischemia, however, is limited. A closely related disease to brain ischemia is brain hypoxia. [en.wikipedia.org]
Accidental hypothermia and impaired temperature homoeostasis in the elderly. Br Med J. 1977 Feb 5; 1 (6057):353–356. [ PMC free article ] [ PubMed ] [ Google Scholar ] JOHNSON RH, SMITH AC, SPALDING JM, WOLLNER L. [ncbi.nlm.nih.gov]
This sometimes took place daily for up to 2 weeks or until the patient could tolerate the compression. 53 In the past, hypothermia, hypercarbia, and hypocarbia were used for cerebral protection. [stroke.ahajournals.org]
- Difficulty Walking
Other symptoms include: confusion, difficulty speaking or understanding speech; difficulty seeing with one or both eyes; difficulty walking, dizziness, loss of balance or coordination; severe headache with no known cause; fainting or unconsciousness. [who.int]
Sudden difficulty walking or dizziness, loss of balance or problems with coordination. Severe headache with no known cause. Stroke is the leading cause of adult disability in the United States. [webmd.com]
walking or unexplained dizziness or unsteadiness; especially in combination with any of the previously noted symptoms Other less common symptoms of stroke may include sudden nausea or vomiting, fainting, confusion, seizures or coma. [barnesjewish.org]
They include Sudden numbness or weakness of the face, arm, or leg (especially on one side of the body) Sudden confusion, trouble speaking, or understanding speech Sudden trouble seeing in one or both eyes Sudden difficulty walking, dizziness, loss of [medlineplus.gov]
Gastrointestinal
- Vomiting
We present a case of a previously healthy 36-year-old man who presented with vertigo and vomiting. MRI showed posterior circulation territory infarction. [ncbi.nlm.nih.gov]
Slurred speech or dysarthria Double vision or other vision problems A headache Nausea and or vomiting 2017 Fast Parody Video When it comes to spotting stroke and getting help, the faster, the better. [strokeassociation.org]
Four common effects of strokes in the cerebellum include the following: inability to walk and problems with coordination and balance (ataxia) dizziness headache nausea and vomiting Effects of a stroke in the brain stem: The brain stem is located at the [web.archive.org]
* Sudden nausea and vomiting, unrelated to viral illness. * An episode of unconsciousness or convulsions. [curlie.org]
- Nausea
Slurred speech or dysarthria Double vision or other vision problems A headache Nausea and or vomiting 2017 Fast Parody Video When it comes to spotting stroke and getting help, the faster, the better. [strokeassociation.org]
He developed headache, nausea, vomiting, blurred vision, diplopia, dizziness, and ataxia following the procedure. Initial history and examination suggested that the patient's symptoms were vascular in origin. [ncbi.nlm.nih.gov]
Four common effects of strokes in the cerebellum include the following: inability to walk and problems with coordination and balance (ataxia) dizziness headache nausea and vomiting Effects of a stroke in the brain stem: The brain stem is located at the [web.archive.org]
* Sudden nausea and vomiting, unrelated to viral illness. * An episode of unconsciousness or convulsions. [curlie.org]
Sudden severe headache with no apparent cause Sudden episodes of difficulty walking or unexplained dizziness or unsteadiness; especially in combination with any of the previously noted symptoms Other less common symptoms of stroke may include sudden nausea [barnesjewish.org]
- Constipation
Loss of bowel control or constipation also may occur after a stroke. [web.archive.org]
Constipation is a common side effect of some pain medications, not drinking enough liquids, or not being as physically active. It’s also possible for the stroke to affect the part of your brain that controls your bowels. [healthline.com]
[…] problems with your speech, reading and writing problems with your sight – you might have double vision or find it hard to see problems with your memory and difficulty concentrating difficulty controlling your bladder and bowel movements (incontinence or constipation [bupa.co.uk]
Bladder and bowel problems: urinary incontinence, faecal incontinence, constipation. Swallowing problems, poor oral health, malnutrition, dehydration. Sexual dysfunction. Difficulties with activities of daily living: personal, social and vocational. [patient.info]
Liver, Gall & Pancreas
- Protein S Deficiency
In other patients, especially younger patients, other causes should be considered, including the following: [7, 42] Hypercoagulable states (eg, antiphospholipid antibodies, protein C deficiency, protein S deficiency, pregnancy) Sickle cell disease Fibromuscular [emedicine.com]
Testing for protein C, protein S, and antithrombin deficiency is generally indicated 2 to 4 weeks after completion of anticoagulation. [doi.org]
Cardiovascular
- Hypertension
Abstract Hypertension and stroke Hypertension is a major risk factor for stroke, and stroke prevention is the most important achievement of modern antihypertensive treatment. [doi.org]
Hypertension and stroke Hypertension is a major risk factor for stroke, and stroke prevention is the most important achievement of modern antihypertensive treatment. [web.archive.org]
This has been reported in particular in the initial treatment of very severe hypertension, and occasionally in the elderly hypertensive. [journals.lww.com]
hypertensive or not (5665 patients). [ncbi.nlm.nih.gov]
- Tachycardia
Decompensation on the ward during thrombolysis with worsening abdominal distension and pain, hypotension and tachycardia prompted a CT angiogram scan, which displayed proximal inferior mesenteric artery occlusion. [ncbi.nlm.nih.gov]
Ventricular tachycardia represents a series of irregular heartbeats that may cause the heart to completely shut down resulting in cessation of oxygen flow. [en.wikipedia.org]
[…] cranial nerve deficits (eg, nystagmus, vertigo, dysphagia, dysarthria, diplopia, blindness), truncal or limb ataxia, spastic paresis, crossed sensory and motor deficits*, impaired consciousness, coma, death (if basilar artery occlusion is complete), tachycardia [msdmanuals.com]
There is a higher prevalence of CD in patients with Postural Orthostatic Tachycardia Syndrome (POTS)[ 163 ]; thus these patients should also be screened for CD[ 164 ]. [doi.org]
Eyes
- Diplopia
The second patient (male, 62 years old) developed diplopia, dysarthria and trunk ataxia after consuming 4-units of alcohol, and his symptoms were attributed to alcohol intoxication. [ncbi.nlm.nih.gov]
Symptoms associated with high agreement for the diagnosis of stroke or transient ischemic attack vs no vascular event are a sudden change in speech, visual loss, diplopia, numbness or tingling, paralysis or weakness, and non-orthostatic dizziness (κ = [doi.org]
- Blurred Vision
He developed headache, nausea, vomiting, blurred vision, diplopia, dizziness, and ataxia following the procedure. Initial history and examination suggested that the patient's symptoms were vascular in origin. [ncbi.nlm.nih.gov]
Signs that you may be having a stroke: Sudden numbness or weakness of the face, arm or leg, especially on one side of the body Sudden confusion, trouble speaking or understanding Sudden trouble seeing or blurred vision in one or both eyes Sudden trouble [goredforwomen.org]
[…] or blurred vision · feeling numb or weak (or being paralysed) on one side of the body. [bloodpressureuk.org]
[…] changes, blurred vision, or trouble with eyesight in one or both eyes Dizziness Severe headache that usually is unlike headaches in the past Confusion Inability to speak, slurred speech, or inability to understand speech Loss of sensation in any part [medicinenet.com]
Signs of a stroke in older children are often similar to signs in adults, such as: sudden weakness slurred speech blurred vision Babies who have a perinatal stroke often don't show any signs of it until months or years later. [kidshealth.org]
- Visual Impairment
Visual impairments and hemianopia. Bladder and bowel problems: urinary incontinence, faecal incontinence, constipation. Swallowing problems, poor oral health, malnutrition, dehydration. Sexual dysfunction. [patient.info]
- Anisocoria
Decreased levels of consciousness, hypertension, bradycardia and anisocoria may indicate a pathological rise of intracranial pressure due to cerebral edema. Another possible source of delayed aggravation is reperfusion injury. [symptoma.com]
Skin
- Alopecia
• Young women presents as a photosensitive facial rash with pruritic lower lip cheilitis, • May be a/w conjunctivitis, eyebrow alopecia and pterygion. • Distinguished from actinic cheilitis, which is due to prolonged and excessive exposure to UV irradiation [slideshare.net]
[…] vulgaris 12 086·8 (8150·7 to 17 552·7) 15 067·6 (10 169·9 to 21 752·0) 15 836·0 (10 643·5 to 22 842·6) 31·0 (29·7 to 32·4) * 5·1 (4·3 to 5·8) * 202·3 (136·5 to 292·9) 207·8 (140·1 to 300·1) 212·1 (143·0 to 306·4) 4·9 (4·2 to 5·6) * 2·1 (1·5 to 2·6) * Alopecia [ncbi.nlm.nih.gov]
Musculoskeletal
- Muscle Spasticity
Muscles that are not used usually become permanently spastic and stiff, and painful muscle spasms may occur. Walking, swallowing, physically saying words clearly, and doing daily activities may remain difficult. [msdmanuals.com]
In the recovery period, a stroke patient may develop muscle spasticity and contractures, or abnormal contractions. Contractures may be treated with a combination of stretching and splinting. [medical-dictionary.thefreedictionary.com]
Face, Head & Neck
- Facial Numbness
A 48-year-old man presented with acute onset of left facial numbness, ataxic gait and double vision. He also complained of chronic right lower leg pain with acute onset a year prior to presentation. His vital signs were within normal limits. [ncbi.nlm.nih.gov]
Psychiatrical
- Flat Affect
Post-stroke emotional difficulties include anxiety, panic attacks, flat affect (failure to express emotions), mania, apathy and psychosis. [en.wikipedia.org]
Neurologic
- Confusion
Or the symptoms may be confused with those of other conditions that cause similar symptoms. [stanfordhealthcare.org]
The symptoms of a stroke include sudden numbness or weakness, especially on one side of the body; sudden confusion or trouble speaking or understanding speech; sudden trouble seeing in one or both eyes; sudden trouble with walking, dizziness, or loss [ninds.nih.gov]
– Other Symptoms You Should Know Sudden NUMBNESS or weakness of face, arm, or leg, especially on one side of the body Sudden CONFUSION, trouble speaking or understanding speech Sudden TROUBLE SEEING in one or both eyes Sudden TROUBLE WALKING, dizziness [strokeassociation.org]
Other symptoms include: confusion, difficulty speaking or understanding speech; difficulty seeing with one or both eyes; difficulty walking, dizziness, loss of balance or coordination; severe headache with no known cause; fainting or unconsciousness. [who.int]
- Seizure
Occurrence of single and recurrent seizures. 52 patients had one or more post stroke seizures; in 25 the seizures were recurrent. [ncbi.nlm.nih.gov]
- Dizziness
A healthy 36-year-old man experienced sudden dizziness while swimming. His dizziness persisted irrespective of the change in position, and then improved during transport. He had no neurological abnormality when he arrived at the emergency room. [ncbi.nlm.nih.gov]
The symptoms of a stroke include sudden numbness or weakness, especially on one side of the body; sudden confusion or trouble speaking or understanding speech; sudden trouble seeing in one or both eyes; sudden trouble with walking, dizziness, or loss [ninds.nih.gov]
– Other Symptoms You Should Know Sudden NUMBNESS or weakness of face, arm, or leg, especially on one side of the body Sudden CONFUSION, trouble speaking or understanding speech Sudden TROUBLE SEEING in one or both eyes Sudden TROUBLE WALKING, dizziness [strokeassociation.org]
Other symptoms include: confusion, difficulty speaking or understanding speech; difficulty seeing with one or both eyes; difficulty walking, dizziness, loss of balance or coordination; severe headache with no known cause; fainting or unconsciousness. [who.int]
- Aphasia
To assess the effects of speech and language therapy (SLT) for aphasia following stroke. [ncbi.nlm.nih.gov]
AOS is believed to commonly co‐occur with aphasia, which may also result in sound errors in speech (phonemic paraphasias), but many studies fail to describe the way in which aphasia and AOS coexist. [doi.org]
Studies there showed that she too had global aphasia and right hemiparesis without Horner syndrome, and had an NIHSS score of 17. [web.archive.org]
- Neglect
LESSONS: Allocentric neglect due to injury of IFOF was demonstrated in a stroke patient using DTT. It appears that DTT would be helpful in demonstrating the neglect type and pathway in patients with neglect. Copyright © 2017 The Authors. [ncbi.nlm.nih.gov]
This will be associated with improvements in spatial neglect, activities of daily living and quality of life in these patients. [isrctn.com]
Objectives This systematic review summarizes the effectiveness of mirror therapy for improving motor function, activities of daily living, pain, and visuospatial neglect in patients after stroke. [doi.org]
Workup
Brain imaging is the single most important tool to assess cerebrovascular accidents. Both computed tomography scans and magnetic resonance imaging are employed to this end, and specific approaches include computed tomography or magnetic resonance angiography, diffusion- and perfusion-weighted imaging as well as fluid-attenuated inversion recovery [8] [9]:
- In most cases, initial computed tomography scans will be conducted without contrast agents to exclude intracranial hemorrhages as a possible cause of neurological deficits. This technique is widely available and results can be obtained within short periods of time.
- Subsequently, contrast-enhanced computed tomography angiograms may be recorded. They provide detailed information regarding the cause and location of the interruption of blood flow and are thus highly valuable in guiding treatment decisions.
- However, even greater sensitivity of stroke detection is attributed to diffusion-weighted magnetic resonance imaging. Major disadvantages of this technique are limited availability and high costs.
The aforementioned imaging methods are also very helpful to reveal the cause of the ischemic or hemorrhagic cerebral infarction, but should be complemented with blood analyses and cardiac examination.
EEG
- EEG Slowing
We searched MEDLINE and PubMed data base with the key words: abnormal EEG patterns, coma and EEG, epileptiform EEG, FIRDA, OIRDA, TIRDA and slowing EEG. [scielo.br]
- Intermittent Slow Activity
Continuous slow activity suggests a more severe brain damage (likelihood of increased mass effect, large lesion or deep hemispheric lesion), whereas intermittent slow activity usually indicates a small lesion and absence of mass effect 15. [scielo.br]
- Rhythmic Slowing
Rhythmic slow discharges in the electroencephalogram. J Neurol Neurosurg Psychiatry 1945;8:65. [ Links ] 19. Faure J, Droogleever-Fortuyn, Gastaut H. [scielo.br]
Serum
- Hyperglycemia
Patients are also evaluated for coexisting acute general disorders (eg, infection, dehydration, hypoxia, hyperglycemia, hypertension). Patients are asked about depression, which commonly occurs after stroke. [msdmanuals.com]
Persistent poststroke hyperglycemia is independently associated with infarct expansion and worse clinical outcome. Stroke. 2003 Sep. 34(9):2208-14. [Medline]. Mandelzweig L, Goldbourt U, Boyko V, Tanne D. [emedicine.com]
Fever and hyperglycemia are treated aggressively because elevated body temperatures and elevated blood glucose levels have been linked to poorer outcomes. [medical-dictionary.thefreedictionary.com]
- Creatine Phosphokinase Increased
Interestingly, creatine phosphokinase increased after l-carnitine was stopped, indicating that l-carnitine had helped to reduce muscle damage during rehabilitation. [ncbi.nlm.nih.gov]
Treatment
Treatment for stroke includes acute stroke management and surgical management [10]. Acute stroke management includes restoration of homeostasis done by oxygen therapy, blood sugar control with optimal insulin therapy and antihypertensive treatment for hypertensive encephalopathy, hypertensive nephropathy, hypertensive cardiac failure, aortic dissection, preeclampsia and intracerebral hemorrhage. People with acute stroke have to be provided with aspirin, thrombolytic treatment, anticoagulants and tranquilizers. Surgery is necessary for supratentorial hemorrhage or cerebellar hematoma. Carotid endarterectomy is performed for carotid artery stenosis. Surgical decompressive hemicraniectomy is performed for middle cerebral artery infarction, which has to be finished within 48 hours [11].
Prognosis
Prognosis of stroke was observed in 77 patients in a 7 year follow-up study. The study revealed that 31 patients had normal cranial blood flow and the remaining 46 had subnormal cranial blood flow. During the follow-up study, 7 patients died, 3 from stroke and 4 from other causes. Out of 24 patients of subnormal cranial blood flow group, 13 died from stroke and 11 from various diseases. The survival rate was lower consistently in the subnormal cranial blood flow group than in the normal one. The difference in the survival rate was found significant during the 5 and 7 years of follow-up [5].
Etiology
Etiologies of around 60 patients in the age range of 15 to 40 years with cerebral infarction in a research study by Grindal A.B. et. al. were monitored. Some of the causes for this disease were broadly identified as cardiac, hematologic, inflammatory, occlusive extra cranial vascular disease, postpartum and trauma. Cardiac causes are further divided into rheumatic heart disease with or without atrial fibrillation, sub-acute bacterial endocarditis, atrial fibrillation without rheumatic heart disease and myocardial infarction.
Hematologic causes are divided into polycythemia, sickle cell disease, thrombocytosis and disseminated intravascular coagulation. Inflammatory cause is subdivided into systemic lupus erythematosus, polyarteritis nodosa and syphilis. Other vascular causes of cerebral infarction are atherosclerosis-atherothrombosis, arterial dissection, cardio embolism, vasculitis, meningitis and fungal vasculitis, hypercoagulability, inherited metabolic disorders, and fibromuscular dysplasia and other angiopathies [2].
Epidemiology
In a research sturdy conducted in 1994, hospital and population statistics show that cerebral infarction indicates about 80 percent of all strokes. A decrease in mortality associated stroke and cerebral infarction in particular was observed in many countries in the recent period. Research studies have explained that treatment of severe or moderate hypertension reduces the stroke incidence. Annual risk of cerebral infarction is found to be related to asymptomatic carotid artery stenosis, which is estimated to be between 1 and 2 percent [3].
Pathophysiology
The infarction on the first day appears as poorly demarcated area of softening. In the last stages of edema, the infarction appears hypodense and bright on T2 magnetic resonance imaging. The tissue of infarction will get demarcated sharply and will soften progressively. The tissue starts disintegrating from the second week and a cavity is created at that place. The anatomy of vascular territories indicates the size and location of the infarction. Microscopic evaluation during the first 24 to 48 hours discloses anoxic neurons, vacuolization of the white matter due to disentanglement of swellings of myelin and axon. Initially, there was inflammation around the blood vessels due to the release of arachidonic acid and other fatty acids. As the infarction degenerates, proliferation of peripheral region endothelial cells will continue and the capillaries will form a dead tissue [4].
Prevention
Appropriate risk assessment tool is used for assessing cardiovascular risk. Lifestyle factors like dietary advice, physical activity, weight management, alcohol consumption, and cessation of smoking are performed to prevent the disease. Drug treatment for hypertension, anti-thrombosis, lipid lowering and aspirin are helpful in primary prevention. Secondary prevention is possible with the use of dipyridamole, clopidogrel and anti-lipid agents [12].
Summary
Cerebral infarction of the brain is associated with the tiny spheroidal necrosis of the nervous tissue in the ischemic area with the distribution of the arterial vessel. Ischemia precedes infarction and both are reversible. If infarction is permanent, then there will be irreversible damage to the nervous tissue. Necrosis of nervous tissue needs not occur in all the ischemic cases. Various cell types have different intensities of sensitivities to ischemia. Penumbra is the peripheral area of the ischemic region, where the cells survive for a few hours under risk, if the blood circulation is not established. When a vessel is occluded, the entire region that it is supplying does not become ischemic as collateral circulation occurs effectively and quickly.
Circle of Willis and anastomoses of carotid arteries are examples of effective collateral circulation. Main reasons for cerebral infarction include atherosclerotic obstruction of bigger vessels, embolic blocking of distal vessels, arterial spasm and vasculitis. Common symptoms include stroke accompanied by neurological syndromes [1].
Patient Information
- Definition: Tiny spheroidal necrosis of nervous tissue in the ischemic area with the arterial vessel distribution is called as cerebral infarction of the brain. If the damage due to infarction is permanent in the nervous tissue, then it is irreversible.
- Cause: Some of the causes of cerebral infarction include atherosclerosis, vasculitis, cardio-embolism, systemic lupus erythematosus, vascular spasm, meningitis, sickle cell disease, hypercoagulability and inherited metabolic disorders.
- Symptoms: Some of the symptoms of cerebral infarction are contralateral hemiplegia that is initially flaccid and then become spastic, sensory loss, homonymous hemianopia and dysphasia.
- Diagnosis: Initial diagnosis of cerebral infarction is done by blood tests, ventricular hypertrophy is evaluated by electrocardiogram, chest X-ray and echocardiography are utilized for assessing large left atrium and myocardial infarction. Brain imaging is performed for patients having undergone blood tests and those with severe headache.
- Treatment: Acute stroke management for cerebral infarction is done by oxygen therapy, antihypertensive treatment and optimal insulin therapy. Acute stroke is treated with anticoagulants, thrombolytic treatment, aspirin, and tranquilizers. Surgery is suggested for cerebellar hematoma.
References
- Amarenco P, Lavallée PC, Labreuche J, et al. Prevalence of coronary atherosclerosis in patients with cerebral infarction. Stroke 2011; 42:22.
- Moncayo J, Devuyst G, Van Melle G, Bogousslavsky J. Coexisting causes of ischemic stroke. Arch Neurol 2000; 57:1139.
- Caplan LR, Gorelick PB, Hier DB. Race, sex and occlusive cerebrovascular disease: a review. Stroke 1986; 17:648.
- Caplan LR. Brain embolism. In: Practical Clinical Neurocardiology, Caplan LR, Chimowitz M, Hurst JW. (Eds), Marcel Dekker, New York 1999
- Capes SE, Hunt D, Malmberg K, et al. Stress hyperglycemia and prognosis of stroke in nondiabetic and diabetic patients: a systematic overview. Stroke 2001; 32:2426.
- Bardutzky J, Schwab S. Antiedema therapy in ischemic stroke. Stroke. 2007; 38(11):3084-3094.
- Nour M, Scalzo F, Liebeskind DS. Ischemia-reperfusion injury in stroke. Interv Neurol. 2013; 1(3-4):185-199.
- Birenbaum D, Bancroft LW, Felsberg GJ. Imaging in acute stroke. West J Emerg Med. 2011; 12(1):67-76.
- Wintermark M, Sanelli PC, Albers GW, et al. Imaging recommendations for acute stroke and transient ischemic attack patients: A joint statement by the American Society of Neuroradiology, the American College of Radiology, and the Society of NeuroInterventional Surgery. AJNR Am J Neuroradiol. 2013; 34(11):E117-127.
- Goldstein LB, Samsa GP. Reliability of the National Institutes of Health Stroke Scale. Extension to non-neurologists in the context of a clinical trial. Stroke 1997; 28:307.
- Bruno A, Durkalski VL, Hall CE, et al. The Stroke Hyperglycemia Insulin Network Effort (SHINE) trial protocol: a randomized, blinded, efficacy trial of standard vs. intensive hyperglycemia management in acute stroke. Int J Stroke 2014; 9:246.
- Aiyagari V, Gorelick PB. Management of blood pressure for acute and recurrent stroke. Stroke 2009; 40:2251.