Ischemic Stroke

Aka: Ischemic Stroke, Cerebrovascular Accident, Cerebrovascular Disease, Cerebral Infarction, Ischemic CVA, CVA, Cerebral Cortex CVA, Cortical Stroke, Anterior Circulation CVA, Anterior Circulation Brain Infarction

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II. Definitions

  1. Ischemic Cerebrovascular Accident
    1. Neurologic dysfunction with evidence of infarction on brain imaging
  2. Transient Ischemic Attack
    1. Transient neurologic dysfunction without evidence of infarction on brain imaging

III. Risk Factors

  1. See Cerebrovascular Accident Risk Factors

IV. Epidemiology: Incidence (from most to least common)

  1. Overall Incidence: More than 795,000 cases in U.S. per year (2012)
    1. First Stroke: 610,000
    2. Recurrent Stroke: 185,000
  2. Ischemic Stroke: 85-88%
    1. Thrombotic Stroke (most common)
    2. Embolic Stroke
    3. Lacunar Stroke (least common of Ischemic Strokes)
  3. Hemorrhagic Stroke
    1. Intracerebral Hemorrhage: 9%
    2. Subarachnoid Hemorrhage: 3%
  4. Cerebral Venous Thrombosis
    1. Resulting in secondary Cerebral Infarction or Hemorrhage: 0.5 to 1%

V. Pathophysiology: Types

  1. Thrombotic CVA
    1. Typically in older patients
    2. May also occur over age 40 years old with risks (Hypertension, Hyperlipidemia, Diabetes Mellitus, Tobacco Abuse, Family History)
    3. Large vessel thrombosis (carotid, Vertebral arteries or Circle of Willis) cause fluctuating or recurring deficits developing over days
    4. Small vessel thrombosis involve deeper brain tissue (e.g. Internal Capsule, Basal Ganglia, pons, Thalamus)
  2. Embolic CVA
    1. More common in patients under age 50 years old
    2. Associated with new onset Atrial Fibrillation, valvular heart disease, endocarditis
    3. Cardiac or aortic source with often multiple sites affected and maximal deficit at onset
  3. Hypoperfusion
    1. May present as focal CVA due to asymmetric atherosclosis predisposing to localized injury
    2. Chronic Hypertension predisposes to Lacunar Infarctions (small focal Ischemic Strokes)

VI. History: General

  1. Prehospital Screening Tools
    1. See BE-FAST Stroke Screening Tool
    2. See Cincinnati Prehospital Stroke Scale
    3. See Los Angeles Prehospital Stroke Screen
  2. Exact time of onset (or last seen time when at baseline status)
  3. Seizure activity
    1. Before stroke-like symptoms
      1. Consider postictal paralysis (see below)
    2. After stroke-like symptoms
      1. Contraindicates Thrombolysis
  4. Migraine Headaches (recent)
  5. Trauma (esp. Head Trauma, neck injury) in preceding days
    1. High velocity injuries (e.g. MVA) may result in neck vessel injury and secondary thrombosis
  6. Recent illness (e.g. Pneumonia or urinary tract symptoms)
  7. Diabetes Mellitus

VII. History: Mnemonic ("LoST MIND")

  1. Last well or
  2. Onset (when observed)
  3. Seizure
  4. Trauma
  5. Migraine
  6. Illness
  7. Neck injury
  8. Diabetes Mellitus

VIII. Exam: Rapid Neurologic Exam

  1. See NIH Stroke Scale
  2. See Neurologic Exam
  3. Perform in addition to NIH Stroke Scale
    1. Goal is to rapidly identify classic lesion pattern, including findings suggestive of large vessel Occlusion
    2. High yield, focused testing for pathognomonic CNS signs
    3. Cortical signs are the most localizing CNS findings (specific for cerebral regions)
      1. Contrast with the broad differential of extremity motor and sensory findings
  4. Cortical Signs
    1. Aphasia
      1. Name 2 objects (e.g. "watch, pen")
      2. Repeat a phrase (e.g. "No Ifs Ands or Buts")
      3. Follow a command (e.g. "Raise your left hand and close your eyes")
    2. Visual defect
      1. Gaze deviation
      2. Homonomous Hemianopia (70% of large vessel Occlusions)
        1. One half of Visual Field lost in both eyes by confrontation
        2. Show 2 fingers on one side and one finger on the other side
    3. Hemineglect
      1. Is there a preference for one side over another?
      2. When performing the overall evaluation, switch sides of the bed midway through the exam
  5. Motor Exam
    1. Observe for lateralization (Unilateral Weakness)
    2. Pronator drift
      1. With palms up (supination), arms elevated and reaching forward and eyes closed
      2. Subtle weakness may be identified as the palms fall into pronation (pronator drift)
    3. Coordination
      1. Finger-Nose-Finger
      2. Finger roll
        1. Index fingertips touching and rotating around their axis
  6. Sensory Exam
    1. Light Touch Sensation in large swaths of the face and extremities
    2. CNS isolated sensory deficits may represent thalamic strokes
  7. References
    1. Kobner and Swaminathan in Swadron (2023) EM:Rap 23(3): 13-15

IX. Findings: Most reliable findings suggestive of Ischemic CVA

  1. Symptoms
    1. Acute onset of focal neurologic deficit (96% of patients)
    2. Subjective arm or leg weakness (63 to 54% of patients)
    3. Subjective speech disturbance (53% of patients)
    4. Subjective facial weakness (23% of patients)
  2. Signs
    1. Arm or leg paresis (61-69% of patients)
    2. Dysphagia or Dysarthria (57% of patients)
    3. Hemiparesis or Ataxia (53% of patients)
    4. Facial paresis (45% of patients)
    5. Eye movements or Visual Fields abnormal (27-24% of patients)
  3. References
    1. Hand (2006) Stroke 37(3): 776-80 [PubMed]
    2. Nor (2005) Lancet Neurol 4(11):727-34 [PubMed]

X. Signs: Vascular Distribution

  1. Anterior Circulation CVA
    1. Anterior Cerebral Artery CVA (2-3% of Ischemic Strokes)
      1. Contralateral motor weakness
      2. Contralateral sensory deficit of leg, and to lesser extent head (spares forehead) and arm
      3. May be accompanied by significant cognitive and emotional deficits
    2. Middle Cerebral Artery CVA (90% of Ischemic Strokes, most common)
      1. Contralateral motor weakness
      2. Contralateral sensory deficit of head (spares forehead) and arm, and to a lesser extent leg
      3. Aphasia occurs with left MCA lesion (dominant hemisphere)
      4. Hemineglect occurs with a right MCA lesion (non-dominant hemisphere)
      5. May be associated with eye changes
        1. Conjugate Eye Deviation towards the Brain Lesion
        2. Contralateral homonymous Hemianopsia (blindness in same Visual Field of each eye)
    3. Lacunar CVA (Lacunar Syndrome)
      1. Chronic Hypertension or Diabetes Mellitus results in small vessel infarcts in the distal MCA branches
      2. Microinfarctions occur from Occlusions in small, deep, penetrating vessels
      3. Patterns include pure motor Hemiparesis, pure sensory syndrome, ataxic Hemiparesis, clumsy hand
  2. Posterior Circulation CVA
    1. Posterior Cerebral Artery CVA (PCA CVA, 5% of Ischemic Strokes, affects occipital cortex)
      1. Contralateral homonymous Hemianopsia (Visual Field cut)
      2. Contralateral Visual Agnosia (cannot recognize objects)
      3. Cortical blindness may occur (e.g. CPR)
      4. Dizziness
      5. Memory and language deficits
      6. Minimal motor involvement
    2. Posterior Inferior Cerebellar Artery CVA (PICA CVA)
      1. Dysarthria, Dysphagia, Dysphonia, Vertigo, Nystagmus, and Ataxia
      2. May also be associated with crossed findings of Medullary CVA
        1. Ipsilateral facial deficit
        2. Contralateral extremity deficit
    3. Vertebro-Basilar CVA (1% of Ischemic Strokes, affects Brainstem, Cerebellum, visual cortex)
      1. Similar Posterior Circulation findings to either PCA CVA or PICA CVA described above
      2. Ipsilateral Cranial Nerve deficit and contralateral motor and sensory deficits
      3. Often presents with Vertigo, Nystagmus, and Vomiting
      4. Other associations
        1. Syncope
        2. Coma
        3. Quadriplegia
        4. Diplopia or Visual Field Deficits
        5. Dysphagia
        6. Dysarthria
      5. Associated syndromes
        1. Wallenberg's Syndrome (Vertebral ArteryOcclusion)
        2. Locked-In Syndrome (Basilar ArteryOcclusion at pons)

XI. Signs: Anatomic Distribution

  1. Cerebral Cortex CVA
    1. Motor and sensory deficits of contralateral face (Cranial Nerve deficits) and extremities
  2. Cerebellar CVA
    1. High risk for rapid decompensation and respiratory arrest due to Hemorrhage or infarct edema
      1. Consult neurosurgery early
    2. Severe Nausea and Vomiting (may be only presenting symptom)
    3. Vertigo with Nystagmus
    4. Ataxia
    5. Drop attacks (sudden inability to walk or stand)
    6. Headache
  3. Pons CVA
    1. Abnormal breathing pattern
    2. Coma
    3. Miosis
    4. Gaze Paralysis
  4. Brainstem CVA
    1. Ipsilateral facial weakness (from uncrossed Cranial NerveBrainstem nuclei)
    2. Contralateral extremity weakness (crossed Corticospinal tract)

XII. Exam: Distinguishing CVA etiology

  1. Embolic stroke-related findings
    1. Most severe at onset
    2. Concurrent embolic phenomenon (e.g. sudden pale, cold extremity)
    3. Irregularly irregular heart rhythm (Atrial Fibrillation)
    4. Heart Murmur (especially mitral valve or aortic valve)
    5. Mechanical heart sounds (Heart Valve Replacement)
    6. Fever (risk of Subacute Bacterial Endocarditis)
  2. Hypoperfusion stroke-related findings
    1. Chronic Hypertension
    2. Focal, pure deficits (pure motor or sensory deficit)
  3. Thrombotic stroke-related findings (Peripheral Arterial Disease)
    1. Decreased extremity pulses
    2. Carotid Bruits

XIII. Evaluation

  1. See CVA Evaluation
  2. See NIH Stroke Scale
  3. Bedside Glucose is an initial Vital Sign in CVA
  4. Presentations with other specific evaluation
    1. Acute Vestibular Syndrome
      1. HiNTs Exam may differentiate central Vertigo from peripheral Vertigo
    2. Thunderclap Headache (Subarachnoid Hemorrhage)
      1. Consider Lumbar Puncture if presenting >6 hours after onset
  5. Code Stroke
    1. Code stroke in most U.S. hospitals activates emergent imaging and stroke neurology Consultation
    2. Code stroke Indications (both criteria met)
      1. Reasonable likelihood presenting complaint could be explained by an acute Brain Lesion AND
      2. Patient qualifies for urgent intervention based on stroke guidelines given time and contraindications

XIV. Differential Diagnosis: Most Common (stroke mimics)

  1. Complicated Migraine such as hemiplegic Migraine (especially younger women)
  2. Hemorrhagic Stroke (Intracerebral Hemorrhage)
  3. Hypoglycemia
  4. Hypertensive Encephalopathy (PRES or Posterior Reversible Encephalopathy Syndrome)
  5. Seizure (post-ictal paralysis or Todd's Paralysis)
    1. Seizures may also secondary to Ischemic Stroke in up to 13% of cases

XV. Differential Diagnosis: Less Common (stroke mimics)

  1. Head Trauma or Spinal Trauma (Closed Head Injury)
    1. Subdural Hematoma
    2. Epidural Hematoma
    3. Spinal Epidural Hematoma
  2. CNS Infection
    1. Meningitis
    2. Encephalitis
    3. Headache and Neurologic Deficits with Cerebrospinal Fluid Lymphocytosis (HaNDL Syndrome)
  3. Metabolic Encephalopathy
    1. Nonketotic hyperosmolar coma (Hyperglycemia)
    2. Hyponatremia
    3. Postcardiac Arrest Ischemia
    4. Toxin Ingestion
    5. Myxedema (Severe Hypothyroidism)
    6. Uremia
    7. Wernicke Encephalopathy
  4. Systemic Infection
    1. Respiratory infection
    2. Urosepsis
  5. Miscellaneous
    1. Psychiatric symptoms (e.g. Somatoform Disorder, Conversion Disorder)
    2. Hypotension, shock state or Syncope
    3. Intracranial Mass (e.g. Intracranial Tumor)
    4. Acute confusional state
    5. Multiple Sclerosis
    6. Alcohol Intoxication (or other drug Intoxication)
    7. Moyamoya Disease

XVI. Precautions

  1. Stroke mimic (15-30% of stroke-like presentations) is a diagnosis of exclusion
    1. Err on the side of "Code Stroke" evaluations in first 24 hours despite increased negative work-ups
    2. Consult stroke neurology in acute presentations
    3. Be alert for stroke chameleons (neurologic deficits due to CVA but not appearing consistent with CVA)
      1. Cerebellar Strokes and Medulla Strokes (PICA CVA) may have atypical presentations
  2. Acute stroke presentation requires rapid assessment and management ("time is brain")
    1. Thrombolytics are only indicated within first 3 to 4.5 hours) from CVA onset
    2. Intervention for large vessel Occlusion is also very time sensitive
    3. Discuss with patient and family when interventions are contraindicated or not recommended
  3. ABC Management is critical
    1. Especially important in Hemorrhagic Stroke, where patients typically present obtunded
  4. Posterior Circulation CVA
    1. NIH Stroke Scale significantly underestimates posterior strokes despite disabling strokes
    2. Posterior CVA symptoms (e.g. Vertigo) are often confused with peripheral causes (e.g. Vestibular Neuronitis)
    3. Posterior strokes are not typically visualized on CT (only visualized on MRI Brain)
    4. Vertebral Artery Dissection causes 25% of Posterior Circulation strokes

XVII. Diagnosis

  1. Stroke is overdiagnosed in as many as a third of patients
    1. See differential diagnosis above for stroke mimics
    2. Stroke mimics represent up to 16% of cases in which Thrombolytics were given
    3. Predictors of misdiagnosis (stroke mimic)
      1. Known history of cognitive deficit (underlying Dementia)
      2. Non-neurologic abnormal physical findings
      3. Decreased Level of Consciousness
      4. Younger age
      5. Lower baseline NIHSS Score
      6. Global Aphasia without Hemiparesis
    4. References
      1. Guillan (2012) Cerebrovasc Dis 34(2): 115-20 [PubMed]
      2. Hand (2006) Stroke 37(3): 769-75 [PubMed]
      3. Mehta (2014) J Stroke Cerebrovasc Dis 23(5): 844-9 [PubMed]
  2. Dizziness is poorly corelated with Cerebrovascular Accident
    1. Isolated Dizziness is caused by Cerebrovascular Accident in only 0.7% of cases
      1. However stroke presenting as Dizziness is missed by the examiner in almost half of cases
    2. Factors predictive of Dizziness due to stroke
      1. See Central Causes of Vertigo
      2. Acute vestribular syndrome (Posterior Circulation in 25% of cases)
        1. Rapid onset (<1 hour) of acute, persistent, continuous Vertigo or Dizziness
        2. Associated with Nystagmus, Nausea or Vomiting, head motion intolerance, gait unsteadiness
    3. References
      1. Kerber (2006) Stroke 37(10): 2484-7 [PubMed]
      2. Tarnutzer (2011) CMAJ 183(9): E571-92 [PubMed]

XVIII. Associated Conditions: Disorders that may present concurrently or as causative factor

  1. Acute Coronary Syndrome
  2. Congestive Heart Failure
  3. Atrial Fibrillation
  4. Atrial Flutter
  5. Carotid Dissection
  6. Vertebrobasilar Dissection
  7. Thoracic Aortic Dissection (less common)

XIX. Labs

  1. See CVA Evaluation
  2. Obtain bedside Serum Glucose (fingerstick Blood Sugar)
    1. Hypoglycemia (<63 mg/dl): Administer D50W (do not over-correct)
    2. Hyperglycemia (>300 mg/dl): Administer Insulin
  3. Labs to obtain in all patients
    1. Complete Blood Count (CBC) with Platelet Count
    2. Basic metabolic profile (e.g. Chem8)
    3. INR/ProTime (PT)
    4. Partial Thromboplastin Time (PTT)
    5. Serum Troponin (or other Serum Cardiac Marker)
    6. Electrocardiogram
    7. Oxygen Saturation
  4. Labs and other diagnostics to obtain in selected patients
    1. Liver Function Tests
    2. Urine toxicology screen
    3. Blood Alcohol Level
    4. Pregnancy Test
    5. Arterial Blood Gas or Venous Blood Gas
    6. Chest XRay
    7. Hemoglobin A1C
    8. Thrombin Time (or Ecarin clotting time) Indications
      1. Direct Thrombin Inhibitor use
      2. Direct Factor Xa Inhibitor use
    9. Lumbar Puncture indications
      1. Subarachnoid Hemorrhage is suspected despite negative Head CT
      2. Meningitis or Encephalitis suspected
    10. Electroencephalogram (EEG) indications
      1. Seizure suspected
  5. Labs to consider in cryptogenic stroke
    1. Connective Tissue Disorders (e.g. Antiphospholipid Antibody Test)
    2. Hypercoagulable State (e.g. Factor V Leiden)

XX. Imaging: Initial

  1. See CVA Evaluation
  2. CT Head (non-contrast)
    1. Performed immediately in the code stroke algorithm (followed by CTA if negative)
    2. Single most important imaging test that in combination with history drives emergent management
    3. Adequate sensitivity to exclude CNS mass lesions as well as acute Hemorrhage (with caveats)
    4. Negative Head CT does not exclude CVA (especially in first few hours and in posterior CVA)
      1. More than one third of strokes are missed on initial Head CT
  3. MRI Brain with and without contrast
    1. Preferred initial study if delayed presentation (esp. >24 hours)
    2. Consider rapid MRI protocol with Diffusion Weighted Imaging (DWI) as alternative to CT Head
      1. Appears to be better imaging for initial CVA Evaluation (if not so slow)
      2. However too slow for current stroke protocols
      3. Similar efficacy to CT Head for identifying Hemorrhagic CVA
      4. Chalela (2007) Lancet 369:293-8 [PubMed]
    3. Higher Test Sensitivity for Ischemic CVA (especially posterior CVA)
      1. Overall MRI Test Sensitivity 99%
      2. Consider in patients with higher risk of stroke mimic (e.g. age <55 years old)
      3. Ferro (2010) Lancet Neurol 9(11): 1085-96 [PubMed]
      4. Bhattacharya (2013) J Neurol Sci 324(1):62-4 [PubMed]
    4. Preferred imaging to define CNS Injury after CVA
      1. After initial stabilization, MRI should be considered as part of CVA Evaluation
      2. Consider repeating MRI at 3-7 days if posterior CVA is suspected but negative on initial MRI
        1. Initial MRI in first 48 hours misses 15% of posterior strokes
    5. MRI Brain does NOT have a perfect Test Sensitivity in first few days
      1. MRI Brain may miss up to 7% of acute Ischemic Strokes in first 72 hours
      2. Missed Posterior Circulation strokes are more common than Anterior Circulation on MRI

XXI. Imaging: Vascular

  1. Performed simultaneously with initial imaging as above
    1. Identifies large vessel Occlusion
      1. Consider for endovascular intervention (onset <24 hours, large prenumbra on perfusion imaging)
      2. CTA and MRA have Test Sensitivity 87 to 100% and Test Specificity 95% for large vessel Occlusion
        1. CTA has greater accuracy than MRA for large vessel Occlusion
    2. Identifies severe stenosis (esp. Carotid Stenosis)
  2. Preferred vascular imaging modalities
    1. CT Angiogram head and neck
    2. MR Angiogram Circle of Willis and MR Angiogram neck vessels
  3. Other vascular imaging modalities
    1. Digital Subtraction Angiography
      1. Gold standard for Carotid Artery Stenosis (but largely replaced by CTA and MRA in practice)
    2. Transcranial Doppler Ultrasound
      1. Used to monitor large vessel Occlusion after tPA
    3. Carotid Doppler Ultrasound
      1. Largely replaced by CTA and MRA imaging

XXII. Imaging: Perfusion

  1. Indications: Evaluation for Endovascular Intervention in Large Vessel Occlusion
    1. Identifies regional perfusion hemodynamics
    2. Identifies ischemic infarct prenumbra with potentially reversible injury
  2. Perfusion Studies
    1. CT Perfusion
    2. MR Perfusion (esp. with diffusion weighted imaging or DWI)

XXIII. Imaging: Secondary Cause Evaluation

  1. Echocardiogram
    1. Evaluate for cardiac anomaly (esp. Patent Foramen Ovale)

XXIV. Management

  1. See CVA Management

XXV. Prevention

  1. See Prevention of Ischemic Stroke
  2. See Cerebrovascular Accident Risk Factors
  3. Evaluate for secondary causes after cryptogenic Ischemic Stroke or TIA
    1. See CVA Causes
    2. See Transient Ischemic Attack
    3. Evaluate for Carotid Stenosis
    4. Evaluate for paroxysmal Atrial Fibrillation (Event Monitor, implantable loop recorder)
  4. Educate patients and their families
    1. Urgent evaluation for possible CVA (face drooping, arm weakness, speech difficulty)
    2. American Stroke Association (F.A.S.T campaign)
      1. http://www.strokeassociation.org/STROKEORG/WarningSigns/Stroke-Warning-Signs-and-Symptoms_UCM_308528_SubHomePage.jsp

XXVI. Prognosis: Outcomes (based on U.S. 2011-2012 data)

  1. Total strokes: 795,000 per year in U.S.
  2. Recurrent CVA (highest risk in the next week): 25% of all CVAs
  3. Recovery to baseline: 15% (119,000 in U.S/year)
  4. Persistent Aphasia (at 6 months): 15% (119,000 in U.S/year)
  5. Persistent Hemiparesis (at 6 months): 50% (398,000 in U.S/year)
  6. Mortality: 16% (130,000 in U.S./year)
    1. Fifth leading cause of death in the United States (accounts for 5% of U.S. deaths)

XXVII. Resources

  1. CDC Stroke
    1. http://www.cdc.gov/stroke/facts.htm

XXVIII. References

  1. (2019) Neuro-Psych, CCME National Board Review Course, accessed 6/7/2019
  2. Burgess and Stowens (2014) Crit Dec Emerg Med 28(5): 2-13
  3. (2000) Circulation 102(suppl I):I-204 to I-216 [PubMed]
  4. Adams (2007) Stroke 38(5): 1655-711 [PubMed]
  5. Bath (2000) West J Med 173:209 [PubMed]
  6. Choi (2022) Am Fam Physician 105(6): 616-24 [PubMed]
  7. Larson (2023) Am Fam Physician 108(1): 70-7 [PubMed]
  8. Yew (2015) Am Fam Physician 91(8): 528-36 [PubMed]
  9. Yew (2009) Am Fam Physician 80(1):33-40 [PubMed]

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Related Studies

Ontology: Cerebrovascular Disorders (C0007820)

Definition (NCI_CDISC) A disorder resulting from inadequate blood flow in the arteries that supply the brain. The diagnostic criteria may include current or previous history of the following: Ischemic stroke, TIA, Noninvasive or invasive arterial imaging test demonstrating greater than or equal to 50% stenosis of any of the major extracranial or intracranial vessels to the brain; Previous cervical or cerebral artery revascularization surgery or percutaneous intervention.
Definition (NCI) A disorder resulting from inadequate blood flow in the vessels that supply the brain. Representative examples include cerebrovascular ischemia, cerebral embolism, and cerebral infarction.
Definition (CSP) broad category of disorders of blood flow in the arteries and veins which supply the brain; includes cerebral infarction, brain ischemia, brain hypoxia, intracranial embolism and thrombosis, intracranial arteriovenous malformations, etc; not limited to conditions that affect the cerebrum, but refers to vascular disorders of the entire brain.
Definition (MSH) A spectrum of pathological conditions of impaired blood flow in the brain. They can involve vessels (ARTERIES; or VEINS) in the CEREBRUM, the CEREBELLUM, and the BRAIN STEM. Major categories include INTRACRANIAL ARTERIOVENOUS MALFORMATIONS; BRAIN ISCHEMIA; CEREBRAL HEMORRHAGE; and others.
Concepts Pathologic Function (T046)
MSH D002561
ICD9 437.9, 430-438.99
ICD10 I60-I69.9 , I67.9, I60-I69
SnomedCT 195249004, 266312006, 155388006, 155412002, 195595007, 62914000
English Cerebrovascular Disorders, Unspecified cerebrovascular disease, CEREBROVASCULAR DISORDER, CEREBRAL VASCULAR DISTURBANCE, CEREBRAL VASCULAR LESION, Cerebrovascular disease NOS, Cerebrovascular diseases, Cerebrovascular disease, unspecified, CEREBROVASCULAR DIS, BRAIN VASCULAR DIS, INTRACRANIAL VASCULAR DIS, VASCULAR DIS INTRACRANIAL, Cerebral vascular disturbance, Cerebral vascular disturbance (NOS), Cerebral vascular lesion, Cerebral vascular lesion (NOS), Cerebrovascular disorder (NOS), Cerebrovascular disorder NOS, Brain Vascular Disorder, Brain Vascular Disorders, Vascular Disorder, Brain, Vascular Disorders, Brain, Intracranial Vascular Disease, Intracranial Vascular Diseases, Vascular Disease, Intracranial, Vascular Diseases, Intracranial, Intracranial Vascular Disorder, Intracranial Vascular Disorders, Vascular Disorder, Intracranial, Vascular Disorders, Intracranial, Cerebrovasc disease NOS, Cerebrovascular Disorders [Disease/Finding], cerebrovascular diseases, cerebrovascular disorders, Disease;cerebrovascular, cerebral vascular disorder, cerebral vascular disorders, cerebrovascular disorder, Cerebrovascular diseases (I60-I69), cerebrovascular disease (diagnosis), Cerebrovascular disease NOS (disorder), Cerebral Artery Disease, Cerebrovascular disorder, Disorder cerebrovascular, Cerebrovascular disease, CVD - Cerebrovascular disease, Cerebrovascular disease (disorder), Cerebrovascular lesion, brain; lesion, vascular, cerebrovascular; disorder, cerebrovascular; lesion, disease (or disorder); cerebrovascular, lesion; brain, vascular, lesion; cerebrovascular, Cerebrovascular disease, NOS, Cerebrovascular lesion, NOS, Cerebral Vascular Disorders, Cerebrovascular Disorder, Cerebrovascular Disease, CEREBROVASCULAR DISEASE, Cerebrovascular disease or lesion NOS, cerebrovascular disease
Italian Disturbo cerebrovascolare, Vasculopatie cerebrali non specificate, Alterazione vascolare cerebrale (NAS), Lesione vascolare cerebrale, Alterazione vascolare cerebrale, Lesione vascolare cerebrale (NAS), Disturbo cerebrovascolare NAS, Disturbo cerebrovascolare (NAS), Disturbi vascolari intracranici, Disturbi cerebrovascolari
Dutch cerebrale vasculaire stoornis, cerebrale vasculaire laesie, cerebrovasculaire afwijking, cerebrovasculaire afwijking (NAO), cerebrale vasculaire stoornis (NAO), niet-gespecificeerde cerebrovasculaire aandoening, cerebrovasculaire afwijking NAO, cerebrale vasculaire laesie (NAO), aandoening; cerebrovasculair, cerebrovasculair; aandoening, cerebrovasculair; lesie, hersenen; lesie, vasculair, lesie; cerebrovasculair, lesie; hersenen, vasculair, Cerebrovasculaire ziekte, niet gespecificeerd, cerebrovasculaire aandoening, Cerebrovasculaire ziekte, Cerebrovasculaire ziekten, Ziekte, cerebrovasculaire, Ziekten, cerebrovasculaire, Intracraniële vaatziekte, Vasculaire ziekte, intracraniële
French Maladie cérébrovasculaire non précisée, Perturbation vasculaire cérébrale SAI, Lésion cérébrale vasculaire, Trouble vasculaire cérébral, Lésion vasculaire cérébrale SAI, Trouble cérébrovasculaire SAI, Affection vasculaire cérébrale SAI, LESION VASCULAIRE CEREBRALE, TROUBLE CEREBRO-VASCULAIRE, TROUBLE VASCULAIRE CEREBRAL, Trouble cérébrovasculaire, Angiopathies intracrâniennes, Désordres cérébro-vasculaires, Désordres cérébrovasculaires, Maladies vasculaires intracrâniennes, Troubles cérébro-vasculaires, Troubles cérébrovasculaires, Troubles vasculaires intracrâniens
German Erkrankung zerebrovaskulaer, zerebrovaskulaere Laesion (NNB), zerebrovaskulaere Erkrankung (NNB), unspezifische zerebrovaskulaere Erkrankung, zerebrovaskulaere Durchblutungstoerung, zerebrovaskulaere Erkrankung NNB, zerebrovaskulaere Durchblutungstoerung (NNB), zerebrovaskulaere Laesion, ZEREBRALE DURCHBLUT-STOER, ZEREBRALE GEFAESSLAESION, ZEREBROVASKUL STOERUNG, Zerebrovaskulaere Krankheit, nicht naeher bezeichnet, zerebrovaskulaere Erkrankung, Gefäßkrankheiten des Gehirns, Hirngefäßkrankheiten, Intrakranielle vaskuläre Krankheiten, Kreislaufstörungen, zerebrovaskuläre, Vaskuläre Krankheiten, intrakranielle, Zerebrale Durchblutungsstörungen
Portuguese Afecção cerebrovascular, Lesão vascular cerebral NE, Doença cerebrovascular NE, Perturbação vascular cerebral, Lesão vascular cerebral, Perturbação vascular cerebral NE, Afecção cerebrovascular NE, ALTERACAO CEREBROVASCULAR, LESAO CEREBRAL VASCULAR, PERTURBACOES VASCULARES CEREBRAIS, Perturbação cerebrovascular, Doenças Vasculares Intracranianas, Transtornos Cerebrovasculares, Transtornos Vasculares do Cérebro, Transtornos Vasculares Intracranianos
Spanish Lesión vascular cerebral, Trastorno vascular cerebral, Alteración vascular cerebral (NEOM), Trastorno cerebrovascular, Enfermedad cerebrovascular no especificada, Trastorno cerebrovascular NEOM, Trastorno cerebrovascular (NEOM), Lesión vascular cerebral (NEOM), CEREBROVASCULAR, LESION, CEREBROVASCULAR, TRASTORNO, enfermedad cerebrovascular, SAI, Cerebrovascular disease NOS, enfermedad cerebrovascular, SAI (trastorno), enfermedad cerebrovascular (trastorno), enfermedad cerebrovascular, lesión cerebrovascular, Alteración cerebrovascular, Enfermedades Intracraneales Vasculares, Trastornos Cerebrovasculares, Trastornos Vasculares del Cerebro, Trastornos Vasculares Intracraneales
Japanese 脳血管病変, 詳細不明の脳血管疾患, 脳血管障害（ＮＯＳ）, 脳血管障害ＮＯＳ, ﾉｳｹｯｶﾝｼｮｳｶﾞｲNOS, ﾉｳｹｯｶﾝﾋﾞｮｳﾍﾝ, ｼｮｳｻｲﾌﾒｲﾉﾉｳｹｯｶﾝｼｯｶﾝ, ﾉｳｹｯｶﾝｼｮｳｶﾞｲ, 脳血管障害
Swedish Cerebrovaskulära sjukdomar
Czech cerebrovaskulární poruchy, Blíže neurčené cerebrovaskulární onemocnění, Cerebrovaskulární porucha (NOS), Léze mozková cévní (NOS), Porucha cerebrovaskulární NOS, Cévní poškození mozku, Cerebrovaskulární poruchy, Mozková cévní léze, Porucha cerebrovaskulární, Mozkové cévní poškození (NOS), cévní onemocnění mozku, cévní nemoci mozku
Finnish Aivojen verenkiertohäiriöt
Russian MOZGOVOGO KROVOOBRASHCHENIIA RASSTROISTVA, TSEREBROVASKULIARNYE RASSTROISTVA, МОЗГОВОГО КРОВООБРАЩЕНИЯ РАССТРОЙСТВА, ЦЕРЕБРОВАСКУЛЯРНЫЕ РАССТРОЙСТВА
Korean 상세불명의 뇌혈관 질환
Croatian CEREBROVASKULARNI POREMEĆAJI
Polish Choroby naczyniowe mózgu, Choroby naczyniopochodne mózgu, Zaburzenia krążenia mózgowego
Hungarian Agyi vascularis zavar, Cerebrovascularis betegség, Agyi vascularis laesio, Cerebrovascularis betegség k.m.n., Agyi érrendszeri zavar, Cerebrovascularis betegség (k.m.n.), Nem meghatározott cerebrovascularis betegség, Agyi vascularis zavar (k.m.n.), Agyi vascularis laesio (k.m.n.)
Norwegian Cerebrovaskulære sykdommer
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Cerebrovascular accident (C0038454)

Definition (MEDLINEPLUS)

A stroke is a medical emergency. Strokes happen when blood flow to your brain stops. Within minutes, brain cells begin to die. There are two kinds of stroke. The more common kind, called ischemic stroke, is caused by a blood clot that blocks or plugs a blood vessel in the brain. The other kind, called hemorrhagic stroke, is caused by a blood vessel that breaks and bleeds into the brain. "Mini-strokes" or transient ischemic attacks (TIAs), occur when the blood supply to the brain is briefly interrupted.

Symptoms of stroke are

  • 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 trouble walking, dizziness, loss of balance or coordination
  • Sudden severe headache with no known cause

If you have any of these symptoms, you must get to a hospital quickly to begin treatment. Acute stroke therapies try to stop a stroke while it is happening by quickly dissolving the blood clot or by stopping the bleeding. Post-stroke rehabilitation helps individuals overcome disabilities that result from stroke damage. Drug therapy with blood thinners is the most common treatment for stroke.

NIH: National Institute of Neurological Disorders and Stroke
Definition (MSHCZE) Cévní mozková příhoda zkr. CMP – postižení určitého okrsku mozkové tkáně na podkladu poruchy cév (srov. cerebrovaskulární nemoci), tj. jejich neprůchodnosti s následnou ischemií (mozkový infarkt) nebo poruchy celistvosti cévní stěny s následným krvácením do mozkové tkáně (mozkové krvácení). Projevy jsou od dočasných poruch hybnosti a řeči až po bezvědomí, ochrnutí a smrt. Kromě strukturního poškození se na příznacích podílí event. vzniklý edém mozku s intrakraniální hypertenzí. Příčinou bývá ateroskleróza mozkových tepen často v kombinaci s hypertenzí. Příčinou krvácení může být ianeurysma některé mozkové tepny srov. subarachnoidální krvácení. Drobnější CMP na ischemickém podkladě se označuje TIA. V diagnostice se uplatňuje zejm. CT, ev. MRI, v některých případech ev. angiografie. Jiné názvy apoplexie, iktus, laicky „mozková mrtvice“. (cit. Velký lékařský slovník online, 2013 http://lekarske.slovniky.cz/ )
Definition (NCI) A sudden loss of neurological function secondary to hemorrhage or ischemia in the brain parenchyma due to a vascular event. Infarction or hemorrhage may be demonstrated either directly by imaging, laboratory, or pathologic examination in patients with symptom duration less than 24 hours, or inferred by symptoms lasting greater than or equal to 24 hours (or fatal within 24 hours) that cannot be attributed to another cause. Diagnostic tests include CT scan, MRI, angiography, and EEG to locate and evaluate the extent of the hemorrhagic or ischemic damage in the brain parenchyma, coagulation studies, complete blood count, comprehensive metabolic panel, and urinalysis.
Definition (NCI_NCI-GLOSS) In medicine, a loss of blood flow to part of the brain, which damages brain tissue. Strokes are caused by blood clots and broken blood vessels in the brain. Symptoms include dizziness, numbness, weakness on one side of the body, and problems with talking, writing, or understanding language. The risk of stroke is increased by high blood pressure, older age, smoking, diabetes, high cholesterol, heart disease, atherosclerosis (a build-up of fatty material and plaque inside the coronary arteries), and a family history of stroke.
Definition (NCI_CDISC) An acute episode of focal or global neurological dysfunction caused by presumed brain, spinal cord, or retinal vascular injury as a result of hemorrhage or infarction but with insufficient information to allow categorization as ischemic or hemorrhagic.
Definition (NCI_CTCAE) A disorder characterized by a sudden loss of sensory function due to an intracranial vascular event.
Definition (CSP) sudden neurologic impairment due to a cerebrovascular disorder, either an arterial occlusion or an intracranial hemorrhage.
Definition (MSH) A group of pathological conditions characterized by sudden, non-convulsive loss of neurological function due to BRAIN ISCHEMIA or INTRACRANIAL HEMORRHAGES. Stroke is classified by the type of tissue NECROSIS, such as the anatomic location, vasculature involved, etiology, age of the affected individual, and hemorrhagic vs. non-hemorrhagic nature. (From Adams et al., Principles of Neurology, 6th ed, pp777-810)
Concepts Disease or Syndrome (T047)
MSH D020521
ICD10 I64 , I63.9
SnomedCT 270883006, 155405006, 82797006, 155388006, 266315008, 195208004, 313267000, 266312006, 230690007
LNC MTHU020801
English Cerebrovascular accident, CVA, Apoplexy, Stroke Syndrome, Stroke and cerebrovascular accident unspecified, Stroke, not specified as haemorrhage or infarction, Stroke, not specified as hemorrhage or infarction, CEREBROVASCULAR ACCIDENT, Strokes, CEREBRAL INFARCTION, Stroke, Cerebrovascular Accident, CVA (cerebral vascular accident), cerebral vascular accident, Stroke/CVA unspecified, Accident cerebrovascular, Cerebrovascular accident NOS, Brain Vascular Accident, Brain Vascular Accidents, Vascular Accident, Brain, Vascular Accidents, Brain, CVA (Cerebrovascular Accident), Apoplexy, Cerebrovascular, Cerebrovascular Apoplexy, Cerebral Stroke, Cerebral Strokes, Stroke, Cerebral, Strokes, Cerebral, Cerebrovascular Stroke, Cerebrovascular Strokes, Stroke, Cerebrovascular, Strokes, Cerebrovascular, Stroke NOS, Stroke [Disease/Finding], cerebrovascular accidents, stroke cerebral, stroke, strokes, vascular cerebral accident, vascular brain accident, cerebral stroke, cerebrovascular stroke, CVAs (Cerebrovascular Accident), Brain Attack, Brain attack, Cerebrovascular accidents, Stroke and cerebrovascular accident unspecified (disorder), Stroke/CVA - undefined, Accident - cerebrovascular, CVA - Cerebrovascular accident unspecified, Stroke unspecified, CVA - cerebrovascular accident (& unspecified [& stroke]) (disorder), Stroke NOS (disorder), CVA unspecified, CVA - cerebrovascular accident (& unspecified [& stroke]), SYNDROME, STROKE, Undetermined Stroke, CVA, CEREBROVASCULAR ACCIDENT, STROKE SYNDROME, STROKE, CEREBROVASCULAR ACCIDENT, (CVA), CVA - Cerebrovascular accident, Cerebrovascular accident (disorder), Stroke/cerebrovascular accident, cerebrovascular accident, apoplexy, cerebral; accident, cerebral; apoplexy, cerebrovascular; accident, accident; cerebral, accident; cerebrovascular, stroke; apoplectic, apoplexy; cerebral, apoplexy; stroke, Apoplexy, NOS, CVA, NOS, Cerebral apoplexy, NOS, Cerebrovascular accident, NOS, Stroke, NOS, Cerebral apoplexy, Cerebrovascular accident (disorder) [Ambiguous], Cerebrovascular Accidents, Stroke (Cerebrum)
Italian Accidente cerebrovascolare, Accidente cerebrovascolare NAS, Ictus, Apoplessia cerebrale, CVA (Incidente cerebrovascolare), Apoplessia cerebrovascolare, Incidente cerebrovascolare, Incidente vascolare cerebrale, Stroke, Apoplessia, Ictus cerebrale
Dutch accident cerebrovasculair, apoplexie, cerebrovasculair accident NAO, beroerte, Cerebrovasculair accident (CVA), accident; cerebraal, accident; cerebrovasculair, apoplexie; beroerte, apoplexie; cerebraal, beroerte; apoplexie, cerebraal; accident, cerebraal; apoplexie, cerebrovasculair; accident, Beroerte, niet gespecificeerd als bloeding of infarct, cerebrovasculair accident, Accident, cerebrovasculair, Apoplexie, Beroerte, CVA, Cerebrale beroerte, Cerebrovasculair accident, Cerebrovasculaire apoplexie, Vasculair accident van de hersenen
French Accident, cérébrovasculaire, Apoplexie, Accident cérébro-vasculaire SAI, AVC, Ictus, ACCIDENT VASCULAIRE CEREBRAL, Accident cérébrovasculaire, Accident vasculaire cérébral, Accident ischémique cérébral, AVC (Accident Vasculaire Cérébral), Accident cérébro-vasculaire, Apoplexie cérébrale, Attaque d'apoplexie
German CVA, Schlaganfall NNB, SCHLAGANFALL, Schlaganfall, nicht als Blutung oder Infarkt bezeichnet, apoplektischer Insult, Apoplexie, Schlaganfall, Zerebraler Schlaganfall, Vaskulärer Insult des Gehirns, Zerebrovaskuläre Apoplexie, Zerebrovaskulärer Insult
Portuguese Acidente vascular cerebral, Acidente vascular cerebral NE, Acidente Vascular Encefálico, Acidente Cerebrovascular, ACIDENTE VASCULAR CEREBRAL, Apoplexia Cerebrovascular, Acidente Vascular Cerebral, AVC, Apoplexia Cerebral, Icto Cerebral, Acidente Vascular do Cérebro, Acidentes Cerebrovasculares, Ictus Cerebral, AVE, Acidente Cerebral Vascular, Acidentes Vasculares Cerebrais, Acidentes Cerebrais Vasculares, Derrame Cerebral, Acidente cerebrovascular, Apoplexia
Spanish Accidente cerebrovascular NEOM, Accidente cerebral vascular, ICTUS, Apoplejía Cerebrovascular, apoplejía, accidente cerebrovascular, no especificado, apoplejía cerebral, accidente cerebrovascular, SAI (trastorno), accidente cerebrovascular, no especificado (trastorno), stroke, ACV, SAI, accidente cerebrovascular, SAI, Accidente Vascular Cerebral, Ataque, AVE, Apoplejía Cerebral, Ictus, Accidente Vascular del Cerebro, Accidentes Cerebrovasculares, Ictus Cerebral, AVC, Derrame Cerebral, Accidente Cerebral Vascular, ACV, accidente cerebrovascular (concepto no activo), accidente cerebrovascular (trastorno), accidente cerebrovascular, Accidente cerebrovascular, Accidente Cerebrovascular, Accidente Vascular Encefálico, Apoplejía, Ataque Cerebral
Japanese 脳血管発作ＮＯＳ, ｿｯﾁｭｳ, ﾉｳｹｯｶﾝﾎｯｻNOS, ﾉｳｹｯｶﾝﾎｯｻ, ﾉｳｿｯﾁｭｳ, 脳血管発作, 血管発作-脳血管, ストローク, 卒中, 卒中発作, 発作症候群, 脳クリーゼ, 脳出血発作症候群, 脳卒中, 脳卒中発作, 脳発症
Swedish Slaganfall
Czech cévní mozková příhoda, apoplexie, mozková mrtvice, Apoplexie, Cévní mozková příhoda, Cévní mozková příhoda NOS, Mozková příhoda, ictus, iktus, CMP
Finnish Aivohalvaus
Russian TSEREBROVASKULIARNAIA APOPLEKSIIA, INSUL'T TSEREBROVASKULIARNYI, GEMORRAGICHESKII INSUL'T, ИНСУЛЬТ ЦЕРЕБРОВАСКУЛЯРНЫЙ, APOPLEKSIIA MOZGA, INSUL'T GEMORRAGICHESKII, INSUL'T ISHEMICHESKII, ISHEMICHESKII INSUL'T, INSUL'T, ИНСУЛЬТ, АПОПЛЕКСИЯ МОЗГА, ГЕМОРРАГИЧЕСКИЙ ИНСУЛЬТ, ИНСУЛЬТ ГЕМОРРАГИЧЕСКИЙ, ИНСУЛЬТ ИШЕМИЧЕСКИЙ, ИШЕМИЧЕСКИЙ ИНСУЛЬТ, ЦЕРЕБРОВАСКУЛЯРНАЯ АПОПЛЕКСИЯ
Korean 출혈 또는 경색증으로 명시되지 않은 뇌중풍
Polish Apopleksja, Udar mózgowy, Ostry udar mózgu, Udar mózgu, Incydent naczyniowo-mózgowy
Croatian MOŽDANA KAP, MOŽDANI UDAR, CEREBROVASKULARNI INCIDENT
Hungarian Stroke, Cerebrovascularis esemény, Cerebralis insultus k.m.n., Cerebralis insultus, Apoplexia, CVA
Norwegian Hjerneslag, Slag, Apopleksi, Cerebrovaskulær hendelse
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Anterior Circulation Brain Infarction (C0751952)

Concepts Disease or Syndrome (T047)
MSH D020520
English INFARCT ANTERIOR CIRC BRAIN, ANTERIOR CIRC BRAIN INFARCT, INFARCT BRAIN ANTERIOR CIRC, ANTERIOR CIRC INFARCT BRAIN, BRAIN INFARCT ANTERIOR CIRC, Anterior Circulation Infarction, Brain, Brain Infarction, Anterior Circulation, Infarction, Anterior Circulation, Brain, Infarction, Brain, Anterior Circulation, Anterior Circulation Brain Infarction
French Infarctus de la circulation antérieure de l'encéphale, Infarctus de la circulation antérieure encéphalique
German Anterior Circulation Brain Infarction
Norwegian Fremre kretsløpssyndrom, Fremre kretsløp-syndrom
Derived from the NIH UMLS (Unified Medical Language System)

Related Topics in Cardiovascular Medicine

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