III. 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%

IV. 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)

V. History

  1. Exact time of onset (or last seen time when at baseline status)
  2. Seizure activity
    1. Before stroke-like symptoms
      1. Consider postictal paralysis (see below)
    2. After stroke-like symptoms
      1. Contraindicates Thrombolysis
  3. Migraine Headaches (recent)
  4. 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
  5. Recent illness (e.g. Pneumonia or urinary tract symptoms)
  6. Diabetes Mellitus

VI. 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

VII. 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]

VIII. 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)

IX. 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)

X. 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

XI. Evaluation

  1. See CVA Evaluation
  2. See NIH Stroke Scale
  3. Bedside Glucose is an initial Vital Sign in CVA

XII. 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
  5. Seizure (post-ictal paralysis or Todd's Paralysis)
    1. Seizures may also secondary to Ischemic Stroke in up to 13% of cases

XIII. 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 abnormality
    1. Nonketotic hyperosmolar coma (Hyperglycemia)
    2. Postcardiac Arrest Ischemia
    3. Toxin Ingestion
    4. Myxedema
    5. Uremia
  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

XIV. Precautions

  1. Stroke mimics (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

XV. 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]

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

XVII. 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 I (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. Thrombin Time (or Ecarin clotting time) Indications
      1. Direct Thrombin Inhibitor use
      2. Direct Factor Xa Inhibitor use
    8. Lumbar Puncture indications
      1. Subarachnoid Hemorrhage is suspected despite negative Head CT
      2. Meningitis or Encephalitis suspected
    9. Electroencephalogram (EEG) indications
      1. Seizure suspected

XVIII. Imaging

  1. See CVA Evaluation
  2. CT Head
    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 Head
    1. Appears to be better imaging for initial CVA Evaluation
      1. However too slow for current stroke protocols
      2. Similar efficacy to CT Head for identifying Hemorrhagic CVA
      3. Chalela (2007) Lancet 369:293-8 [PubMed]
    2. Higher sensitivity for Ischemic CVA (especially posterior CVA)
      1. Consider in patients with higher risk of stroke mimic (e.g. age <55 years old)
      2. Ferro (2010) Lancet Neurol 9(11): 1085-96 [PubMed]
      3. Bhattacharya (2013) J Neurol Sci 324(1):62-4 [PubMed]
    3. 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

XIX. Management

XX. Prevention

  1. See Prevention of Ischemic Stroke
  2. See Cerebrovascular Accident Risk Factors
  3. Evaluate for Carotid Stenosis after Ischemic Stroke or TIA
    1. See Transient Ischemic Attack
  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

XXI. 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)
  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. Fourth leading cause of death in the United States (accounts for 5% of U.S. deaths)

XXII. Resources

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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ガイNOS, ノウケッカンビョウヘン, 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ガイ, 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
Korean 상세불명의 뇌혈관 질환
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

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
Korean 출혈 또는 경색증으로 명시되지 않은 뇌중풍
Polish Apopleksja, Udar mózgowy, Ostry udar mózgu, Udar mózgu, Incydent naczyniowo-mózgowy
Hungarian Stroke, Cerebrovascularis esemény, Cerebralis insultus k.m.n., Cerebralis insultus, Apoplexia, CVA
Norwegian Hjerneslag, Slag, Apopleksi, Cerebrovaskulær hendelse

Ontology: Cerebellar infarction (C0236073)

Concepts Disease or Syndrome (T047)
SnomedCT 195191006, 95460007
English CEREBELLAR INFARCTION, Cerebellar infarction, Cerebellar infarction (disorder), cerebellar; infarction, infarction; cerebellar
Italian Infarto cerebellare
Japanese 小脳梗塞, ショウノウコウソク
Portuguese ENFARTO DO CEREBELO, Enfarte do cerebelo
French INFARCTUS CEREBELLEUX, Infarctus cérébelleux
Spanish INFARTO CEREBELOSO, infarto cerebeloso (trastorno), infarto cerebeloso, Infarto cerebeloso
German KLEINHIRNINFARKT, Kleinhirninfarkt
Czech Infarkt mozečku
Hungarian Cerebellaris infarctus
Dutch cerebellair; infarct, infarct; cerebellair, cerebellair infarct

Ontology: Brain Stem Infarctions (C0521542)

Definition (MSH) Infarctions that occur in the BRAIN STEM which is comprised of the MIDBRAIN; PONS; and MEDULLA OBLONGATA. There are several named syndromes characterized by their distinctive clinical manifestations and specific sites of ischemic injury.
Concepts Disease or Syndrome (T047)
MSH D020526
SnomedCT 195192004, 95457000, 230697005, 195191006
English Brainstem infarction, Brainstem infarction NOS, BRAIN STEM INFARCTION, BRAIN STEM INFARCT, BRAINSTEM INFARCT, INFARCT BRAIN STEM, INFARCT BRAINSTEM, brainstem strokes (diagnosis), brainstem strokes, Brain Stem Infarction, Brain Stem Infarctions, Infarction, Brain Stem, Infarctions, Brain Stem, Brainstem Infarction, Brainstem Infarctions, Infarction, Brainstem, Infarctions, Brainstem, Brainstem Stroke, Stroke, Brainstem, Brain Stem Infarctions [Disease/Finding], brainstem infarct, brain stem infarct, brainstem infarction, brainstem stroke, brain stem infarction, stroke brainstem, Brainstem infarction (disorder), Infarction of brain stem, Brain stem stroke, Brainstem infarction NOS (disorder), Brain stem infarct, Brain stem infarction, Brain stem infarction (disorder)
Italian Infarto del tronco encefalico, Ictus del tronco encefalico, Infarti del tronco cerebrale
Swedish Hjärnstamsinfarkter
Japanese ノウカンコウソク, Claude症候群, Benedikt症候群, 舌下神経交代性片麻痺, 動眼神経交代性片麻痺, フォヴィーユ症候群, ベーネディクト症候群, ミラード-グブラー症候群, 橋底下部外側症候群, 上交代性麻痺, ミラール・グブラー症候群, 下交代性麻痺, 赤核脊髄小脳脚症候群, フォービーユ麻痺, ミラール-グブラー症候群, ウェーバー麻痺, クロード症候群, 上部交代性片麻痺, ミヤール・ギュブレル症候群, ミラード・グブラー症候群, Foville症候群, ウェーバー症候群, 下部赤核症候群, 側方注視麻痺, Millard-Gublar症候群, Weber徴候, 上交代性片麻痺, ミヤール-ギュブレル症候群, ウェーバー徴候, 顔面神経交代性片麻痺, 上部交代性麻痺, フォビーユ症候群, ミラール-ギュブレ症候群, ミラール・ギュブレ症候群, Weber症候群, グブレル麻痺, 赤核下部症候群, ベネディクト症候群, ノウカンソッチュウ, 脳幹卒中, 脳幹梗塞, Benedict症候群
Finnish Aivorunkoinfarktit
Portuguese ENFARTO DO TRONCO CEREBRAL, AVC do tronco cerebral, Síndrome do Topo da Artéria Basilar, Enfarte do tronco cerebral, Infartos do Tronco Encefálico
French INFARCTUS DU TRONC CEREBRAL, AVC du tronc cérébral, Infarctus du tronc cérébral
Czech Infarkt mozkového kmene, Mozková příhoda mozkového kmene, infarkty mozkového kmene, mozkový kmen - infarkty
Spanish Ictus troncoencefálico, infarto del tronco encefálico, SAI (trastorno), infarto del tronco encefálico, SAI, infarto de tronco encefálico (trastorno), infarto de tronco encefálico, Infarto del tronco del encéfalo, Infartos del Tronco Encefálico
Dutch hersenstam beroerte, hersenstaminfarct, Hersenstaminfarct, Hersenstaminfarcten, Infarct, hersenstam-, Infarcten, hersenstam-
German Hirnstamminsult, Hirnstamminfarkt, Hirnstamminfarkte
Polish Zawał pnia mózgu
Hungarian Agytörzsi infarctus, Agytörzs stroke
Norwegian Hjernestammeinfarkt, Hjernestammeinfarkter

Ontology: Pontine infarction (C0877587)

Concepts Pathologic Function (T046)
Dutch ponsinfarct
French Infarctus pontin
German pontiner Infarkt
Italian Infarto pontino
Portuguese Enfarte pôntico
Spanish Infarto pontino
Japanese 橋梗塞, キョウコウソク
Czech Infarkt pontu
English pontine infarction, Pontine infarction
Hungarian Pontin infarctus