Stroke (or cerebrovascular accident (CVA)) is the clinical designation for a rapidly developing loss of brain function due to an interruption in the blood supply to all or part of the brain. This phenomenon can be caused by thrombosis, embolism, or hemorrhage.^[1] In medicine, the process of being struck down by a stroke, fit, or faint is sometimes referred to as an ictus [cerebri], from the Latin icere ("to strike"), especially prior to a definitive diagnosis. Stroke can mean: In medicine, a cerebrovascular accident (or cerebral accident) A sunstroke In writing, a single line without any break such as stroke in graphics or Chinese characters, see stroke order. ... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). ... // I00-I99 - Diseases of the circulatory system (I00-I02) Acute rheumatic fever (I00) Rheumatic fever without mention of heart involvement (I01) Rheumatic fever with heart involvement (I02) Rheumatic chorea (I05-I09) Chronic rheumatic heart diseases (I05) Rheumatic mitral valve diseases (I050) Mitral stenosis (I051) Rheumatic mitral insufficiency (I06) Rheumatic aortic... // I00-I99 - Diseases of the circulatory system (I00-I02) Acute rheumatic fever (I00) Rheumatic fever without mention of heart involvement (I01) Rheumatic fever with heart involvement (I02) Rheumatic chorea (I05-I09) Chronic rheumatic heart diseases (I05) Rheumatic mitral valve diseases (I050) Mitral stenosis (I051) Rheumatic mitral insufficiency (I06) Rheumatic aortic... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... The Mendelian Inheritance in Man project is a database that catalogues all the known diseases with a genetic component, and - when possible - links them to the relevant genes in the human genome. ... The Disease Bold textDatabase is a free website that provides information about the relationships between medical conditions, symptoms, and medications. ... MedlinePlus (medlineplus. ... eMedicine is an online clinical medical knowledge base that was founded in 1996. ... Medical Subject Headings (MeSH) is a huge controlled vocabulary (or metadata system) for the purpose of indexing journal articles and books in the life sciences. ... Thrombosis is the formation of a clot or thrombus inside a blood vessel, obstructing the flow of blood through the circulatory system. ... An embolism occurs when an object (the embolus, plural emboli) migrates from one part of the body (through circulation) and cause(s) a blockage (occlusion) of a blood vessel in another part of the body. ... To meet Wikipedias quality standards, this article or section may require cleanup. ...

Stroke is a medical emergency and can cause permanent neurological damage and death if not promptly diagnosed and treated. It is the third leading cause of death and the leading cause of adult disability in the United States and Europe. It is predicted that stroke will soon become the leading cause of death worldwide.^[2] {{Otheruses4|the medical term|the Australian television series|Medical Emergenc an immediate threat to a persons life or long term health. ... For other uses, see Death (disambiguation), Dead (disambiguation), or Death (band). ...

The symptoms of stroke can be quite heterogeneous, and patients with the same cause of stroke can have widely differing symptoms. Conversely, patients with the same symptoms handicap can in fact have different underlying causes.

Risk factors for stroke include advanced age, hypertension (high blood pressure), previous stroke or transient ischaemic attack (TIA, see below), diabetes, high cholesterol, cigarette smoking, atrial fibrillation, migraine with aura, and thrombophilia (a tendency to thrombosis). In clinical practice, blood pressure is the most important modifiable risk factor of stroke; however many other risk factors, such as cigarette smoking cessation and treatment of atrial fibrillation with anticoagulant drugs, are important. Paul Kruger in his old age. ... For other forms of hypertension, see Hypertension (disambiguation). ... Transient ischemic attacks (TIA) are caused by temporary disturbance of blood supply to a restricted area of brain and cause recurrent and brief (less than 24 hours) neurologic dysfunctions. ... For the disease characterized by excretion of large amounts of very dilute urine, see diabetes insipidus. ... Hypercholesterolemia (literally: high blood cholesterol) is the presence of high levels of cholesterol in the blood [1]. It is not a disease but a metabolic derangement that can be secondary to many diseases and can contribute to many forms of disease, most notably cardiovascular disease. ... Tobacco smoking is the act of smoking tobacco products, especially cigarettes and cigars. ... Atrial fibrillation (AF or afib) is a cardiac arrhythmia (abnormal heart rhythm) that involves the two upper chambers (atria) of the heart. ... Thrombophilia is the propensity to develop thrombosis (blood clots) due to an abnormality in the system of coagulation. ... Thrombosis is the formation of a clot or thrombus inside a blood vessel, obstructing the flow of blood through the circulatory system. ... A risk factor is a variable associated with an increased risk of disease or infection but risk factors are not necessarily causal. ... A No Smoking sign Smoking cessation (commonly known as quitting, or kicking the habit) is the effort to stop smoking tobacco products. ...

The traditional definition of stroke, devised by the World Health Organisation in the 1970s,^[3] is of a "neurological deficit of cerebrovascular cause that persists beyond 24 hours or is interrupted by death within 24 hours". This definition was largely devised for the purpose of research and the time frame of 24 hours appears purely arbitrarily chosen as a cut-off point. It divides stroke from TIA, which is the same as above but completely resolves clinically within 24 hours. The division of stroke and TIA into separate clinical entities is considered impractical and even unhelpful in practice by many stroke doctors. The main reason for this is the fact that stroke and TIA are caused by the same disease process, and both persons with a stroke or a TIA are at a higher risk of a subsequent stroke. In recognition of this, and improved methods for the treatment of stroke, the term "brain attack" is being promoted in the Western World as a substitute for stroke or TIA. The new term makes an analogy with "heart attack" (myocardial infarction), because in both conditions, an interruption of blood supply causes death of tissue that is highly time dependent ("time is brain") and potentially life-threatening. Many hospitals have "brain attack" teams within their neurology departments specifically for swift treatment of stroke. Heart attack redirects here. ... Neurology is a branch of medicine dealing with disorders of the nervous system. ...

Treatment of stroke is occasionally with thrombolysis ("clot buster"), but usually with supportive care (physiotherapy and occupational therapy) and secondary prevention with antiplatelet drugs (aspirin and often dipyridamole), blood pressure control, statins and anticoagulation (in selected patients). Thrombolysis is the breakdown (lysis) by pharmacological means, of blood clots. ... Physical therapy can help restore lost functionality in many people. ... Occupational therapy refers to the use of meaningful occupation to assist people who have difficulty in achieving healthy and balanced life; and to enable an inclusive society so that all people can participate to their potential in daily occupations of life. ... An antiplatelet drug is a member of a class of pharmaceuticals that decreases platelet aggregation and inhibits thrombus formation. ... This article is about the drug. ... Dipyridamole is a drug that inhibits platelet aggregation and causes vasodilation. ... Lovastatin, the first statin to be marketed The statins (or HMG-CoA reductase inhibitors) form a class of hypolipidemic agents, used as pharmaceutical agents to lower cholesterol levels in people with or at risk for cardiovascular disease. ... An anticoagulant is a substance that prevents coagulation; that is, it stops blood from clotting. ...

Classification

Strokes can be classified into two major categories: ischemic and hemorrhagic. Ischemia is due to interruption of the blood supply, while hemorrhage is due to rupture of a blood vessel. 80% of strokes are due to ischemia; the remainder are due to hemorrhage. In medicine, ischemia (Greek ισχαιμία, isch- is restriction, hema or haema is blood) is a restriction in blood supply, generally due to factors in the blood vessels, with resultant damage or dysfunction of tissue. ... To meet Wikipedias quality standards, this article or section may require cleanup. ... f you all The blood vessels are part of the circulatory system and function to transport blood throughout the body. ...

Ischemic stroke

In an ischemic stroke, blood supply to part of the brain is decreased, leading to dysfunction and necrosis of the brain tissue in that area. There are four reasons why this might happen: thrombosis (obstruction by a blood vessel by a blood clot forming locally), embolism (idem due to a blood clot from elsewhere in the body), systemic hypoperfusion (general decrease in blood supply, e.g. in shock) and venous thrombosis. Necrosis (in Greek Νεκρός = Dead) is the name given to accidental death of cells and living tissue. ... A thrombus is the final product of blood coagulation, through the aggregation of platelets and the activation of the humoral coagulation system. ... This article is about the medical condition. ... Cerebral venous sinus thrombosis is a rare form of thrombosis (a blood clot) affecting the dural venous sinuses which drain blood from the brain. ...

Thrombotic stroke

In thrombotic stroke, a thrombus (blood clot) usually forms around atherosclerotic plaques. Since blockage of the artery is gradual, onset of symptomatic thrombotic strokes is slower. A thrombus itself (even if non-occluding) can lead to an embolic stroke (see below) if the thrombus breaks off, at which point it is called an "embolus". Thrombotic stroke can be divided into two types depending on the type of vessel the thrombus is formed on: Atherosclerosis is a disease affecting arterial blood vessels. ...

• Large vessel disease involves the common and internal carotids, vertebral, and the Circle of Willis. Diseases that may form thrombi in the large vessels include (in descending incidence): atherosclerosis, vasoconstriction (tightening of the artery), aortic or carotid artery dissection, various inflammatory diseases of the blood vessel wall (Takayasu arteritis, giant cell arteritis, vasculitis), noninflammatory vasculopathy, Moyamoya disease and fibromuscular dysplasia
• Small vessel disease involves the smaller arteries inside the brain: branches of the circle of Willis, middle cerebral artery, stem, and arteries arising from the distal vertebral and basilar artery. Diseases that may form thrombi in the small vessels include (in descending incidence): lipohyalinosis (build-up of fatty hyaline matter in the blood vessel as a result of high blood pressure and aging) and fibrinoid degeneration (stroke involving these vessels are known as lacunar infarcts) and microatheroma (small atherosclerotic plaques).

Embolic stroke

Embolic stroke refers to the blockage of an artery by an embolus, a traveling particle or debris in the arterial bloodstream originating from elsewhere. An embolus is most frequently a blood clot, but it can also be a number of other substances including fat (e.g. from bone marrow in a broken bone), air, cancer cells or clumps of bacteria (usually from infectious endocarditis). The carotid artery is a major artery of the head and neck that supplies blood to the head and neck. ... The vertebral arteries are branches of the subclavian arteries. ... The circle of Willis (also called the cerebral arterial circle or arterial circle of Willis) is a circle of arteries that supply blood to the brain. ... The blood vessels are part of the circulatory system and function to transport blood throughout the body. ... Aortic dissection is a tear in the wall of the aorta (the largest artery of the body). ... Carotid artery dissection is an important cause of stroke in young patients. ... Takayasus arteritis is an inflammatory disease of unknown etiology that affects the aorta and its branches. ... Temporal arteritis, also called giant cell arteritis (GCA) is an inflammatory disease of blood vessels (most commonly large and medium arteries of the head). ... In medicine, vasculitis (plural: vasculitides) is a group of diseases featuring inflammation of the wall of blood vessels due to leukocyte migration and resultant damage. ... Moyamoya disease is an extremely rare disorder in most parts of the world except in Japan. ... This article or section does not cite its references or sources. ... The circle of Willis (also called the cerebral arterial circle or arterial circle of Willis) is a circle of arteries that supply blood to the brain. ... The middle cerebral artery (MCA) is one of the three major arteries that supplies blood to the brain. ... The basilar artery is one of the arteries which the brain supplies with oxygen-rich blood. ... lacunar stroke occurs when one of the small arteries(Φ:0. ... In medicine, an embolism occurs when an object (the embolus, plural emboli) migrates from one part of the body (through the circulation) and cause(s) a blockage (occlusion) of a blood vessel in another part of the body. ... For other uses, see FAT. Fats consist of a wide group of compounds that are generally soluble in organic solvents and largely insoluble in water. ... This article does not cite any references or sources. ... Internal and external views of an arm with a compound fracture, both before and after surgery A bone fracture is a medical condition in which a bone breaks. ... Cancer is a class of diseases or disorders characterized by uncontrolled division of cells and the ability of these to spread, either by direct growth into adjacent tissue through invasion, or by implantation into distant sites by metastasis (where cancer cells are transported through the bloodstream or lymphatic system). ... Phyla Actinobacteria Aquificae Chlamydiae Bacteroidetes/Chlorobi Chloroflexi Chrysiogenetes Cyanobacteria Deferribacteres Deinococcus-Thermus Dictyoglomi Fibrobacteres/Acidobacteria Firmicutes Fusobacteria Gemmatimonadetes Lentisphaerae Nitrospirae Planctomycetes Proteobacteria Spirochaetes Thermodesulfobacteria Thermomicrobia Thermotogae Verrucomicrobia Bacteria (singular: bacterium) are unicellular microorganisms. ... Endocarditis is an inflammation of the inner layer of the heart, the endocardium. ...

Because an embolus arises from elsewhere, local therapy only solves the problem temporarily. Thus, the source of the embolus must be identified. Because the embolic blockage is sudden in onset, symptoms usually are maximal at start. Also, symptoms may be transient as the embolus is partially resorbed and moves to a different location or dissipates altogether.

Emboli most commonly arise from the heart (especially in atrial fibrillation) but may originate from elsewhere in the arterial tree. In paradoxical embolism, a deep vein thrombosis embolises through an atrial or ventricular septal defect in the heart into the brain. The heart and lungs, from an older edition of Grays Anatomy. ... Atrial fibrillation (AF or afib) is a cardiac arrhythmia (abnormal heart rhythm) that involves the two upper chambers (atria) of the heart. ... A paradoxical embolism is a kind of stroke or other form of arterial thrombosis caused by embolism of a thrombus (blood clot) of venous origin through a lateral opening in the heart, typically an atrial septal defect. ... This article is about Deep-vein thrombosis. ... Atrial septal defects (ASD) are a group of congenital heart diseases that enables communication between atria of the heart and may involve the interatrial septum. ... A ventricular septal defect (or VSD) is a defect in the ventricular septum (the wall dividing the left and right ventricles of the heart). ...

Cardiac causes can be distinguished between high- and low-risk:^[4]

• High risk: atrial fibrillation and paroxysmal atrial fibrillation, rheumatic disease of the mitral or aortic valve disease, artificial heart valves, known cardiac thrombus of the atrium or vertricle, sick sinus syndrome, sustained atrial flutter, recent myocardial infarction, chronic myocardial infarction together with ejection fraction <28 percent, symptomatic congestive heart failure with ejection fraction <30 percent, dilated cardiomyopathy, Libman-Sacks endocarditis, Marantic endocarditis, infective endocarditis, papillary fibroelastoma, left atrial myxoma and coronary artery bypass graft (CABG) surgery
• Low risk/potential: calcification of the annulus (ring) of the mitral valve, patent foramen ovale (PFO), atrial septal aneurysm, atrial septal aneurysm with patent foramen ovale, left ventricular aneurysm without thrombus, isolated left atrial "smoke" on echocardiography (no mitral stenosis or atrial fibrillation), complex atheroma in the ascending aorta or proximal arch

Systemic hypoperfusion

Systemic hypoperfusion is the reduction of blood flow to all parts of the body. It is most commonly due to cardiac pump failure from cardiac arrest or arrhythmias, or from reduced cardiac output as a result of myocardial infarction, pulmonary embolism, pericardial effusion, or bleeding. Hypoxemia (low blood oxygen content) may precipitate the hypoperfusion. Because the reduction in blood flow is global, all parts of the brain may be affected, especially "watershed" areas - border zone regions supplied by the major cerebral arteries. Blood flow to these areas does not necessarily stop, but instead it may lessen to the point where brain damage can occur. This phenomenon is also referred to as "last meadow" to point to the fact that in irrigation the last meadow receives the least amount of water. Atrial fibrillation (AF or afib) is a cardiac arrhythmia (abnormal heart rhythm) that involves the two upper chambers (atria) of the heart. ... Atrial fibrillation (AF or AFib) is an cardiac arrhythmia (irregular heartbeat) originating in the atria. ... Rheumatic fever is an inflammatory disease which may develop after a Group A streptococcal infection (such as strep throat or scarlet fever) and can involve the heart, joints, skin, and brain. ... The mitral valve (also known as the bicuspid valve or left atrioventricular valve), is a dual flap (bi = 2) valve in the heart that lies between the left atrium (LA) and the left ventricle (LV). ... The aortic valve is one of the valves of the heart. ... It has been suggested that this article or section be merged with Heart valve prosthesis. ... Sick sinus syndrome, also called Bradycardia-tachycardia syndrome is a group of abnormal heartbeats (arrhythmias) presumably caused by a malfunction of the sinus node, the hearts natural pacemaker. ... Atrial flutter is an abnormal fast heart rhythm that occurs in the atria of the heart. ... Heart attack redirects here. ... In cardiovascular physiology, ejection fraction (Ef) is the fraction of blood pumped out of a ventricle with each heart beat. ... Congestive heart failure (CHF), also called congestive cardiac failure (CCF) or just heart failure, is a condition that can result from any structural or functional cardiac disorder that impairs the ability of the heart to fill with or pump a sufficient amount of blood throughout the body. ... Dilated cardiomyopathy or DCM (also known as congestive cardiomyopathy), is a disease of the myocardium (the muscle of the heart) in which a portion of the myocardium is dilated, often without any obvious cause. ... Libman-Sachs endocarditis is a form of nonbacterial endocarditis that is seen in systemic lupus erythematosus. ... Marantic endocarditis is the deposition of fibrin on valve leaflets. ... Endocarditis is an inflammation of the inner layer of the heart, the endocardium. ... left atrial myxoma Is a benign tumor located in the left upper chamber of the heart (atrium) on the wall that separates the left chamber from the right (the atrial septum). ... A coronary artery bypass graft (CABG) or heart bypass is a surgical procedure performed in patients with coronary artery disease (see atherosclerosis) for the relief of angina and possible improved heart muscle function. ... An atrial septal defect (ASD) is a group of congenital heart diseases that involve the inter-atrial septum of the heart. ... Post surgical photo of brain aneurysm survivor. ... An echocardiogram. ... Mitral stenosis is a narrowing of the orifice of the mitral valve of the heart. ... The arch of the aorta, and its branches. ... A heart-lung machine (upper right) in a coronary artery bypass surgery. ... Cardiac output (CO) is the volume of blood being pumped by the heart, in particular by a ventricle in a minute. ... Heart attack redirects here. ... Pericardial effusion is an abnormal accumulation of fluid in the pericardial cavity. ... Hypoxia is a pathological condition in which the body as a whole (generalised hypoxia) or region of the body (tissue hypoxia) is deprived of adequate oxygen supply. ...

Venous thrombosis

Cerebral venous sinus thrombosis leads to stroke due to locally increased venous pressure, which exceeds the pressure generated by the arteries. Infarcts are more likely to undergo hemorrhagic transformation (leaking of blood into the damaged area) than other types of ischemic stroke. Cerebral venous sinus thrombosis is a rare form of thrombosis (a blood clot) affecting the dural venous sinuses which drain blood from the brain. ...

Hemorrhagic stroke

Main articles: Intracranial hemorrhage and intracerebral hemorrhage

Intracranial hemorrhage is the accumulation of blood anywhere within the skull vault. A distinction is made between intra-axial hemorrhage (blood inside the brain) and extra-axial hemorrhage (blood inside the skull but outside the brain). Intra-axial hemorrhage is due to intraparenchymal hemorrhage or intraventricular hemorrhage (blood in the ventricular system). The main types of extra-axial hemorrhage are epidural hematoma (bleeding between the dura mater and the skull), subdural hematoma (in the subdural space) and subarachnoid hemorrhage (between the arachnoid mater and pia mater). Most of the hemorrhagic stroke syndromes have specific symptoms (e.g. headache, previous head injury). This article needs cleanup. ... ... Intra-axial hemorrhages, or intra-axial hematomas, are a subtype of intracranial hemorrhage that occur within the brain tissue itself. ... Extra-axial hematoma, or extra-axial hemorrhage is a subtype of intracranial hemorrhage, or bleeding within the intracranial space, that occurs within the skull but outside of the brain tissue itself. ... Intra-axial hemorrhages, or intra-axial hematomas, are a subtype of intracranial hemorrhage that occur within the brain tissue itself. ... Intra-axial hemorrhages, or intra-axial hematomas, are a subtype of intracranial hemorrhage that occur within the brain tissue itself. ... Nontraumatic epidural hematoma in a young woman. ... The dura mater (from the Latin hard mother), or pachymeninx, is the tough and inflexible outermost of the three layers of the meninges surrounding the brain. ... A subdural hematoma (SDH) is a form of traumatic brain injury in which blood collects between the dura (the outer protective covering of the brain) and the arachnoid (the middle layer of the meninges). ... The subdural space (or subdural cavity) is an artificial space created by the separation of the arachnoid mater from the dura mater as the result of trauma or pathologic process. ... Subarachnoid hemorrhage (SAH) is bleeding into the subarachnoid space surrounding the brain, i. ... The Arachnoid mater is one of the three layers of the meninges, interposed between the dura mater and the pia mater and separated from the pia mater by the subarachnoid space. ... [www. ... A headache (cephalgia in medical terminology) is a condition of pain in the head; sometimes neck or upper back pain may also be interpreted as a headache. ... Head injury is a trauma to the head, that may or may not include injury to the brain (see also brain injury). ...

Intracerebral hemorrhage (ICH) is bleeding directly into the brain tissue, forming a gradually enlarging hematoma (pooling of blood). It generally occurs in small arteries or arterioles and is commonly due to hypertension, trauma, bleeding disorders, amyloid angiopathy, illicit drug use (e.g. amphetamines or cocaine), and vascular malformations. The hematoma enlarges until pressure from surrounding tissue limits its growth, or until it decompresses by emptying into the ventricular system, CSF or the pial surface. A third of intracerebral bleed is into the brain's ventricles. ICH has a mortality rate of 44 percent after 30 days, higher than ischemic stroke or even the very deadly subarachnoid hemorrhage. ... Hematoma on thigh, 6 days after a fall down stairs, 150ml of blood drained a few days later A hematoma, or haematoma, is a collection of blood, generally the result of hemorrhage, or, more specifically, internal bleeding. ... For other forms of hypertension, see Hypertension (disambiguation). ... Haemophilia or hemophilia (from Greek haima blood and philia to love[1]) is the name of a family of hereditary genetic disorders that impair the bodys ability to control blood clotting, or coagulation. ... This article or section is in need of attention from an expert on the subject. ... Recreational drug use is the use of psychoactive drugs for recreational rather than medical or spiritual purposes, although the distinction is not always clear. ... Amphetamine is a synthetic drug originally developed (and still used) as an appetite suppressant. ... Cocaine is a crystalline tropane alkaloid that is obtained from the leaves of the coca plant. ... The ventricular system is a set of structures in the brain continuous with the central canal of the spinal cord. ... Cerebrospinal fluid (CSF), Liquor cerebrospinalis, is a clear bodily fluid that occupies the subarachnoid space in the brain (the space between the skull and the cerebral cortex—more specifically, between the arachnoid and pia layers of the meninges). ... Crude death rate by country Mortality rate is a measure of the number of deaths (in general, or due to a specific cause) in some population, scaled to the size of that population, per unit time. ...

Signs and symptoms

The symptoms of stroke depend on the type of stroke and the area of the brain affected. Ischemic strokes usually only affect regional areas of the brain perfused by the blocked artery. Hemorrhagic strokes can affect local areas, but often can also cause more global symptoms due to bleeding and increased intracranial pressure.

If the area of the brain affected contains one of the three prominent Central nervous system pathways—the spinothalamic tract, corticospinal tract, and dorsal column (medial lemniscus), symptoms may include: A neural pathway is a neural tract connecting one part of the nervous system with another, usually consisting of bundles of elongated, myelin insultated neurons, known collectively as white matter. ... The spinothalamic tract is a sensory pathway originating in the spinal cord that transmits information about pain, temperature, itch and crude touch to the thalamus. ... The corticospinal or pyramidal tract is a massive collection of axons that travel between the cerebral cortex of the brain and the spinal cord. ... The posterior column-medial lemniscus pathway (called the dorsal column in non-humans) is the sensory pathway responsible for transmitting discriminative sensation from the skin to the thalamus, and on to the cerebral cortex. ... The medial lemniscus, also known as Reils band or Reils ribbon, is a pathway in the brainstem that carries sensory information from the gracile and cuneate nuclei to the thalamus. ...

• hemiplegia and muscle weakness of the face
• numbness
• reduction in sensory or vibratory sensation

In most cases, the symptoms affect only one side of the body. The defect in the brain is usually on the opposite side of the body (depending on which part of the brain is affected). However, the presence of any one of these symptoms does not necessarily suggest a stroke, since these pathways also travel in the spinal cord and any lesion there can also produce these symptoms. Central facial palsy, (also called colloquially central seven) is a symptom or finding characterized by paralysis or paresis of the lower half of one side of the face. ... The Spinal cord nested in the vertebral column. ...

In addition to the above CNS pathways, the brainstem also consists of the 12 cranial nerves. A stroke affecting the brainstem therefore can produce symptoms relating to deficits in these cranial nerves: The brain stem is the stalk of the brain below the cerebral hemispheres. ... Cranial nerves Cranial nerves are nerves that emerge directly from the brain in contrast to spinal nerves which emerge from segments of the spinal cord. ...

• altered smell, taste, hearing, or vision (total or partial)
• drooping of eyelid (ptosis) and weakness of ocular muscles
• decreased reflexes: gag, swallow, pupil reactivity to light
• decreased sensation and muscle weakness of the face
• balance problems and nystagmus
• altered breathing and heart rate
• weakness in sternocleidomastoid muscle with inability to turn head to one side
• weakness in tongue (inability to protrude and/or move from side to side)

If the cerebral cortex is involved, the CNS pathways can again be affected, but also can produce the following symptoms: In ophthalmology, ptosis is an abnormally low position (drooping) of the upper eyelid which may grow more or less severe during the day. ... The extraocular muscles are the six muscles that control the movements of the eye. ... Central facial palsy, (also called colloquially central seven) is a symptom or finding characterized by paralysis or paresis of the lower half of one side of the face. ... Balance is the result of a number of body systems working together. ... Nystagmus is involuntary eye movement that can be part of the vestibulo-ocular reflex (VOR), with the eyes moving first in the direction of the lesioned side (slow phase) followed by a quick correction (fast phase) to the opposite side or away from the lesioned side. ... In human anatomy, the sternocleidomastoid (pronounced ) muscles are muscles in the neck that act to flex and rotate the head. ... For other uses, see Cortex. ...

• aphasia (inability to speak or understand language from involvement of Broca's or Wernicke's area)
• apraxia (altered voluntary movements)
• visual field defect
• memory deficits (involvement of temporal lobe)
• hemineglect (involvement of parietal lobe)
• disorganized thinking, confusion, hypersexual gestures (with involvement of frontal lobe)

If the cerebellum is involved, the patient may have the following: For other uses, see Aphasia (disambiguation). ... Brocas area is the section of the human brain (in the opercular and triangular sections of the inferior frontal gyrus of the frontal lobe of the cortex) that is involved in language processing, speech production and comprehension. ... Wernickes area is a part of the human brain that forms part of the cortex, on the left posterior section of the superior temporal gyrus, encircling the auditory cortex, on the Sylvian fissure (part of the brain where the temporal lobe and parietal lobe meet). ... Apraxia is a neurological disorder characterized by loss of the ability to execute or carry out learned (familiar) movements, despite having the desire and the physical ability to perform the movements. ... The term visual field is sometimes used as a synonym to field of view, though they do not designate the same thing. ... The temporal lobes are part of the cerebrum. ... Hemineglect occurs after parietal lesions. ... The parietal lobe is a lobe in the brain. ... Hypersexuality describes human sexual behavior at levels high enough to be considered clinically significant. ... The cerebellum (Latin: little brain) is a region of the brain that plays an important role in the integration of sensory perception and motor output. ...

• trouble walking
• altered movement coordination
• vertigo and or disequilibrium

Loss of consciousness, headache, and vomiting usually occurs more often in hemorrhagic stroke than in thrombosis because of the increased intracranial pressure from the leaking blood compressing on the brain. For other uses, see Vertigo. ... Unconsciousness is the absence of consciousness. ...

If symptoms are maximal at onset, the cause is more likely to be a subarachnoid hemorrhage or an embolic stroke.

Diagnosis

Stroke is diagnosed through several techniques: a neurological examination, CT scans (most often without contrast enhancements) or MRI scans, Doppler ultrasound, and arteriography. The diagnosis of stroke itself is clinical, with assistance from the imaging techniques. Imaging techniques also assist in determining the subtypes and cause of stroke. There is yet no commonly used blood test for the stroke diagnosis itself, though blood tests may be of help in finding out the likely cause of stroke ^[5]. CAT apparatus in a hospital Computed axial tomography (CAT), computer-assisted tomography, computed tomography, CT, or body section roentgenography is the process of using digital processing to generate a three-dimensional image of the internals of an object from a large series of two-dimensional X-ray images taken around... MRI Image Magnetic resonance imaging (MRI) is a method of creating images of the inside of opaque organs in living organisms as well as detecting the amount of bound water in geological structures. ... Medical ultrasonography is an ultrasound-based imaging diagnostic technique used to visualize internal organs, their size, structure and their pathological lesions. ... Angiography or arteriography is a medical imaging technique in which an X-ray picture is taken to visualize the inner opening of blood filled structures, including arteries, veins and the heart chambers. ... Blood tests are laboratory tests done on blood to gain an appreciation of disease states and the function of organs. ...

Physical examination

A systematic review found that acute facial paresis, arm drift, or abnormal speech are the best findings ^[6]. Systematic reviews are named as the highest level of medical evidence, by evidence based medicine professionals. ...

Imaging

For diagnosing ischemic stroke in the emergency setting ^[7]:

• CT scans (without contrast enhancements)

sensitivity= 16%

specificity= 96%

• MRI scan

sensitivity= 83%

specificity= 98%

For diagnosing hemorrhagic stroke in the emergency setting: CAT apparatus in a hospital Computed axial tomography (CAT), computer-assisted tomography, computed tomography, CT, or body section roentgenography is the process of using digital processing to generate a three-dimensional image of the internals of an object from a large series of two-dimensional X-ray images taken around... The sensitivity of a binary classification test or algorithm, such as a blood test to determine if a person has a certain disease, or an automated system to detect faulty products in a factory, is a parameter that expresses something about the tests performance. ... The specificity is a statistical measure of how well a binary classification test correctly identifies the negative cases, or those cases that do not meet the condition under study. ... MRI Image Magnetic resonance imaging (MRI) is a method of creating images of the inside of opaque organs in living organisms as well as detecting the amount of bound water in geological structures. ... The sensitivity of a binary classification test or algorithm, such as a blood test to determine if a person has a certain disease, or an automated system to detect faulty products in a factory, is a parameter that expresses something about the tests performance. ... The specificity is a statistical measure of how well a binary classification test correctly identifies the negative cases, or those cases that do not meet the condition under study. ...

• CT scans (without contrast enhancements)

sensitivity= 89%

specificity= 100%

• MRI scan

sensitivity= 81%

specificity= 100%

For detecting hemorrhages, MRI scan is more sensitive.^[8] CAT apparatus in a hospital Computed axial tomography (CAT), computer-assisted tomography, computed tomography, CT, or body section roentgenography is the process of using digital processing to generate a three-dimensional image of the internals of an object from a large series of two-dimensional X-ray images taken around... The sensitivity of a binary classification test or algorithm, such as a blood test to determine if a person has a certain disease, or an automated system to detect faulty products in a factory, is a parameter that expresses something about the tests performance. ... The specificity is a statistical measure of how well a binary classification test correctly identifies the negative cases, or those cases that do not meet the condition under study. ... MRI Image Magnetic resonance imaging (MRI) is a method of creating images of the inside of opaque organs in living organisms as well as detecting the amount of bound water in geological structures. ... The sensitivity of a binary classification test or algorithm, such as a blood test to determine if a person has a certain disease, or an automated system to detect faulty products in a factory, is a parameter that expresses something about the tests performance. ... The specificity is a statistical measure of how well a binary classification test correctly identifies the negative cases, or those cases that do not meet the condition under study. ... MRI Image Magnetic resonance imaging (MRI) is a method of creating images of the inside of opaque organs in living organisms as well as detecting the amount of bound water in geological structures. ...

Investigation of underlying etiology

When a stroke has been diagnosed, various other studies may be performed to determine the underlying etiology. With the current treatment and diagnosis options available, it is of particular importance to determine whether there is a peripheral source of emboli. Test selection may vary, since the cause of stroke varies with age, comorbidity and the clinical presentation. Commonly used techniques include: In medicine, an embolism occurs when an object (the embolus, plural emboli) migrates from one part of the body (through the circulation) and cause(s) a blockage (occlusion) of a blood vessel in another part of the body. ... In medicine and in psychiatry, comorbidity is either The presence of one or more disorders (or diseases) in addition to a primary disease or disorder; or The effect of such additional disorders or diseases. ...

• an ultrasound/doppler study of the carotid arteries (to detect carotid stenosis) or dissection of the precerebral artieries
• an electrocardiogram (ECG) and echocardiogram (to identify arrhythmias and resultant clots in the heart which may spread to the brain vessels through the bloodstream)
• a Holter monitor study to identify intermittent arrhythmias
• an angiogram of the cerebral vasculature (if a bleed is thought to have originated from an aneurysm or arteriovenous malformation)
• blood tests to determine hypercholesterolemia, bleeding diathesis and some rarer causes such as homocysteinuria

Medical ultrasonography (sonography) is an ultrasound-based diagnostic imaging technique used to visualize muscles and internal organs, their size, structures and possible pathologies or lesions. ... In human anatomy, the carotid artery is a major artery of the head and neck. ... Carotid artery stenosis is obstruction of the carotid artery, usually by atheroma (a fatty lump, the result of atherosclerosis). ... Carotid artery dissection is an important cause of stroke in young patients. ... “QRS” redirects here. ... The echocardiogram is an ultrasound of the heart. ... Cardiac arrhythmia is any of a group of conditions in which the electrical activity of the heart is irregular or is faster or slower than normal. ... Holter monitor In medicine, a Holter monitor (also called an ambulatory electrocardiography device), named after its inventor, Dr. Norman J. Holter, is a portable device for continuously monitoring the electrical activity of the heart for 24 hours or more. ... Patient about to undergo an angiogram, image courtesy of WHO. Angiography or arteriography is a medical imaging technique in which an X-ray picture is taken to visualize the inner opening of blood filled structures, including arteries, veins and the heart chambers. ... Post surgical photo of brain aneurysm survivor. ... Arteriovenous malformation or AVM is a congenital disorder of the veins and arteries that make up the vascular system . ... Blood tests are laboratory tests done on blood to gain an appreciation of disease states and the function of organs. ... Hypercholesterolemia (literally: high blood cholesterol) is the presence of high levels of cholesterol in the blood [1]. It is not a disease but a metabolic derangement that can be secondary to many diseases and can contribute to many forms of disease, most notably cardiovascular disease. ... In medicine (hematology), a bleeding diathesis is a propensity to bleeding (hemorrhage) due to a defect in the system of coagulation. ... Homocystinuria, also known as Cystathionine beta synthase deficiency, is an inherited disorder of the metabolism of the amino acid methionine, often involving cystathionine beta synthase. ...

Treatment

Early assessment

Early recognition of the signs of stroke is generally regarded as important. Only detailed physical examination and medical imaging provide information on the presence, type, and extent of stroke, and hence hospital attendance — even if the symptoms were brief — is advised.^{[citation needed]} In medicine, the physical examination or clinical examination is the process by which the physician investigates the body of a patient for signs of disease. ... Medical imaging designates the ensemble of techniques and processes used to create images of the human body (or parts thereof) for clinical purposes (medical procedures seeking to reveal, diagnose or examine disease) or medical science (including the study of normal anatomy and function). ...

Studies show that patients treated in hospitals with a dedicated Stroke Team or Stroke Unit and a specialized care program for stroke patients have improved odds of recovery.

Ischemic stroke

An ischemic stroke is due to a thrombus (blood clot) occluding a cerebral artery, a patient is given antiplatelet medication (aspirin, clopidogrel, dipyridamole), or anticoagulant medication (warfarin), dependent on the cause, when this type of stroke has been found. Hemorrhagic stroke must be ruled out with medical imaging, since this therapy would be harmful to patients with that type of stroke. For Trombe wall (used in solar homes), see Trombe wall. ... An antiplatelet drug is a member of a class of pharmaceuticals that decreases platelet aggregation and inhibits thrombus formation. ... This article is about the drug. ... A box of Plavix Clopidogrel is a potent oral antiplatelet agent often used in the treatment of coronary artery disease, peripheral vascular disease, and cerebrovascular disease. ... Dipyridamole is a drug that inhibits platelet aggregation and causes vasodilation. ... An anticoagulant is a substance that prevents coagulation; that is, it stops blood from clotting. ... Warfarin (also known under the brand names of Coumadin, Jantoven, Marevan, and Waran) is an anticoagulant medication that is administered orally or, very rarely, by injection. ...

Whether thrombolysis is performed or not, the following investigations are required:

• Stroke symptoms are documented, often using scoring systems such as the National Institutes of Health Stroke Scale, the Cincinnati Stroke Scale, and the Los Angeles Prehospital Stroke Screen. The Cincinnati Stroke Scale is used by emergency medical technicians (EMTs) to determine whether a patient needs transport to a stroke center.
• A CT scan is performed to rule out hemorrhagic stroke
• Blood tests, such as a full blood count, coagulation studies (PT/INR and APTT), and tests of electrolytes, renal function, liver function tests and glucose levels are carried out.

Other immediate strategies to protect the brain during stroke include ensuring that blood sugar is as normal as possible (such as commencement of an insulin sliding scale in known diabetics), and that the stroke patient is receiving adequate oxygen and intravenous fluids. The patient may be positioned so that his or her head is flat on the stretcher, rather than sitting up, since studies have shown that this increases blood flow to the brain. Additional therapies for ischemic stroke include aspirin (50 to 325 mg daily), clopidogrel (75 mg daily), and combined aspirin and dipyridamole extended release (25/200 mg twice daily). The Cincinnati Stroke Scale is a system used to diagnose the presence of a stroke in a patient. ... An emergency medical technician (EMT) is an emergency responder trained to provide emergency medical services (EMS) to the critically ill and injured. ... CT apparatus in a hospital Computed axial tomography (CAT), computer-assisted tomography, computed tomography, CT, or body section roentgenography is the process of using digital processing to generate a three-dimensional image of the internals of an object from a large series of two-dimensional X-ray images taken around... Blood tests are laboratory tests done on blood to gain an appreciation of disease states and the function of organs. ... A full blood count (FBC) or complete blood count (CBC) is a test requested by a doctor or other medical professional that gives information about the cells in a patients blood. ... This article is about the clotting of blood. ... The prothrombin time (PT) and its derived measures of prothrombin ratio (PR) and international normalized ratio (INR) are measures of the extrinsic pathway of coagulation. ... The partial thromboplastin time (PTT) or activated partial thromboplastin time (aPTT or APTT) is a performance indicator measuring the efficacy of both the intrinsic and the common coagulation pathways. ... An electrolyte is a substance containing free ions that behaves as an electrically conductive medium. ... In medicine (nephrology) renal function is an indication of the state of the kidney and its role in physiology. ... Liver function tests (LFTs or LFs), which include liver enzymes, are groups of clinical biochemistry laboratory blood assays designed to give information about the state of a patients liver. ... Glucose (Glc), a monosaccharide (or simple sugar), is an important carbohydrate in biology. ... In medicine, blood sugar is a term used to refer to levels of glucose in the blood. ... This article is about the disease that features high blood sugar. ... General Name, symbol, number oxygen, O, 8 Chemical series nonmetals, chalcogens Group, period, block 16, 2, p Appearance colorless (gas) pale blue (liquid) Standard atomic weight 15. ... An intravenous drip in a hospital Intravenous therapy or IV therapy is the administration of liquid substances directly into a vein. ... This article is about the drug. ... A box of Plavix Clopidogrel is a potent oral antiplatelet agent often used in the treatment of coronary artery disease, peripheral vascular disease, and cerebrovascular disease. ... Dipyridamole is a drug that inhibits platelet aggregation and causes vasodilation. ...

It is common for the blood pressure to be elevated immediately following a stroke. Studies indicated that while high blood pressure causes stroke, it is actually beneficial in the emergency period to allow better blood flow to the brain. A sphygmomanometer, a device used for measuring arterial pressure. ... Arterial hypertension, or high blood pressure is a medical condition where the blood pressure is chronically elevated. ...

If studies show carotid stenosis, and the patient has residual function in the affected side, carotid endarterectomy (surgical removal of the stenosis) may decrease the risk of recurrence if performed rapidly after stroke. Carotid artery stenosis is obstruction of the carotid artery, usually by atheroma (a fatty lump, the result of atherosclerosis). ... Carotid entarterectomy is a surgical procedure used to correct carotid stenosis (obstruction of the carotid artery by atheroma), used particularly when this causes medical problems, such as transient ischemic attacks (TIAs) or cerebrovascular accidents (CVAs, strokes). ...

If the stroke has been the result of cardiac arrhythmia with cardiogenic emboli, treatment of the arrhythmia and anticoagulation with warfarin or high-dose aspirin may decrease the risk of recurrence. Stroke prevention treatment for a common arrhythmia, atrial fibrillation, is determined according to the CHADS/CHADS2 system. Cardiac arrhythmia is any of a group of conditions in which the electrical activity of the heart is irregular or is faster or slower than normal. ... An anticoagulant is a substance that prevents coagulation; that is, it stops blood from clotting. ... Warfarin (also known under the brand names of Coumadin, Jantoven, Marevan, and Waran) is an anticoagulant medication that is administered orally or, very rarely, by injection. ... Atrial fibrillation (AF or afib) is a cardiac arrhythmia (abnormal heart rhythm) that involves the two upper chambers (atria) of the heart. ... For other uses, see Chad (disambiguation). ...

Thrombolysis

In increasing numbers of primary stroke centers, pharmacologic thrombolysis ("clot busting") with the drug tissue plasminogen activator, tPA, is used to dissolve the clot and unblock the artery. However, the use of tPA in acute stroke is controversial. On one hand, it is endorsed by the American Heart Association and the American Academy of Neurology as the recommended treatment for acute stroke within three hours of onset of symptoms as long as there are not other contraindications (such as abnormal lab values, high blood pressure, or recent surgery). This position for tPA is based upon the findings of one study ^[9] which showed that tPA improves the chances for a good neurological outcome. When administered within the first three hours, 39% of all patients who were treated with tPA had a good outcome at three months, only 26% of placebo controlled patients had a good functional outcome. However, in the NINDS trial 6.4% of patients with large strokes developed substantial brain hemorrhage as a complication from being given tPA. tPA is often misconstrued as a "magic bullet" and it is important for patients to be aware that despite the study that supports its use, some of the data were flawed and the safety and efficacy of tPA is controversial. A recent study found the mortality to be higher among patients receiving tPA versus those who did not.^[10] Additionally, it is the position of the American Academy of Emergency Medicine that objective evidence regarding the efficacy, safety, and applicability of tPA for acute ischemic stroke is insufficient to warrant its classification as standard of care. ^[11] Until additional evidence clarifies such controversies, physicians are advised to use their discretion when considering its use. Given the cited absence of definitive evidence, AAEM believes it is inappropriate to claim that either use or non-use of intravenous thrombolytic therapy constitutes a standard of care issue in the treatment of stroke. Thrombolysis is the breakdown (lysis) by pharmacological means, of blood clots. ... In blood coagulation, tissue plasminogen activator (tPA) is an enzyme (EC 3. ... The American Heart Association (AHA) is a non-profit organization in the United States that fosters appropriate cardiac care in an effort to reduce disability and deaths caused by cardiovascular disease and stroke American Stroke Association Web site. ... In tort law, the standard of care is the degree of prudence and caution required of an individual who is under a duty of care. ...

Thrombectomy

Another intervention for acute ischemic stroke is removal of the offending thrombus directly. This is accomplished by inserting a catheter into the femoral artery, directing it up into the cerebral circulation, and deploying a corkscrew-like device to ensnare the clot, which is then withdrawn from the body. In August 2004, based on data from the MERCI (Mechanical Embolus Removal in Cerebral Ischemia) Trial, the FDA cleared several of these devices, called the Merci X5 and X6 Retrievers.^[12][13] The newer generation Merci L5 Retriever was cleared for thrombus removal in acute stroke based on data from the Multi MERCI trial.^[14][15] Both the MERCI and Multi MERCI trials evaluated the use of mechanical thrombectomy up to 8 hours after onset of symptoms. Femoral artery and its major branches - right thigh, anterior view. ... Cerebral circulation refers to the blood vessels, arteries and veins, carrying blood to and away from the brain, respectively. ... Cerebral ischemia is an ischemic condition where the brain or parts of the brain do not receive enough blood flow to maintain normal neurological function. ...

Embolic stroke

Anticoagulation can prevent recurrent stroke. Among patients with nonvalvular atrial fibrillation, anticoagulation can reduce stroke by 60% while antiplatelet agents can reduce stroke by 20%. ^[16]. However, a recent meta-analysis suggests harm from anti-coagulation started early after an embolic stroke.^[17] Atrial fibrillation (AF or afib) is a cardiac arrhythmia (abnormal heart rhythm) that involves the two upper chambers (atria) of the heart. ... A meta-analysis is a statistical practice of combining the results of a number of studies. ...

Hemorrhagic stroke

Patients with bleeding into (intracerebral hemorrhage) or around the brain (subarachnoid hemorrhage), require