Ischemic Stroke Disease Summary

Overview

Ischemic stroke is a type of stroke characterized by the sudden absence of blood supply to an area of the brain, spinal cord, or retina secondary to a thrombus, emboli, or intracranial small vessel disease, as stated in the Introduction section.

Ischemic stroke accounts for 65% of all incident strokes worldwide. A detailed discussion about the prevalence of stroke and ischemic stroke is in the Epidemiology section.

The Pathophysiology section states that in stroke, there is a significant reduction or cessation of cerebral blood flow, whether due to systemic hypoperfusion, severe arterial stenosis, or vessel occlusion, that triggers a cascade of metabolic and molecular disturbances that disrupt neuronal function and ultimately lead to structural brain injury.

The most common risk factors in ischemic stroke include hypertension and diabetes mellitus (DM). Other risk factors are further discussed in the Risk Factors section.

Ischemic Stroke_Disease Summary

History and Physical Examination

The Clinical Presentation section describes the common presentation of patients with acute ischemic stroke by region, such as left and right hemisphere, brainstem and cerebellum.

The History section explains the essential information needed in the evaluation of ischemic stroke.

The importance of a complete physical and neurologic examination in the assessment of ischemic stroke is stated in the Physical Examination section.

Diagnosis

The Diagnosis or Diagnostic Criteria section features the clinical stroke scores, such as the National Institutes of Health Stroke Scale (NIHSS), the Rapid Arterial Occlusion Evaluation Scale (RACE) or the Los Angeles Motor Scale (LAMS) in the evaluation of ischemic stroke.

Discussion on diagnostic tests that may be done in ruling out other diseases that may mimic the symptoms of ischemic stroke is in the Laboratory Tests and Ancillaries section.

The Imaging section discusses the need for neuroimaging and vascular imaging studies for the prompt management of patients suspected of having ischemic stroke.

Stroke mimics or conditions with stroke-like symptoms that should be ruled out in the diagnosis of ischemic stroke are listed in the Differential Diagnosis section.

Management

Patients should be assessed prior to initiating and delivering thrombolysis in patients with ischemic stroke. The patient inclusion and exclusion criteria are enumerated in the Evaluation section.

The Pharmacological Therapy section discusses in detail blood pressure management, thrombolysis, other therapeutic measures and management options for both primary and secondary prevention.

The Non-pharmacological section explains the importance of supportive care in the management of ischemic stroke.

Endovascular interventions, revascularization procedures, and other surgical options are in the Surgery section.

The Prevention section discusses primary and secondary prevention in the management of ischemic stroke.

The Monitoring section discusses the need for rehabilitation in all patients with ischemic stroke after careful assessment.