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Transcript
Internal Medicine
•
Associated symptoms
o
Headache, vomiting, reduced alertness suggest hemorrhagic stroke than
ischemic stroke. Very severe headache with altered consciousness without major
neurologic deficit may suggest subarachnoid hemorrhage.
o
If patient is having fever raises suspicion of infective endocarditis.
o
Seizure is common in embolic stroke.
•
Look for risk factors for stroke
•
Looking for other medical conditions associated with stroke such as hypertension,
diabetes, smoking and use of drugs like OCP* may suggest the diagnosis.
Physical Examination
•
Physical Findings may give clue to the type of stroke the patient is suffering from.
•
Absent/reduced peripheral pulses suggest atherosclerosis or embolism
•
Presence of neck bruit suggests extra cranial occlusion of carotid arteries
•
Cardiac abnormalities: such as atrial fibrillation, murmurs or cardiac enlargement may
suggest embolic stroke, the embolus originating from the heart.
•
Fever raises concern for infectious etiologies
•
Ophthalmoscopic examination: papilledma or retinal hemorrhage may suggest
subarachnoid hemorrhage or increased intracranial pressure.
Table VIII-3-1. Characteristic features of different types of stroke
Embolic
Intracerebral
Large vessel
stroke
hemorrhage
thrombosis
Subarachnoid
Lacunar
hemorrhage
infarctions
Onset
Sudden onset
Sudden (deficit
Sudden,
Sudden,
Sudden,
with maximum
Progresses over
Gradual,
Gradual,
Usually few or
deficit at
minutes to
stepwise, or
Stepwise
not focal signs
onset
hours)
Stuttering
or
Stuttering
When the
When the
When the
When the
When the
Time of
patient is
patient is
patient is
patient is
patient is
occurrence
Awake
Awake and
Asleep or
Asleep or
Awake and
active
inactive
inactive
active
510