Download Ischemic stroke

Clinical impression:
Ischemic stroke
Ischemic stroke
• Death of brain tissue resulting from an
inadequate supply of blood and oxygen to the
brain due to blockage of an artery.
 by blood clots or fat deposits
Ischemic stroke
Patient
• Symptoms occur suddenly
and may include:
• awoke one morning nothing
that she was unable to move
her entire left side of the body.
• slurred speech with saliva
drooling on the left corner of
her mouth.
• MSE:
– muscle weakness
– paralysis
– lost or abnormal sensation on
one side of the body
– difficulty speaking
– confusion, problems with
vision
– dizziness
– loss of balance and
coordination
– showed an awake, conscious
and coherent individual who
followed commands,
– with poverty of verbal
response.
– mood was dysthymic,
– teary eyed even on neutral
queries,
– withdrawn and with
disturbances in sleep and
appetite.
Patient
Ischemic stroke
• Diagnosis is usually
based on
– symptoms
– results of a physical
examination
– imaging tests
– blood tests
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on confrontation test- unable to see the
left side of her visual field.
can clench both teeth tightly,
had a shallow nasolabial fold on the left,
tongue deviates to the left on protrusion.
manual muscle testing –
– 2/5 weakness on the left upper extremity
– 3/5 on the left lower extremity.
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the right limbs were unaffected.
DTR were generally hyperactive on the left
with babinski reflex on the left foot.
no sensory deficit noted
precordial ausculation, - irregular
heartbeat with an ECG finding of atrial fib.
blood chem showed an
elevated cholesterol level.
Ischemic stroke
Causes
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Thrombus
Embolus
Heart related problems
Blood disorders
OCP’s
Lipohyalinosis
Fat embolism syndrome
Vasculitis
Cocaine& amphetamines
RF of patient
• hypertensive
• diabetic woman
– very poor compliance with
her antihypertensive and
hypoglycemic maintenance
medications.
Diagnosis
• based on the history of
events and PE.
• Can usually identify which
artery in the brain is
blocked based on
symptoms.
– For example, weakness or
paralysis of the left leg
suggests blockage of the
artery supplying the area
on the right side of the
brain that controls the left
leg's muscle movements.
• CT
– usually done first
– helps distinguish an
ischemic stroke from a
hemorrhagic stroke, a
brain tumor, an abscess,
and other structural
abnormalities.
Diagnosis
• Measure the blood sugar level to rule out a
hypoglycemia.
• Diffusion MRI
– which can detect ischemic strokes within minutes
of their start, may be done next.
• Identifying the precise cause of the stroke is
important.
– ECG - look for abnormal heart rhythms
– Echocardiography - check the heart for blood clots,
pumping or structural abnormalities, and valve
disorders
– Imaging tests (angiography) - to determine whether
arteries, especially the internal carotid arteries, are
blocked or narrowed.
• Blood tests
– check for anemia, polycythemia, blood clotting
disorders, vasculitis, and some infections and for risk
factors such as high cholesterol levels or diabetes