29th April 2024

Stroke

Stroke

Background

Stroke is amongst the most common causes of death and neurological disability worldwide. It is defined as rapid onset of focal neurological deficit due to infarction or haemorrhage.

Clinical presentation

Clinical presentation depends on the brain territory affected. Anterior circulation stroke leads to some combination of hemiparesis, hemisensory loss, hemianopia and dysphasia, as well as sensory/visual inattention. Posterior circulation strokes are much more likely to lead to ataxia as well as cranial nerve involvement. The diagnosis of stroke is clinical, based on clinical examination in a large part.

Diagnosis

The national institute of health stroke scale (NIHSS) is used to assess patients presenting with a stroke and identify those who may require thrombolysis. Imaging, initially, is vital in ruling haemorrhage rather than confirming any stroke diagnosis. CT tends to reveal the lesion in around half of cases. A diffusion-weighted MRI can show ischaemia. It can also be useful in distinguishing acute from chronic lesions.

Management

Management should be in a stroke unit, something which has been shown to reduce mortality and improve outcomes. Thrombolysis should be considered if a patient presents within 4.5 hours of symptom onset, followed by antiplatelet therapy if haemorrhage has been ruled out. The remainder of patient management is essentially supportive and based on rehabilitation, as well as prevention of further events.

References

• Manji H, Connolly S, Dorward N, Kitchen N, Mehta A, Wills A.  S. Oxford Handbook of Neurology.  (2nd ed.). Oxford (UK): Oxford University Press; 2014.
• Royal College of Physicians. National clinical guideline for stroke. London: 2016.  Available from: https://www.strokeaudit.org/SupportFiles/Documents/Guidelines/2016-National-Clinical-Guideline-for-Stroke-5t-(1).aspx