2. Stroke in the emergency room
2.1 Is this a stroke?
2.1. 2. Diagnosis
2.1.3 Stroke mimics
The target of this course is doctors. Also bring some light to patients and their families. You have just been called to the emergency department to evaluate and treat a possible stroke patient. You ask yourself: What should I do first? How do I know it is a stroke? Is it too late to reverse the damage, and if not, how do I do it? How do I make sure that I do things correctly during the first day or so to prevent worsening? This course is designed to answer these real-life questions.
The term ‘‘stroke’’ usually refers either to a cerebral infarction or to non-traumatic cerebral hemorrhage. Depending on the population you are seeing (ethnicity, age, comorbidities) the ratio of infarcts to hemorrhages is about 4:1. As will be described later, cerebral infarcts can be caused by a number of pathological processes, but all end with an occlusion of a cerebral artery or vein. If the arterial occlusion results in a reduction of blood flow insufficient to cause death of tissue (infarction), it is termed ‘‘ischemia.’’
3. Stroke in the emergency room
3.1 Is this a stroke?
There is currently no 100% sensitive and specific test for cerebral infarction in the emergency department, so that the diagnosis is usually made on the basis of a characteristic history, exam, presence of comorbidities, and the absence of seizures or other stroke mimics.
4. Stroke mimics
All of the following may present similarly to a stroke. In all cases, the distinction can be made by an emergent MRI scan, which will show abnormal diffusion-weighted signal in most stroke cases, but not in mimics.
- 5. What type of stroke?
- 6. What to do first
- 7. Ischemic stroke
- 8. Hyperglycemia
- 9. Hyperthermia
- 10. Etiological work-up for secondary prevention
- 11. Screening for arterial/stenosis/obstruction
- 12. Cardiac Evaluation
- 13. Prevention of neurological deterioration or medical complications
- 14. TPA protocol