Diagnosis and Management of Stroke (Brain Attack)

Bart M. Demaerschalk

doi:10.1055/s-2003-814740

Seminars in Neurology, Table of Contents

Semin Neurol 2003; 23(3): 241-252
DOI: 10.1055/s-2003-814740

Diagnosis and Management of Stroke (Brain Attack)

Bart M. Demaerschalk

Assistant Professor of Neurology, Mayo Clinic College of Medicine, Department of Neurology, Mayo Clinic Scottsdale, Scottsdale, Arizona

Abstract

ABSTRACT

Clinicians commonly encounter patients with cerebrovascular disorders in the hospital. Now, as never before, there are many effective diagnostic and therapeutic modalities. Several examples of typical cases of stroke and transient ischemic attack are presented in order to illustrate a rational approach to diagnosis and treatment. A redefinition of transient ischemic attack and stroke, salient elements of the neurological history and examination, localization techniques, stroke mimickers, mechanisms of infarction and hemorrhage, acute stroke teams, thrombolysis, and secondary prevention are highlighted.

KEYWORDS

Cerebrovascular disorders - cerebral infarction - transient ischemic attack - cerebral hemorrhage - thrombolytic therapy

Full Text

References

REFERENCES

1 American Stroke Association. Impact of stroke. Available at http://www.strokeassociation.org. Accessed July 24, 2003
2 Johnston S C, Gress D R, Browner W S. et al . Short-term prognosis after emergency department diagnosis of TIA. JAMA . 2000; 284 2901-2906
3 Blight A, Pereira A C, Brown M M. A single consultation cerebrovascular disease clinic is cost effective in the management of transient ischaemic attack and minor stroke. J R Coll Physicians Lond . 2000; 34 452-455
4 Brown M M. Brain attack. Clin Med . 2002; 2 60-65
5 Hachinski V. Brain Attack: The Clinical Handbook. Guelph, Ontario, Canada: Meducom International; 1999
6 Weisberg L A. Clinical characteristics of transient ischemic attacks in black patients. Neurology . 1991; 41 1410-1414
7 Pessin M S, Duncan G W, Mohr J P. et al . Clinical and angiographic features of carotid transient ischemic attacks. N Engl J Med . 1977; 296 358-62
8 Marler J R, Tilley B C, Lu M. et al . Early stroke treatment associated with better outcome: the NINDS rt-PA stroke study. Neurology . 2000; 55 1649-1655
9 Kidwell C S, Alger J R, Di Salle F. et al . Diffusion MRI in patients with transient ischemic attacks. Stroke . 1999; 30 1174-1180
10 Engelter S T, Provenzale J M, Petrella J R. et al . Diffusion MR imaging and transient ischemic attacks. Stroke . 1999; 30 2762-2763
11 Ay H, Buonanno F S, Schaefer P W. et al . Clinical and diffusion-weighted imaging characteristics of an identifiable subset of TIA patients with acute infarction. Stroke . 1999; 30 235
12 Ay H, Oliveira-Filho J, Buonanno F S. et al . `Footprints' of transient ischemic attacks: a diffusion-weighted MRI study. Cerebrovasc Dis . 2002; 14 177-186
13 Albers G W, Caplan L R, Easton J D. et al . Transient ischemic attack-proposal for a new definition. N Engl J Med . 2002; 347 1713-1716
14 Sauve J S, Laupacis A, Ostbye T. et al . Does this patient have a clinically important carotid bruit?. JAMA . 1993; 270 2843-2845
15 Teitelbaum J S, Eliasziw M, Garner M. Tests of motor function in patients suspected of having mild unilateral cerebral lesions. Can J Neurol Sci . 2002; 29 337-344
16 Bladin C F, Alexandrov A V, Bellavance A. et al . Seizures after stroke: a prospective multicenter study. Arch Neurol . 2000; 57 1617-1622
17 Libman R B, Wirkowski E, Alvir J. et al . Conditions that mimic stroke in the emergency department: implications for acute stroke trials. Arch Neurol . 1995; 52 1119-1122
18 Ay H, Oliveira-Filho J, Buonanno F S. et al . Diffusion-weighted imaging identifies a subset of lacunar infarction associated with embolic source. Stroke . 1999; 30 2644-2650
19 Tejada J, Díez-Tejedor E, Hernández-Echebarría L. et al . Does a relationship exist between carotid stenosis and lacunar infarction?. Stroke . 2003; 34 1404-1409
20 Jung D K, Devuyst G, Maeder P, Bogousslavsky J. Atrial fibrillation with small subcortical infarcts. J Neurol Neurosurg Psychiatry . 2001; 70 344-349
21 Goldstein L B, Matchar D B. Clinical assessment of stroke. JAMA . 1994; 271 1114-1120
22 Adams H P, Bendixen B H, Kappelle L J. et al . Classification of subtype of acute ischemic stroke: definitions for use in a multicenter clinical trial. Stroke . 1993; 24 35-41
23 Parizel P M, Makkat S, Van Miert E. et al . Intracranial hemorrhage: principles of CT and MRI interpretation. Eur Radiol . 2001; 11 1770-1783
24 Weisberg L A. Computerized tomography in intracranial hemorrhage. Arch Neurol . 1979; 36 422-426
25 Blecic S, Bogousslavsky J. Stroke in young adults. In: Barnett JM, Mohr JP, Stein B, et al, eds. Stroke: Pathophysiology, Diagnosis, and Management Philadelphia: Churchill Livingstone 1998: 1001-1012
26 Blecic S, Bogousslavsky J. Stroke in young adults. Table 4.1 In: Barnett JM, Mohr JP, Stein B, et al, eds. Stroke: Pathophysiology, Diagnosis, and Management Philadelphia: Churchill Livingstone 1998: 1002
27 Hill M D, Barber P A, Demchuk A M. et al . Building a “brain attack” team to administer thrombolytic therapy for acute ischemic stroke. CMAJ . 2000; 162 1589-1593
28 National Institute of Neurological Disorders and Stroke rtPA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med . 1995; 333 1581-1587
29 Gladstone D J, Black S E. Update on intravenous tissue plasminogen activator for acute stroke: from clinical trials to clinical practice. CMAJ . 2001; 165 311-317
30 Wardlaw J M, del Zoppo G, Yamaguchi T. Thrombolysis for acute ischaemic stroke (Cochrane Review). In: The Cochrane Library, Issue 2 Oxford: Update Software 2003
31 Adams Jr P H, Brott T G, Furlan A J. et al . Guidelines for thrombolytic therapy for acute stroke: a supplement to the guidelines for the management of patients with acute ischemic stroke: a statement for healthcare professionals from a special writing group of the stroke council, American Heart Association. Stroke . 1996; 27 1711-1718
32 Practice Advisory: thrombolytic therapy for acute ischemic stroke-summary statement: report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology . 1996; 47 835-839
33 Brott T G, Clark W M, Fagan S C. et al .National Stroke Association. Stroke the First Hours: Guidelines for Acute Treatment. Englewood, CO: National Stroke Association; 2000
34 Hill M D, Buchan A M, for the CASES investigators. The Canadian Activase for Stroke Effectiveness Study (CASES): final results. Stroke . 2002; 33 359
35 Katzan I L, Furlan A J, Lloyd L E. et al . Use of tissue-type plasminogen activator for acute ischemic stroke: the Cleveland area experience. JAMA . 2000; 283 1151-1158
36 Meschia J F, Miller D A, Brott T G. Thrombolytic treatment of acute ischemic stroke. Mayo Clin Proc . 2002; 77 542-551
37 Hill M D, Lye T, Moss H. et al . Hemi-orolingual angioedema and ACE inhibition after alteplase treatment of stroke. Neurology . 2003; 60 1525-1527
38 CAST (Chinese Acute Stroke Trial) Collaborative Group. CAST: randomized placebo-controlled trial of early aspirin use in 20,000 patients with acute ischaemic stroke. Lancet . 1997; 349 1641-1649
39 IST (International Stroke Trial) Collaborative Group. IST: a randomized trial of aspirin, subcutaneous heparin, both, or neither among 19435 patients with acute ischaemic stroke. Lancet . 1997; 349 1569-1581
40 Gubitz G, Counsell C, Sandercock P. et al .Anticoagulants for acute ischaemic stroke (Cochrane Review). In: The Cochrane Library, Issue 3 Oxford: Update Software 2003
41 Stroke Unit Trialists' Collaboration. Organised inpatient (stroke unit) care for stroke (Cochrane Review). In: The Cochrane Library, Issue 2 Oxford: Update Software 2003
42 Wald N J, Law M R. A strategy to reduce cardiovascular disease by more than 80%. BMJ . 2003; 326 1419-1424
43 Cina C S, Clase C M, Haynes R B. Carotid endarterectomy for symptomatic carotid stenosis (Cochrane Review). In: The Cochrane Library, Issue 2 Oxford: Update Software 2003
44 Koudstaal P J. Anticoagulants for preventing stroke in patients with nonrheumatic atrial fibrillation and a history of stroke or transient ischemic attacks (Cochrane Review). In: The Cochrane Library, Issue 2 Oxford: Update Software 2003
45 Koudstaal P J. Anticoagulants versus antiplatelet therapy for preventing stroke in patients with nonrheumatic atrial fibrillation and a history of stroke or transient ischemic attacks (Cochrane Review). In: The Cochrane Library, Issue 2 Oxford: Update Software 2003
46 Sandercock P, Mielke O, Liu M. et al .Anticoagulants for preventing recurrence following presumed non-cardioembolic ischaemic stroke or transient ischaemic attack (Cochrane Review). In: The Cochrane Library, Issue 2 Oxford: Update Software 2003
47 Algra A, De Schryver E L M L, van Gijn J. et al .Oral anticoagulants versus antiplatelet therapy for preventing further vascular events after transient ischaemic attack or minor stroke of presumed arterial origin (Cochrane Review). In: The Cochrane Library, Issue 2 Oxford: Update Software 2003
48 Straus S E, Majumdar S R, McAlister F A. New evidence for stroke prevention. JAMA . 2002; 288 1388-1395
49 Gorelick P. Stroke prevention therapy beyond antithrombotics: unifying mechanisms in ischemic stroke pathogenesis and implications for therapy: an invited review. Stroke . 2002; 33 862-875