Ischemic%20stroke Signs and Symptoms

Signs and Symptoms

Introduction

Stroke or cerebrovascular disease is defined as a sudden onset of focal neurological deficit or any alteration in level of consciousness due to an underlying vascular pathology
- Brain involvement is evident clinically or as documented in imaging studies based on the onset of symptoms
Ischemic stroke is a type of stroke characterized by the sudden absence of blood supply to an area of the brain, spinal cord or retina secondary to a thrombus, emboli, or intracranial small vessel disease
Most common risk factors include hypertension and diabetes mellitus
Rapid evaluation is essential for use of time-sensitive treatments and to prevent further brain damage

Epidemiology

Second most common cause of mortality and disability worldwide
- Ischemic stroke accounts for 62% of all incident strokes worldwide
Incidence of stroke increases with age and doubles after 55 years of age
Lifetime risk of stroke is higher in females than in males

Pathophysiology of Ischemic Stroke

Significant impairment or interruption of blood supply to the brain due to decreased systemic perfusion, severe stenosis or occlusion of a blood vessel leads to metabolic and molecular alterations resulting in neuronal function loss and morphological damage

Signs and Symptoms

Common Presentation of Patients with Acute Ischemic Stroke

Left (Dominant) Hemisphere

Left gaze preference
Right visual field deficit
Right hemiparesis
Right hemisensory loss
Dysarthria
Aphasia (Broca’s, Wernicke’s, Global)
Apraxia
Visual agnosia

Right (Non-dominant) Hemisphere

Right gaze preference
Left visual field deficit
Left hemiparesis
Left hemisensory loss (hemi-inattention)
Neglect of left side
Dysarthria

Brainstem

Nausea/vomiting
Diplopia, dysconjugate gaze, gaze palsy, nystagmus
Dysarthria, dysphagia
Vertigo, syncope
Hemiparesis or quadriplegia
Sensory loss in hemibody or all 4 limbs
Decreased consciousness
Hiccups, abnormal respirations
Alexia or inability to understand words written

Cerebellum

Truncal/gait ataxia, limb ataxia
Dysarthria
Vertigo, nystagmus

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