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Semin Neurol 2003; 23(3): 241-252
DOI: 10.1055/s-2003-814740
Copyright © 2003 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

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
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Publication History

Publication Date:
14 January 2004 (online)

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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

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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 4 Brown M M. Brain attack.  Clin Med . 2002;  2 60-65
    PubMedGoogle Scholar
  • 5 Hachinski V. Brain Attack: The Clinical Handbook.  Guelph, Ontario, Canada: Meducom International; 1999
    Google Scholar
  • 6 Weisberg L A. Clinical characteristics of transient ischemic attacks in black patients.  Neurology . 1991;  41 1410-1414
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 10 Engelter S T, Provenzale J M, Petrella J R. et al . Diffusion MR imaging and transient ischemic attacks.  Stroke . 1999;  30 2762-2763
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 14 Sauve J S, Laupacis A, Ostbye T. et al . Does this patient have a clinically important carotid bruit?.  JAMA . 1993;  270 2843-2845
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 16 Bladin C F, Alexandrov A V, Bellavance A. et al . Seizures after stroke: a prospective multicenter study.  Arch Neurol . 2000;  57 1617-1622
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 20 Jung D K, Devuyst G, Maeder P, Bogousslavsky J. Atrial fibrillation with small subcortical infarcts.  J Neurol Neurosurg Psychiatry . 2001;  70 344-349
    CrossrefPubMedGoogle Scholar
  • 21 Goldstein L B, Matchar D B. Clinical assessment of stroke.  JAMA . 1994;  271 1114-1120
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 24 Weisberg L A. Computerized tomography in intracranial hemorrhage.  Arch Neurol . 1979;  36 422-426
    PubMedGoogle Scholar
  • 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
    Google Scholar
  • 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
    Google Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    Google Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    Google Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 36 Meschia J F, Miller D A, Brott T G. Thrombolytic treatment of acute ischemic stroke.  Mayo Clin Proc . 2002;  77 542-551
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    Google Scholar
  • 41 Stroke Unit Trialists' Collaboration. Organised inpatient (stroke unit) care for stroke (Cochrane Review). In: The Cochrane Library, Issue 2 Oxford: Update Software 2003
    Google Scholar
  • 42 Wald N J, Law M R. A strategy to reduce cardiovascular disease by more than 80%.  BMJ . 2003;  326 1419-1424
    CrossrefPubMedGoogle Scholar
  • 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
    Google Scholar
  • 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
    Google Scholar
  • 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
    Google Scholar
  • 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
    Google Scholar
  • 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
    Google Scholar
  • 48 Straus S E, Majumdar S R, McAlister F A. New evidence for stroke prevention.  JAMA . 2002;  288 1388-1395
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
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