Stroke Explained Types Warning Signs Risk Factors Management

Below is a **complete, exhaustive, NEET-PG–ready / clinician-level detailed note on STROKE**, written cleanly and structured exactly the way Google SEO + medical standards require. This covers **definition → pathophysiology → causes → symptoms → diagnosis → differentials → full management → drugs with MOA, doses, adverse effects → rehabilitation → prevention**. --- # 🧠 **STROKE — COMPLETE DETAILED NOTE** --- ## ✅ **1. DEFINITION** A **stroke (cerebrovascular accident)** is an acute neurological deficit caused by interruption of blood flow to the brain—either due to vessel **occlusion** (ischemic stroke) or **rupture** (hemorrhagic stroke)—leading to rapid loss of brain function. --- ## ✅ **2. CLASSIFICATION** ### **A. Ischemic Stroke (≈ 85%)** Caused by reduced or blocked blood flow. **Types:** 1. **Thrombotic** – plaque rupture & clot formation in cerebral artery 2. **Embolic** – clot from heart or large vessels → brain 3. **Lacunar** – small perforator artery occlusion (HTN related) 4. **Watershed infarcts** – systemic hypotension ### **B. Hemorrhagic Stroke (≈ 15%)** 1. **Intracerebral hemorrhage (ICH)** – rupture of small arteries (HTN common) 2. **Subarachnoid hemorrhage (SAH)** – rupture of saccular aneurysm --- ## ✅ **3. PATHOPHYSIOLOGY** * Brain needs **continuous oxygen and glucose**. * Interruption of blood flow → **energy failure** → Na⁺/K⁺ pump failure → cellular swelling → **cytotoxic edema**. * Excitotoxicity via glutamate release → neuronal death. * **Ischemic core** (irreversible) + **penumbra** (salvageable with timely reperfusion). Hemorrhagic stroke: bleeding → mass effect, ↑ ICP → reduced perfusion → neuronal injury. --- ## ✅ **4. RISK FACTORS / CAUSES** ### **Non-modifiable** * Age * Male sex * Family history * Prior stroke/TIA * Genetic disorders (CADASIL) ### **Modifiable** * **Hypertension (strongest risk factor)** * Diabetes mellitus * Dyslipidemia * Atrial fibrillation * Smoking, alcohol * Obesity * Carotid stenosis * Sedentary lifestyle * Oral contraceptives * Hypercoagulable states ### **Causes of Embolic Stroke** * Atrial fibrillation * MI with mural thrombus * Prosthetic valves * Endocarditis * PFO/ASD with paradoxical emboli --- ## ✅ **5. CLINICAL FEATURES** Symptoms depend on the arterial territory. ### **General Symptoms** * Sudden onset focal neurological deficit * Weakness, numbness (face/arm/leg) * Speech difficulty (aphasia, dysarthria) * Vision loss (amaurosis fugax) * Ataxia * Severe headache (more SAH/ICH) * Altered consciousness ### **FAST Screening** * **F**ace drooping * **A**rm weakness * **S**peech difficulty * **T**ime to call EMS --- ## ✅ **6. VASCULAR TERRITORY SYNDROMES** ### **MCA Stroke** (Most common) * Contralateral hemiparesis (face/arm > leg) * Aphasia (left MCA) * Neglect (right MCA) * Homonymous hemianopia ### **ACA Stroke** * Leg > arm weakness * Urinary incontinence * Abulia (lack of will) ### **PCA Stroke** * Homonymous hemianopia * Visual hallucinations * Memory impairment ### **Lacunar Syndromes** * Pure motor * Pure sensory * Ataxic hemiparesis * Dysarthria-clumsy hand --- ## ✅ **7. INVESTIGATIONS & DIAGNOSTIC WORKUP** ### **Immediate (Emergency)** 1. **Non-contrast CT brain** * Rule out hemorrhage * Must be done ASAP (within minutes) 2. **Blood glucose** 3. **ECG** (AF detection) 4. **Oxygen saturation** 5. **CBC, PT/INR, aPTT, creatinine** ### **Further Tests** * CT angiography / MR angiography * MRI (DWI) — best to detect early ischemia * Carotid Doppler * Echocardiography * Lipid profile, HbA1c --- ## ✅ **8. DIFFERENTIAL DIAGNOSES** * Hypoglycemia * Seizure with post-ictal Todd’s paralysis * Hemiplegic migraine * Brain tumor * MS flare * Syncope * Drug toxicity --- # 🏥 **9. MANAGEMENT (ACUTE & COMPLETE)** ## **A. Pre-hospital** * FAST identification * Maintain airway * Oxygen if hypoxic * Transport to stroke centre --- ## **B. Emergency Room Management** ### **1. Determine type: ischemic vs hemorrhagic.** CT scan is mandatory before treatment. --- # 🔵 **10. MANAGEMENT OF ISCHEMIC STROKE** ## **1. IV Thrombolysis (tPA – Alteplase)** **Time window:** within **4.5 hours** of symptom onset. ### **Dose** * **0.9 mg/kg (max 90 mg)** * 10% bolus + 90% over 60 min ### **Contraindications** * BP > 185/110 * Recent surgery * Recent GI bleed * Platelets < 100k * INR > 1.7 ### **Monitoring** * BP every 15 minutes * Watch for bleeding --- ## **2. Mechanical Thrombectomy** Indicated for **large vessel occlusion** (ICA, M1). **Time window:** up to **24 hours** (DAWN/DEFUSE-3 criteria). --- ## **3. Antiplatelets** ### **Aspirin** * **160–325 mg** initial (after CT excludes bleed) * Continue **81 mg daily** long-term **MOA:** COX-1 inhibitor → ↓ thromboxane A2 **Side effects:** GI bleed, dyspepsia **Avoid:** active bleed, aspirin allergy ### **Clopidogrel** * **75 mg daily** **MOA:** P2Y12 inhibitor **Side effects:** bleeding, rash ### **Dual Antiplatelet Therapy (DAPT)** * For **minor stroke / high-risk TIA** (NIHSS ≤3) * Aspirin + Clopidogrel for **21 days**, then aspirin alone --- ## **4. Anticoagulation** (for AF-related stroke) * **Apixaban 5 mg BID** or * **Rivaroxaban 20 mg daily** Start after **3–14 days** depending on infarct size. --- ## **5. Blood Pressure Control** * In ischemic stroke (not thrombolysed): treat only if **>220/120** * If thrombolysed: must keep **<185/110** **Drugs:** labetalol, nicardipine IV. --- ## **6. Control glucose** * Keep *140–180 mg/dL* * Avoid hypoglycemia --- ## **7. Neuroprotection / Supportive** * Elevate head 30° * Avoid hyperthermia * DVT prophylaxis * Early physiotherapy --- # 🔴 **11. MANAGEMENT OF HEMORRHAGIC STROKE** ## **Intracerebral Hemorrhage (ICH)** * Strict BP control: **target 140–160 mmHg** * Reverse anticoagulation * Manage ICP (mannitol, hypertonic saline) * Neurosurgery consult for large bleeds ## **Subarachnoid Hemorrhage (SAH)** * Secure aneurysm (clipping/coiling) * **Nimodipine 60 mg q4h** (prevents vasospasm) * Monitor with transcranial Doppler --- # 🧩 **12. COMPLICATIONS** * Hemorrhagic transformation * Increased ICP * Seizures * Aspiration pneumonia * DVT/PE * Depression * Cognitive decline --- # 🧑‍⚕️ **13. REHABILITATION** * Start within **24–48 hours** * Physiotherapy − gait, spasticity control * Occupational therapy − daily activities * Speech therapy * Cognitive rehabilitation * Nutrition counselling --- # 🛡️ **14. SECONDARY PREVENTION** ### **A. Lifestyle** * BP < 130/80 * LDL < 70 mg/dL * Diabetes control * Smoking cessation * Weight reduction * Healthy diet (Mediterranean) * Regular exercise ### **B. Medical** * **Statins:** Atorvastatin 40–80 mg/day * Antiplatelet therapy * Anticoagulants for AF * Control HTN, DM ### **C. Surgical** * Carotid endarterectomy if stenosis ≥70% --- # 🧪 **15. MEDICATION TABLE (QUICK REFERENCE)** | Drug | Dose | MOA | Side Effects | Monitoring | | ------------------- | --------- | --------------------------- | -------------- | ---------------- | | **Aspirin** | 81–325 mg | COX-1 inhibitor | GI bleeding | CBC | | **Clopidogrel** | 75 mg | P2Y12 blocker | Bleeding, rash | Platelets | | **Atorvastatin** | 40–80 mg | HMG-CoA reductase inhibitor | Myalgia, ↑LFT | LFTs | | **Alteplase (tPA)** | 0.9 mg/kg | Plasminogen activator | ICH, bleeding | BP, neuro checks | | **Apixaban** | 5 mg BID | Factor Xa inhibitor | Bleed | Renal function | | **Nimodipine** | 60 mg q4h | Ca-channel blocker | Hypotension | BP | --- # 📌 **16. PATIENT COUNSELLING** * Recognize FAST warning signs * Adherence to antiplatelets/anticoagulants * Importance of BP, sugar, lipid control * Avoid smoking and alcohol * Early rehab improves outcome --- If you want, I can also generate: ✅ Stroke infographic ✅ HTML page version for your website ✅ NEET-PG MCQs on stroke ✅ Stroke case scenarios Just tell me!

Log in to comment.

No comments yet.