Clinical impression:

Ischemic stroke

Ischemic stroke

• Death of brain tissue resulting from an inadequate supply of blood and oxygen to the brain due to blockage of an artery.

by blood clots or fat deposits

Ischemic stroke

• Symptoms occur suddenly and may include:– muscle weakness– paralysis– lost or abnormal sensation on

one side of the body– difficulty speaking – confusion, problems with

vision– dizziness – loss of balance and

coordination

Patient• awoke one morning nothing

that she was unable to move her entire left side of the body.

• slurred speech with saliva drooling on the left corner of her mouth.

• MSE: – showed an awake, conscious

and coherent individual who followed commands,

– with poverty of verbal response.

– mood was dysthymic, – teary eyed even on neutral

queries, – withdrawn and with

disturbances in sleep and appetite.

Ischemic stroke Patient

• Diagnosis is usually based on – symptoms – results of a physical

examination– imaging tests– blood tests

• on confrontation test- unable to see the left side of her visual field.

• can clench both teeth tightly, • had a shallow nasolabial fold on the left,• tongue deviates to the left on protrusion. • manual muscle testing –

– 2/5 weakness on the left upper extremity – 3/5 on the left lower extremity.

• the right limbs were unaffected. • DTR were generally hyperactive on the left

with babinski reflex on the left foot.• no sensory deficit noted• precordial ausculation, - irregular heartbeat

with an ECG finding of atrial fib.• blood chem showed an

elevated cholesterol level.

Ischemic strokeCauses• Thrombus• Embolus• Heart related problems• Blood disorders• OCP’s• Lipohyalinosis• Fat embolism syndrome• Vasculitis• Cocaine& amphetamines

RF of patient

• hypertensive • diabetic woman

– very poor compliance with her antihypertensive and hypoglycemic maintenance medications.

Diagnosis• based on the history of

events and PE. • Can usually identify which

artery in the brain is blocked based on symptoms.– For example, weakness or

paralysis of the left leg suggests blockage of the artery supplying the area on the right side of the brain that controls the left leg's muscle movements.

• CT – usually done first – helps distinguish an

ischemic stroke from a hemorrhagic stroke, a brain tumor, an abscess, and other structural abnormalities.

Diagnosis

• Measure the blood sugar level to rule out a hypoglycemia.

• Diffusion MRI – which can detect ischemic strokes within minutes

of their start, may be done next.

• Identifying the precise cause of the stroke is important.– ECG - look for abnormal heart rhythms– Echocardiography - check the heart for blood clots,

pumping or structural abnormalities, and valve disorders

– Imaging tests (angiography) - to determine whether arteries, especially the internal carotid arteries, are blocked or narrowed.

• Blood tests – check for anemia, polycythemia, blood clotting

disorders, vasculitis, and some infections and for risk factors such as high cholesterol levels or diabetes