Last reviewed: November 2017
Last updated: November  2017

Summary

Definition

History and exam

Key diagnostic factors

  • vision loss or visual field deficit
  • weakness
  • aphasia
  • impaired co-ordination (ataxia)

Other diagnostic factors

  • hx TIA
  • sudden onset of symptoms
  • negative symptoms (i.e., loss of function)
  • altered sensation
  • headache
  • diplopia
  • sensory loss
  • dysarthria
  • gaze paresis
  • arrhythmias, murmurs, or pulmonary oedema
  • vertigo/dizziness
  • nausea and/or vomiting
  • neck or facial pain
  • miosis, ptosis, and facial anhidrosis (hemilateral)
  • altered level of consciousness/coma
  • confusion

Risk factors

  • older age
  • male sex
  • African-American or Hispanic ancestry
  • FHx stroke
  • Hx of ischaemic stroke
  • HTN
  • smoking
  • diabetes mellitus
  • atrial fibrillation
  • comorbid cardiac conditions
  • carotid artery stenosis
  • sickle cell disease
  • dyslipidaemia
  • poor diet and nutrition
  • physical inactivity
  • obesity
  • alcohol abuse
  • oestrogen-containing therapy
  • illicit drug use
  • migraine
  • hyperhomocysteinaemia
  • elevated lipoprotein(a)
  • hypercoagulable states
  • elevated C-reactive protein
  • aortic arch plaques

Diagnostic investigations

1st investigations to order

  • CT head
  • MRI brain
  • serum glucose
  • serum electrolytes
  • serum urea and creatinine
  • cardiac enzymes
  • ECG
  • FBC
  • prothrombin time (PT) and PTT (with international normalised ratio)
Full details

Investigations to consider

  • serum toxicology screen
  • CXR
  • CT or MRI angiography
  • CT or MR venography
  • carotid ultrasound
  • transcranial Doppler ultrasound
  • conventional (invasive) angiography
Full details

Emerging tests

  • CT perfusion or MRI perfusion-weighted imaging
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Assistant Professor of Internal Medicine

Medical School

University of Thessaly

Secretary General

Hellenic Stroke Organization

Larissa University Hospital

Larissa

Greece

Disclosures

GN is one the advisory boards for, and has received honoraria, speaker fees, and research support from: Amgen; Bayer; Boehringer-Ingelheim; BMS/Pfizer; Elpen; Galenica; Medtronic; Sanofi; and Winmedica.

Dr George Ntaios would like to gratefully acknowledge Dr Alireza Minagar, a previous contributor to this monograph. AM declares that he has no competing interests.

Peer reviewers VIEW ALL

Neurology Registrar

Neurology Service

Centre Hospitalier Universitaire Vaudois (CHUV)

Lausanne

Switzerland

Disclosures

JM declares that he has no competing interests.

Lecturer in Neurology

Hospital Chief

Cerebrovascular/Stroke Division

Beth Israel Deaconess Medical Center

Division of Cerebrovascular/Stroke

Boston

MA

Disclosures

LRC declares that he has no competing interests.

National Clinical Director

Stroke NHS England

Professor, Stroke Medicine

Kings College London

Chair, Intercollegiate Stroke Working Party

Royal College of Physicians

London

UK

Disclosures

TR declares that he has no competing interests.

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