Summary
Definition
History and exam
Key diagnostic factors
- pérdida visual o déficit del campo visual
- debilidad
- afasia
- ataxia (alteración de la coordinación)
Other diagnostic factors
- antecedentes de accidente isquémico transitorio (AIT)
- inicio repentino de los síntomas
- síntomas negativos (es decir, pérdida de función)
- sensación alterada
- cefalea
- diplopía
- pérdida sensorial
- disartría
- Síndromes "cruzados"
- paresia de la mirada
- arritmias, soplos o edema pulmonar
- vértigo o mareos
- náuseas o vómitos, o ambos
- dolor facial o de cuello
- miosis, ptosis y anhidrosis facial (hemilateral)
- alteración del nivel de consciencia/coma
- confusión
Risk factors
- hipertensión
- edad avanzada
- anemia falciforme
- antecedentes familiares de accidentes cerebrovasculares
- antecedentes de accidente isquémico transitorio (AIT)
- antecedentes de accidentes cerebrovasculares isquémicos
- microhemorragias cerebrales
- tabaquismo
- diabetes mellitus
- fibrilación auricular
- enfermedades cardiacas concurrentes
- estenosis carotídea
- aterosclerosis intracraneal (ICAS)
- dislipidemia
- niveles educativos inferiores
- grupo étnico
- dieta insuficiente y desnutrición
- bajo peso al nacer
- inactividad física
- obesidad
- consumo indebido de alcohol
- uso de terapia oral con estrógenos
- embarazo
- migraña
- apnea del sueño obstructiva grave
- sueño de larga duración y mala calidad del mismo
- consumo de drogas ilícitas
- hiperhomocisteinemia
- aumento de lipoproteína-A
- estados de hipercoagulabilidad
- nivel elevado de proteína C-reactiva
- placas en el cayado aórtico
- foramen oval permeable (FOP)
- la contaminación atmosférica
- cigarrillos electrónicos
- infecciones
- endometriosis
Diagnostic investigations
1st investigations to order
- TC craneal
- imagen por resonancia magnética (IRM) cerebral
- Angiografía por TC o angiografía por resonancia magnética
- Perfusión por TC o IRM
- glucosa sérica
- electrolitos séricos
- urea y creatinina séricas
- enzimas cardíacas
- electrocardiograma (ECG)
- hemograma completo (HC)
- cribado de coagulopatía
Investigations to consider
- cribado toxicológico en suero
- cribado de infección
- pruebas genéticas
- radiografía del tórax (RT)
- TC o resonancia magnética o venografía de sustracción digital
- ultrasonido carotídeo
- ecocardiograma
- ultrasonido Doppler transcraneal
- angiografía convencional (invasiva)
Treatment algorithm
sin trombosis de los senos venosos cerebrales
con trombosis de los senos venosos cerebrales
Contributors
Authors
David Wang, DO, FAHA, FAAN
Professor of Neurology
Co-Director
Petznick Stroke Center
Neurovascular Division
Barrow Neurological Institute
Phoenix
AZ
Disclosures
DW received honorarium from Boehringer Ingelheim for lectures on the use of thrombolytics for acute ischaemic stroke. He has also received honorarium from Amgen, Zhongmei Huadong, and ShiYao Pharmaceuticals for speaking. DW was Chair, Stroke Section of the American Academy of Neurology, 2017-2019. He was Chair, Quality and Safety Subcommittee of the American Academy of Neurology (term ended June 2018). DW is an author of references cited in this topic.
Yi Dong, MD, PhD
Department of Neurology
Huashan Hospital
Fudan University
Shanghai
China
Disclosures
YD declares that she has no competing interests.
Yilong Wang, MD, PhD
Professor of Neurology
Deputy Director, Department of Neurology
Beijing Tiantan Hospital, Capital Medical University
Beijing
China
Disclosures
YW declares that he has no competing interests.
Acknowledgements
Dr David Wang, Dr Yi Dong, and Dr Yilong Wang would like to gratefully acknowledge Dr George Ntaios and Dr Alireza Minagar, the previous contributors to this topic.
Disclosures
GN is on 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. AM declares that he has no competing interests.
Peer reviewers
Nishant K. Mishra, MD, PhD, FRCP, FAHA
Assistant Professor of Neurology
Yale University
New Haven
CT
Disclosures
NM declares that he has no competing interests.
Julien Morier, MD
Neurology Registrar
Neurology Service
Centre Hospitalier Universitaire Vaudois (CHUV)
Lausanne
Switzerland
Disclosures
JM declares that he has no competing interests.
Louis R. Caplan, MD
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.
Tony Rudd, MD
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.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Kleindorfer DO, Towfighi A, Chaturvedi S, et al. 2021 guideline for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline from the American Heart Association/American Stroke Association. Stroke. 2021 Jul;52(7):e364-467.Full text Abstract
Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2019 Dec;50(12):e344-418.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Hemorragia intracerebral
- Accidente isquémico transitorio
- Amnesia global transitoria
More DifferentialsGuidelines
- Diagnosis and management of cerebral venous thrombosis: a scientific statement from the American Heart Association
- European Stroke Organisation (ESO) - European Society for Minimally Invasive Neurological Therapy (ESMINT) guidelines on mechanical thrombectomy in acute ischaemic stroke
More GuidelinesPatient information
Accidente cerebrovascular causado por un coágulo sanguíneo: prevención de otro accidente cerebrovascular
preguntas para formularle al médico si ha sufrido un accidente cerebrovascular
More Patient informationCalculators
Escala de accidente cerebrovascular del NIH
Puntuación ABCD2 para predecir el riesgo de accidente cerebrovascular después de un AIT
More CalculatorsVideos
Demostración animada de la intubación traqueal
Demostración animada de la ventilación de bolsa-válvula-máscara
More videos
Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer