Summary
Definition
History and exam
Key diagnostic factors
- perda de visão ou deficit de campo visual
- fraqueza
- afasia
- ataxia (coordenação prejudicada)
Other diagnostic factors
- história de ataque isquêmico transitório (AIT)
- início súbito de sintomas
- sintomas negativos (por exemplo, perda da capacidade funcional)
- alterações sensitivas
- cefaleia
- diplopia
- perda sensitiva
- disartria
- Síndromes "cruzadas"
- paresia da mirada
- arritmias, sopros ou edema pulmonar
- vertigens/tonturas
- náuseas e/ou vômitos
- dor cervical ou facial
- miose, ptose e anidrose facial (hemilateral)
- nível alterado de consciência ou coma
- confusão
Risk factors
- hipertensão
- idade avançada
- doença falciforme
- história familiar de AVC
- história de ataque isquêmico transitório (AIT)
- história de AVC isquêmico
- microssangramentos cerebrais
- tabagismo
- diabetes mellitus
- fibrilação atrial
- comorbidades cardíacas
- estenose da artéria carótida
- aterosclerose intracraniana (AEIC)
- dislipidemia
- menor grau de escolaridade
- etnia
- nutrição e dieta deficientes
- baixo peso ao nascer
- sedentarismo
- obesidade
- abuso de álcool
- uso de terapia oral contendo estrogênio
- gestação
- enxaqueca
- apneia obstrutiva do sono grave
- sono de duração longa ou má qualidade do sono
- uso de substâncias ilícitas
- hiper-homocisteinemia
- lipoproteína(a) elevada
- estados hipercoaguláveis
- proteína C-reativa elevada
- placas no arco aórtico
- forame oval patente (FOP)
- poluição do ar
- cigarros eletrônicos
- infecções
- endometriose
Diagnostic tests
1st tests to order
- tomografia computadorizada (TC) do crânio
- ressonância nuclear magnética (RNM) cranioencefálica
- Angiotomografia ou angiografia por ressonância magnética
- Perfusão por TC ou RNM
- glicose sérica
- eletrólitos séricos
- ureia e creatinina séricas
- enzimas cardíacas
- eletrocardiograma (ECG)
- Hemograma completo
- rastreamento para coagulopatia
Tests to consider
- análise toxicológica sérica
- rastreamento de infecção
- teste genético
- radiografia torácica
- venografia por TC ou ressonância magnética ou venografia digital por subtração
- ultrassonografia de carótidas
- ecocardiograma
- ultrassonografia com Doppler transcraniano
- angiografia convencional (invasiva)
Treatment algorithm
ausência de trombose venosa cerebral
com trombose venosa cerebral
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.
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.
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- Hemorragia intracerebral
- Ataque isquêmico transitório
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