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Pathology
Acute occlusion of intracranial blood supply leading to hypoxia and infarction.
80% are ischaemic, 20% are haemorrhagic
Aetiology
Non-modifiable risk factors: Age > 65, male gender, family history
Modifiable risk factors: Hypertension, diabetes, smoking, hypercholesterolemia,
atrial fibrillation, obesity
Signs
Sensory and motor deficits
Symptoms
Weakness, visual disturbance, aphasia, ataxia, vertigo
Investigations
Bloods: FBC, U&E, fasting glucose, lipids, clotting
ECG: ECG, 24 hour tape, echo
Imaging: CT or MRI brain – assess for ischaemic changes
ECG: Assess for arrhythmias; may require 24 hour tape
Echo: Assess for structural abnormality and valve function
Treatment
Acute treatment: Thrombolysis if presenting within 4.5 hours of symptom onset
Secondary prevention: Antiplatelets, antihypertensives, statins
Carotid endarterectomy if >70% carotid artery stenosis
Rehabilitation
Prognosis
Poor prognosis associated with increased age, large areas affected, severe motor impairment, loss of consciousness
Full recovery in 40% and 10% risk of 1 year recurrence.
25% one month mortality
Disability, sepsis, arrhythmias, DVT, pressure sores, dysphagia, depression, seizures
Key Facts
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Key References
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