Stroke.
Stoke results from ischaemic infarction of the brain or from intra cerebral haemorrhage.
Risk factors: HT, smoking, DM, hyperlipidaemia, contraceptive steroids, obesity, heart and peripheral vascular disease, AF, previous TIA, increased PCV, excessive alcohol intake.
Clinical features: usually sudden onset of signs and symptoms. Sometimes step wise progression over hours, even days. Focal damage relates to distribution of affected artery, but collateral supplies cloud the issue.
Tests: look for hypo and hyperglycaemia
AF (look for large left atrium on CXR, consider echo, and anticoagulation, but first excuse cerebral haemorrhage with CT scan)
Hypertension: HT retinopathy, large heart,
Giant cell arteritis: increased ESR, history of temporal headaches or tenderness. Give steroids promptly.
Look for active disease of syphilis. Rule out polycythaemia, thrombocytopenia, embolic stroke and carotid artery stenosis.
Management of stroke: explain to the patient and relatives what has happened. Consider the kindest level of intervention. No drug is of proven value. Admit to stroke unit for skilled nursing and physiotherapy.
Maintain hydration, but take care not to over hydrate. Risk of cerebral oedema. Nil by mouth if there is no gag reflex.
Turn regularly and keep dry to stop bedsores.
Monitor BP but treat if only high. If conscious level impaired consider treating cerebral oedema with glycerol. If cerebral haemorrhage suspected consider immediate referral for evacuation.
Consider naftidrofuryl and heparin.
Secondary prevention: Prevent risk factors. Consider aspirin and warfarin if embolic stroke or in AF patients.
Complications: pneumonia, depression, contractures, constipation and bedsores.
Primary prevention: Good medical care to prevent strokes. Control risk factors like HT, DM, Smoking and hyperlipidaemia. Lifelong anticoagulation in patients with rheumatic or prosthetic heart valves and in chronic AF.