Pathophysiology of Stroke 11_19_12

Accessed 02 nov 2012 laboratory tests tests for

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[Accessed 02 Nov 2012].
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Laboratory Tests Tests for hypercoagulable state should be done when cause of stroke cannot be determined based on other well-known risk factors Proteins C & S and antithrombin III Best measured at “steady state,” not in acute stage Antiphospholipid antibodies are of higher yield Reserve for young patients (< 50 years) with multiple venous/arterial thrombotic events OR Patients who have livedo reticularis (skin rash) Fagan SC, Hess DC. Stroke. In: DiPiro JT, Talbert RL, Yee GC, et al., editors. Pharmacotherapy a pathophysiologic approach. 8th ed. New York: McGraw Hill Medical; 2011:353-356.
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Other Diagnostic Tests Computed tomography (CT) scan Hyperintense (white) in area of hemorrhage Normal or hypointense (dark) in area of infarction May take up to 24 areas to reveal area of infarction Magnetic resonance imaging (MRI) Reveals areas of ischemia earlier than CT scan 1. Fagan SC, Hess DC. Stroke. In: DiPiro JT, Talbert RL, Yee GC, et al., editors. Pharmacotherapy a pathophysiologic approach. 8th ed. New York: McGraw Hill Medical; 2011:353-356. 2. Image (left): Brunicardi FC, Andersen DK, Billiar TR, et al. Schwartz’s Principles of Surgery, 9th Edition : . [Accessed 30 Oct 2012]. 3. Image (right): Usatine RP, Smith MA, Mayeaux EJ Jr, et al. The Color Atlas of Family Medicine: [Accessed 30 Oct 2012].
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Other Diagnostic Tests Carotid Doppler (CD) Determine degree of stenosis in carotid arteries Electrocardiogram (ECG) Detect presence of atrial fibrillation Transthoracic echocardiography (TTE) Identify valve abnormalities or wall-motion abnormalities that could be sources of emboli to the brain Transesophageal echocardiography (TEE) Fagan SC, Hess DC. Stroke. In: DiPiro JT, Talbert RL, Yee GC, et al., editors. Pharmacotherapy a pathophysiologic approach. 8th ed. New York: McGraw Hill Medical; 2011:353-356.
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NIH Stroke Scale (NIHSS) Neurologic exam used to evaluate the effects of acute cerebral infarction Level of consciousness, orientation questions, response to commands Visual-field loss Facial movements Motor strength, limb ataxia Sensory loss Language, articulation Extinction or inattention Adams HP et al. Guidelines for the Early Management of Adults with Ischemic Stroke. Stroke 2007;38:1655-1711.
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Hemorrhagic Stroke: Definitions & Etiology Fagan SC, Hess DC. Stroke. In: DiPiro JT, Talbert RL, Yee GC, et al., editors. Pharmacotherapy a pathophysiologic approach. 8th ed. New York: McGraw Hill Medical; 2011:353-356.
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Pathophysiology of Hemorrhagic Stroke Presence of blood in brain parenchyma damages surrounding tissue through mass effect and neurotoxicity of blood components Hemorrhage volume is the most important predictor of outcome 30% continue to enlarge over first 24 hours Volume > 60 mL associated with 71-93% mortality at 30 days Most early mortality due to abrupt increase in intracranial pressure leading to Fagan SC, Hess DC. Stroke. In: DiPiro JT, Talbert RL, Yee GC, et al., editors. Pharmacotherapy a pathophysiologic approach. 8th ed. New York: McGraw Hill Medical; 2011:353-356.
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  • Fall '12
  • lipsh
  • ischemic stroke, McGraw Hill Medical, Talbert RL

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