Pathophysiology of Stroke 11_19_12

Fagan sc hess dc stroke in dipiro jt talbert rl yee

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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: http://www.indiatalkies.com/2011/03/24-teeth-stroke.html [Accessed 30 Oct 2012].
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Symptoms Weakness on one side of the body Inability to speak Loss of vision Vertigo Falling Possible headache More severe with 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: Wall HK, Beagan BM, O’Neill HJ, et al. Addressing stroke signs and symptoms through public education: the Stroke Heroes Act FAST campaign. Prev Chronic Dis 2008;5(2). http://www.cdc.gov/pcd/issues/2008/apr/07_0214.htm.
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Signs Multiple signs of neurologic dysfunction Hemi- or monoparesis Hemisensory deficit Vertigo, double vision Aphasia Expressive vs. receptive Dysphagia Dysarthria Visual field defects 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: http://www.wales.nhs.uk/strokeservicesimprovement [Accessed 30 Oct 2012].
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Clinical Features in Ischemic Artery Symptoms and Signs Anterior cerebral Paresis and sensory loss of contralateral leg and foot Middle cerebral Aphasia, neglect, contralateral hemisensory loss, homonymous hemianopia, hemiparesis Vertebral Ipsilateral cerebellar ataxia, Horner’s syndrome, crossed sensory loss, nystagmus, vertigo, hiccup, dysarthria, dysphagia Basilar Nystagmus, vertigo, diplopia, skew deviation, gaze palsies, hemi- or crossed sensory loss, dysarthria, hemi- or quadriparesis, ipsilateral cerebellar ataxia, Horner’s syndrome, coma Posterior cerebral Distal: contralateral homonymous hemianopia, dyslexia, visual hallucinations, memory defect, cortical blindness Proximal: Sensory loss, ataxia, third nerve palsy, contralateral hemiparesis, vertical gaze palsy, skew deviation, hemiballismus, choreoathetosis, impaired consciousness Adapted from: Lomen-Hoerth C, Messing RO. Nervous System Disorders. In: McPhee SJ, Hammer GD, editors. Pathophysiology of Disease. 6th ed. New York: McGraw-Hill; 2010. http://accessmedicine.com/content.aspx?aID=5368376.
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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 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
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Fagan SC Hess DC Stroke In DiPiro JT Talbert RL Yee GC et...

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