Mar. Nov 30th, 2021
    The strokes bad decisions

    Stroke causes

    A risk factor is something that increases your chance of getting a disease or health problem. Some stroke risk factors cannot be changed, but others can. Changing risk factors that you have control over will help you live a longer, healthier life.Risk factors you cannot change

    You can’t change these stroke risk factors:Blood clots from the heart can travel to the brain, block blood vessels there, and cause a stroke. This can happen in people with artificial or infected heart valves. It can also happen because of a heart defect you were born with.A very weak heart and an abnormal heart rate, such as atrial fibrillation, can also cause blood clots.Risk Factors You Can Change

    American Diabetes Association. Standards of medical care in diabetes – 2020. Diabetes Care. 2020 Jan;43(Suppl 1). clinical.diabetesjournals.org/content/38/1/10.full-text.pdf.Biller J, Schneck MJ, Ruland S. Ischemic cerebrovascular disease. In: Jankovic J, Mazziotta JC, Pomeroy SL, Newman NJ, eds. Bradley and Daroff’s Neurology in Clinical Practice. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 65.Campbell BCV, Khatri P. Stroke. Lancet. 2020;396(10244):129-142. PMID: 32653056 pubmed.ncbi.nlm.nih.gov/32653056/.

    Hemorrhagic stroke

    Stroke victims often experience an immediate impairment in their ability to think and reason. But a new study shows that a stroke can also have a more insidious and long-term effect on mental processes.

    The impairment centered primarily around two domains fundamentally affected by stroke: global cognition and executive function, Levine said. Global cognition reflects a person’s overall ability to think and reason, while executive function reflects his or her ability to organize, prioritize, manage time and make decisions.

    Lubin found the results particularly surprising given that the researchers ruled out patients who had suffered aphasia (an impairment of their language abilities) as a result of their stroke.

    «They left out one of the big symptoms that make patients look like they are suffering from cognitive impairment,» Lubin commented. «I think it’s interesting that they still found a connection even after excluding these patients.»

    Stroke wikipedia

    However, because of the sometimes nonspecific clinical presentation and normal/low scores on established stroke assessment scales (e.g., FAST: Face Arm Speech Test, NIHSS: National Institute of Health Stroke Scale) [ 2 , 33 , 37 ], PCS is three times more often than ACS in the acute phase [ 37 ].  In addition, patients with SCA have a longer median time from symptom onset to admission and are more likely to arrive at the hospital beyond the 4.5-h time window [ 29 ], which may imply increased door-to-needle times [ 32 ] or a completely missed opportunity for IVT [ 17 , 28 ].

    Identifying the patient with a PCS among many other dizzy patients with benign peripheral-vestibular or non-vestibular disease in the ED can be quite easy if the patient shows severe focal neurologic abnormalities (e.g., hemiparesis, aphasia/ anarthria, or hemianopsia) that clearly point to a central nervous system (CNS) lesion.  Furthermore, these significant deficits are often considered to be clearly disabling symptoms that justify IVT per se, regardless of vestibular impairment.  However, there is considerable uncertainty in making the diagnosis of SCA and initiating IVT if the patient presents primarily with AVS / AIS and does not have vague or mild clinical signs of CNS involvement, e.g., focal abnormalities such as hemiataxia, dysarthria, and sensory or central deficits. oculomotor signs [ 18, 28 ].  Even the HINTS triad (head impulse, nystagmus, s kew test), which has been shown to have a high sensitivity for detecting stroke as a central cause of AVS [ 12 ], has not been investigated in the context of IVT decision making .

    Stroke consequences

    There are two main types of stroke:Ischemic stroke occurs when a blood vessel that supplies blood to the brain becomes blocked by a blood clot. This can happen in two ways:Ischemic strokes can also be caused by a sticky substance called plaque that can clog arteries.Watch this video about:StrokeA hemorrhagic stroke occurs when a blood vessel in one part of the brain weakens and ruptures. This causes blood to leak into the brain. Some people have defects in the blood vessels of the brain that make this more likely. These defects can include:Hemorrhagic strokes can also occur when someone is taking blood thinners, such as warfarin (Coumadin). Very high blood pressure can cause blood vessels to burst, resulting in a hemorrhagic stroke.An ischemic stroke can bleed and become a hemorrhagic stroke.High blood pressure is the main risk factor for strokes. Other important risk factors are:The risk of stroke is also higher in:Symptoms

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