Ischemic Stroke, Hemorrhagic Stroke, and Stroke Treatment Flashcards
Algorithm for a new or worsening focal neurological deficit suspected to be a stroke
STAT head CT to rule out hemorrhage (MRI if symptoms resolved spontaneously) or Multi-modal CT or MRI imaging for ischemic stroke (if reperfusion is thought after the timeframe for IV TPA) + Catheter Angiography, Labs, etc.
![](https://s3.amazonaws.com/brainscape-prod/system/cm/205/841/685/a_image_thumb.png?1485705056)
What if imaging shows intracranial bleeding?
If SAH-STAT CTA head +/- catheter angiography
If ICH-CTA or MRA/MRA +/- catheter angiography
and then surgical vs endovascular or medical management
What if imaging shows a cardioembolic state, hypercoaguable state, or cerebral venous thrombosis?
initiate anticoagulation
What if imaging shows large vessel atherothromobosis, lacunar stroke, or cyrptogenic stroke?
antiplatelet therapy
What is this non-contrast CT brain scan showing?
![](https://s3.amazonaws.com/brainscape-prod/system/cm/205/841/863/q_image_thumb.png?1485705208)
subcortical hypertensive hemorrhage
What is this non-contrast CT brain scan showing?
![](https://s3.amazonaws.com/brainscape-prod/system/cm/205/841/923/q_image_thumb.png?1485705260)
Lobar Hemorrhage due to Cerebral Amyloid Angiopathy
What is this non-contrast CT brain scan showing?
![](https://s3.amazonaws.com/brainscape-prod/system/cm/205/841/956/q_image_thumb.png?1485705281)
intracerebral hemorrhage
What is this non-contrast CT brain scan showing?
![](https://s3.amazonaws.com/brainscape-prod/system/cm/205/841/985/q_image_thumb.png?1485705313)
subarachnoid hemorrhage
What is this non-contrast CT brain scan showing?
![](https://s3.amazonaws.com/brainscape-prod/system/cm/205/841/993/q_image_thumb.png?1485705375)
subdural hemorrhage
What is this non-contrast CT brain scan showing?
![](https://s3.amazonaws.com/brainscape-prod/system/cm/205/842/091/q_image_thumb.png?1485705386)
epidural hemorrhage
How is intracranial hemorrhage tx?
aggressive lowering of BP
How is subdural hemorrhage, epidural hemorrhage, and ICH or SAH with life-threatening edema, herniation, or hydrocephalus tx?
neurosurgical decompression
How is SAH tx?
surgical clipping or endovascular coiling of cerebral aneurysms
What are these non-contrast CT scans showing?
![](https://s3.amazonaws.com/brainscape-prod/system/cm/205/842/191/q_image_thumb.png?1485705560)
left: normal brain
middle: acute infarct
right: acute infarct 4 day follow up
What is considered the “gold standard” of diagnostic imaging in patients with stroke symptoms?
•A noncontrast CT scan
It should be performed quickly to differentiate between a hemorrhagic and ischemic stroke. Useful information regarding the stage of the stroke can also be obtained.