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Upon completion of the chapter, the reader will be able to:

  1. Differentiate the types of cerebrovascular disease including transient ischemic attack, ischemic stroke (cerebral infarction), and hemorrhagic stroke.

  2. Identify modifiable and nonmodifiable risk factors associated with ischemic stroke and hemorrhagic stroke.

  3. Explain the pathophysiology of ischemic stroke and hemorrhagic stroke.

  4. Describe the clinical presentation of transient ischemic attack, ischemic stroke, and hemorrhagic stroke.

  5. Evaluate the various treatment options for acute ischemic stroke.

  6. Determine whether thrombolytic therapy is indicated in a patient with acute ischemic stroke.

  7. Formulate strategies for primary and secondary prevention of acute ischemic stroke.

  8. Evaluate treatment options for acute hemorrhagic stroke.




  • Image not available. Ischemic stroke, which may be thrombotic or embolic, is the abrupt development of a focal neurological deficit that occurs due to inadequate blood supply to an area of the brain.

  • Image not available. Hemorrhagic stroke is a result of bleeding into the brain and other spaces within the CNS and includes subarachnoid hemorrhage (SAH), intracerebral hemorrhage (ICH), and subdural hematomas.

  • Image not available. Transient ischemic attacks (TIAs) are a risk factor for acute ischemic stroke and precede acute ischemic stroke in approximately 15% of cases; therefore, preventive measures are the same for both TIA and ischemic stroke.

  • Image not available. The long-term treatment goals for acute ischemic stroke include prevention of a recurrent stroke through reduction and modification of risk factors and by use of appropriate treatments.

  • Image not available. All patients should have a brain computed tomography (CT) scan or magnetic resonance imaging (MRI) scan to differentiate an ischemic stroke from a hemorrhagic stroke because treatment differs and thrombolytic (fibrinolytic) therapy must be avoided until a hemorrhagic stroke is ruled out.

  • Image not available. In carefully selected patients, alteplase should be given as soon as possible, preferably within 3 hours and not more than 4.5 hours after symptom onset.

  • Image not available. Aspirin (ASA) therapy with an initial dose of 150 to 325 mg is recommended in most patients with acute ischemic stroke within 48 hours after stroke symptom onset.

  • Image not available. Current stroke treatment guidelines recommend ASA, clopidogrel, or combination therapy with extended-release dipyridamole plus ASA as initial antiplatelet therapy for the secondary prevention of stroke.

  • Image not available. Selection of the initial antiplatelet agent for secondary prevention of ischemic stroke should be individualized based on patient factors and cost. Clopidogrel and the combination of extended-release dipyridamole and ASA are preferred over ASA monotherapy.

  • Image not available. There is no proven treatment for ICH. Management is based on neurointensive care treatment and prevention of complications.




Cerebrovascular disease (CVD), or stroke, is the second most common cause of death worldwide and the fourth leading cause of death in the United States, declining from the third most common cause of death as a result of decades of progress in the treatment and prevention of CVD.1 Approximately 795,000 strokes occur in the United States each year. New strokes account for 610,000 of this total; recurrent strokes account for the remaining 185,000 strokes each year. Stroke ...

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