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LEARNING OBJECTIVES

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LEARNING OBJECTIVES

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

  1. Differentiate 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 various treatment options for acute ischemic stroke.

  6. Determine whether fibrinolytic 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.

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EPIDEMIOLOGY

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Cerebrovascular disease, or stroke, is the second most common cause of death worldwide. It is the fourth leading cause of death in the United States, declining from third most common cause of death due to a decrease in both stroke incidence and stroke case fatality rates. This decline is a result of decades of progress in treatment and prevention of stroke, especially improved control of hypertension and other risk factors.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. Stroke is the leading cause of long-term disability in adults, with 90% of survivors having residual deficits. Moderate to severe disability is seen in 70% of survivors. An estimated 15% to 30% of stroke survivors are permanently disabled, and 20% require institutional care at 3 months after the stroke. The American Heart Association estimates that there are currently over 7 million stroke survivors in the United States. Societal impact and economic burden is great, with total costs of $36.5 billion reported in the United States in 2010. Stroke mortality has declined due to improved recognition and treatment of risk factors; however, risk factor management is still inadequate. Stroke incidence increases with age, especially after age 55 years, resulting in an increased incidence in the elderly population.2

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ETIOLOGY

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Strokes can either be ischemic (87% of all strokes) or hemorrhagic (13% of all strokes). KEY CONCEPT 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. A thrombotic occlusion occurs when a thrombus forms inside an artery in the brain. An embolic stroke typically occurs when a piece of thrombus, originating either inside or outside of the cerebral vessels, breaks loose and is carried to the site of occlusion in the cerebral vessels. An extracerebral source of emboli is often the heart, leading to cardioembolic stroke.

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KEY CONCEPT Hemorrhagic stroke is a result of bleeding into the brain and other spaces within the central nervous system (CNS) and includes subarachnoid hemorrhage (SAH), intracerebral hemorrhage (ICH), and subdural hematomas. SAH results from sudden bleeding into ...

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