Pale infarct → liquefactive necrosis and glial scarring.Surgical intervention if there are signs of herniation or increased ICP.Aspirin or clopidogrel for secondary prevention.tPA (if within Extensive area of hyperdense signals around the circle of Willis (most common location).Hyperdense lesion within cerebral parenchyma.Loss of cortico-medullary differentiation.Noncontrast head CT to rule out hemorrhage.Embolic stroke: possibly, spectacular shrinking deficit.Sudden onset of focal neurologic deficits.Reperfusion injury after ischemic stroke.Ruptured cerebral artery or microaneurysm.Small vessel occlusion ( lipohyalinosis).Long-term management of all types of stroke focuses on the management of modifiable risk factors (i.e., hypertension and atherosclerosis).įor more information, see respective articles “ Ischemic stroke,” “ Intracerebral hemorrhage,” and “ Subarachnoid hemorrhage.” Hemorrhagic strokes are treated with supportive measures and neurosurgical evacuation of blood. In ischemic strokes, immediate revascularization of the affected vessel is vital to preserve brain tissue and prevent further damage. Further neurovascular imaging may be required before deciding on treatment options. Distinguishing between ischemic and hemorrhagic strokes based on physical examination is difficult and requires initial evaluation with a noncontrast head CT. The pattern of clinical features is dictated by the affected vessel. Clinically, strokes are characterized by the acute onset of focal neurologic deficits, including hemiparesis, paresthesias, and hemianopsia. Systemic hypertension and other cardiovascular diseases are common risk factors for both ischemic and hemorrhagic strokes. Hemorrhagic strokes are further classified as intracerebral or subarachnoid. A stroke is an acute neurologic condition resulting from a disruption in cerebral perfusion, either due to ischemia ( ischemic strokes) or hemorrhage ( hemorrhagic strokes).
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