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A Department of Cardiovascular Surgery Grand Rounds from the Icahn School of Medicine at Mount Sinai presented by Stanley Tuhrim, MD, and Christopher Kellner, MD. At the end of this video, viewers will be able to: 1. To review the signs and symptoms of acute stroke. 2. To elucidate the current management of acute ischemic stroke. 3. To describe current approaches to endovascular intervention in acute ischemic stroke.The main risk factor for stroke is high blood pressure.[6] Other risk factors include tobacco smoking, obesity, high blood cholesterol, diabetes mellitus, a previous TIA, end-stage kidney disease, and atrial fibrillation.[2][6][7] An ischemic stroke is typically caused by blockage of a blood vessel, though there are also less common causes.[12][13][14] A hemorrhagic stroke is caused by either bleeding directly into the brain or into the space between the brain's membranes.[12][15] Bleeding may occur due to a ruptured brain aneurysm.[12] Diagnosis is typically based on a physical exam and supported by medical imaging such as a CT scan or MRI scan.[8] A CT scan can rule out bleeding, but may not necessarily rule out ischemia, which early on typically does not show up on a CT scan.[9] Other tests such as an electrocardiogram (ECG) and blood tests are done to determine risk factors and rule out other possible causes.[8] Low blood sugar may cause similar symptoms.[8]
Prevention includes decreasing risk factors, as well as possibly aspirin, statins, surgery to open up the arteries to the brain in those with problematic narrowing, and warfarin in those with atrial fibrillation.[2] A stroke or TIA often requires emergency care.[5] An ischemic stroke, if detected within three to four and half hours, may be treatable with a medication that can break down the clot.[2] Aspirin should be used.[2] Some hemorrhagic strokes benefit from surgery.[2] Treatment to try to recover lost function is called stroke rehabilitation and ideally takes place in a stroke unit; however, these are not available in much of the world.[2]
In 2013 approximately 6.9 million people had an ischemic stroke and 3.4 million people had a hemorrhagic stroke.[16] In 2015 there were about 42.4 million people who had previously had a stroke and were still alive.[10] Between 1990 and 2010 the number of strokes which occurred each year decreased by approximately 10% in the developed world and increased by 10% in the developing world.[17] In 2015, stroke was the second most frequent cause of death after coronary artery disease, accounting for 6.3 million deaths (11% of the total).[11] About 3.0 million deaths resulted from ischemic stroke while 3.3 million deaths resulted from hemorrhagic stroke.[11] About half of people who have had a stroke live less than one year.[2] Overall, two thirds of strokes occurred in those over 65 years old.[17]
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When A Stroke Strikes
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| Physiotherapy for stroke patients is not just about exercises and movement, but also incorporates technology such as functional electrical stimulation and virtual reality. — Photos: SUNWAY MEDICAL CENTRE VELOCITY |
