Ischemic Stroke Questions & Answers

Updated: May 27, 2020
  • Author: Edward C Jauch, MD, MS, FAHA, FACEP; Chief Editor: Helmi L Lutsep, MD  more...
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Questions & Answers

Overview

What is ischemic stroke?

What are the signs and symptoms of ischemic stroke?

What are the goals of a neurologic exam in patients with suspected ischemic stroke?

What are the components of a neurologic exam for ischemic stroke?

Which neuroimaging studies may be performed for the emergent evaluation of apparent acute ischemic stroke (AIS)?

When is a lumbar puncture indicated in the workup of ischemic stroke?

What is the role of lab testing in the workup of ischemic stroke?

What are the goals for the emergent management of ischemic stroke?

What is the focus of emergent treatment decisions for ischemic stroke?

Which specialists should be involved in the treatment of ischemic stroke?

What are the treatment options for ischemic stroke?

Which treatments may be administered to patients with ischemic stroke and comorbidities?

What is primary stroke prevention?

What is secondary prevention of ischemic stroke?

How is stroke characterized?

What is the incidence of ischemic stroke and what is the annual cost?

How are ischemic and hemorrhagic stroke differentiated?

How is ischemic stroke categorized?

How is large-artery ischemic stroke characterized?

How common is cardioembolic infarction ischemic stroke?

How is the small vessel or lacunar ischemic stroke characterized?

What is cryptogenic stroke?

What is the role of recanalization in the treatment of ischemia?

What are the guidelines for rt-PA in the treatment of ischemic stroke?

What are secondary aspects of treatment for acute ischemic stroke (AIS)?

How is venous infarction differentiated from acute ischemic stroke (AIS)?

How is blood supplied to the cerebral hemisphere?

What is the role of the anterior and middle cerebral arteries in the cerebrovascular arterial anatomy?

What is the posterior cerebral arterial distribution in the anatomy of ischemic stroke?

How are the cerebral hemispheres supplied in the anatomy of ischemic stroke?

What is the pathogenesis of acute ischemic stroke (AIS)?

What is the role of ischemic penumbra in the pathogenesis of ischemic stroke?

What is the role of cytotoxic edema in the pathogenesis of ischemic stroke?

What is the role of cerebral ischemia in the pathogenesis of stroke?

What causes increased inflammation and microcirculatory compromise in the pathophysiology of ischemic stroke?

What is the role of infarction in the pathophysiology of ischemic stroke?

What is the role of hemorrhagic transformation in the pathophysiology of ischemic stroke?

What are the mechanisms for hemorrhagic transformation in the pathophysiology of ischemic stroke?

When is hemorrhagic transformation most likely to occur in the pathophysiology of ischemic stroke?

What is the role of cerebral edema in the pathophysiology of ischemic stroke?

What is the role of large-artery occlusion in the etiology of ischemic stroke?

What is the pathogenesis of lacunar ischemic stroke?

What is the etiology of ischemic stroke?

What are the risk factors for ischemic stroke?

Which nonmodifiable factors increase the risk for ischemic stroke?

Are migraines with aura a significant risk factor for ischemic stroke?

Which modifiable factors increase the risk for ischemic stroke?

What are the AHA/ASA recommendations for reduction of stroke risk in women?

What is the role of atherosclerosis in the etiology of ischemic stroke?

Which genetic factors increase susceptibility to ischemic stroke?

What is the role of homocysteine in the pathogenesis of ischemic stroke?

What is the role of amyloid angiopathies in the etiology of ischemic stroke?

What is the role of CADASIL in the etiology of ischemic stroke?

Which genetic mutations are associated with ischemic stroke?

What causes lacunar infarcts in ischemic stroke?

What are the causes of cardiogenic emboli in ischemic stroke?

What is the etiology of thrombotic stroke?

What is the role of vascular watershed infarcts in the etiology of ischemic stroke?

What is the role of cerebral blood flow disturbances in the etiology of ischemic stroke?

What is the incidence of ischemic stroke in the US and globally?

What are the race-related variances in the incidence of ischemic stroke?

How does the incidence of ischemic stroke differ between males and females?

How does the incidence and risk for ischemic stroke vary among age groups?

What is the mortality rate of ischemic stroke and which factors affect the prognosis after acute ischemic stroke (AIS)?

What is the strongest predictor of early mortality risk in patients with ischemic stroke?

Which factors are associated with poor outcome in ischemic stroke?

Which factors in patients with acute ischemic stroke (AIS) are associated with poor outcomes?

What is the degree of recovery for patients with ischemic stroke?

What should public health education about ischemic stroke include and which venues can be used to reach an audience with a higher stroke risk?

According to the ASA, what are the easily recognizable symptoms of stroke?

What are the warning signs of stroke?

Presentation

Which risk factors for atherosclerotic and cardiac disease should be identified in the medical history of patients with suspected ischemic stroke?

What history should be elicited in younger patients with suspected ischemic stroke?

What are signs and symptoms of stroke?

What is the median time from symptom onset of ischemic stroke to emergency department (ED) presentation?

Which factors contribute to delays in seeking care for ischemic stroke?

How is the time of onset defined if the patient awakens with symptoms of stroke?

What are the goals of the physical exam in suspected ischemic stroke?

What should be included in the physical exam for suspected ischemic stroke?

Why is constant reassessment necessary for patients with suspected ischemic stroke?

What is the role of vital sign monitoring in the assessment of suspected ischemic stroke?

Which physical findings from a head exam may suggest trauma or carotid disease as the etiology of ischemic stroke?

Which cardiac conditions may be concurrent with ischemic stroke?

How might aortic dissection be identified in patients with ischemic stroke?

What are the goals of the neurologic exam for ischemic stroke?

Which evaluations should be included in the neurologic exam for ischemic stroke?

What is the NIH Stroke Scale (NIHSS) and how is it performed?

What is the clinical presentation of middle cerebral artery (MCA) occlusions in ischemic stroke?

What is the clinical presentation of anterior cerebral artery (ACA) occlusions in ischemic stroke?

What is the clinical presentation of posterior cerebral artery (PCA) occlusions in ischemic stroke?

What is the clinical presentation of vertebrobasilar artery occlusions in ischemic stroke?

How is a posterior circulation stroke differentiated from an anterior circulation stroke?

What is the clinical presentation of lacunar ischemic stroke?

DDX

Which conditions should be included in the differential diagnoses of ischemic stroke?

What is a transient ischemic attack (TIA) and what is the likelihood it will lead to ischemic stroke?

What clinical findings help differentiate hemorrhagic stroke from ischemic stroke?

What is cerebral venous thrombosis (CVT)?

What are the differential diagnoses for ischemic stroke?

Workup

What is the role of brain imaging studies in the workup of ischemic stroke?

What is the role of MRI in the workup of ischemic stroke?

What is the role of carotid duplex scanning in the workup of ischemic stroke?

What is the role of digital subtraction angiography in the workup of ischemic stroke?

What is the role of lab testing in the workup of ischemic stroke?

Which lab tests may be useful in the workup of select patients with suspected ischemic stroke?

When is a pregnancy test indicated in the workup of ischemic stroke?

What is the role of CT scanning in the workup of ischemic stroke?

What is the role of diffusion-weighted imaging (DWI) in the workup of ischemic stroke?

What is the role of dynamic susceptibility contrast MRI (DSC-MRI) in the workup of ischemic stroke?

What is calculated using either perfusion MRI or CT scanning in the workup of ischemic stroke?

What are the AAN recommendations for imaging studies in the workup of ischemic stroke?

Which imaging findings have been correlated with increased infarct volume size in ischemic stroke?

What are the roles of transcranial Doppler ultrasonography and echocardiography in the workup of ischemic stroke?

What is the role of chest radiography in the workup of ischemic stroke?

What is the role of SPECT scanning in the workup of ischemic stroke?

What is the role of angiography in the workup of ischemic stroke?

What is the role of a CBC and a basic chemistry panel in the workup of ischemic stroke?

What is the role of coagulation studies in the workup of ischemic stroke?

What is the role of cardiac biomarkers in the workup of ischemic stroke?

What is the role of toxicology screening and arterial blood gas studies in the workup of ischemic stroke?

When is a pregnancy test performed in the workup of ischemic stroke?

Treatment

What is the central goal of therapy in acute ischemic stroke (AIS)?

What is the goal of recanalization strategies in the treatment for ischemic stroke?

What is the role of surgical intervention in the treatment of acute ischemic stroke (AIS)?

What are neuroprotective strategies in the treatment of ischemic stroke?

What is the role of palliative care in the treatment for ischemic stroke?

What clinical education is needed for EMTs, physicians, and nurses of patients with ischemic stroke?

Which actions improve the chances for acute intervention in patients with ischemic stroke?

Which patients with ischemic stroke are most likely to use emergency medical services (EMS)?

What is the protocol for emergency medical services (EMS) response to stroke?

What is the role of emergency air transport and telemedicine in the initial treatment of ischemic stroke?

What is the goal for the emergent management of ischemic stroke?

How should hyperthermia be treated in patients with ischemic stroke?

What is the role of supplemental oxygen in the treatment of ischemic stroke?

How should hypoglycemia or hyperglycemia be treated in patients with ischemic stroke?

Which fibrinolytic agent has been shown to benefit patients with acute ischemic stroke (AIS)?

What is the role of fibrinolytics in the treatment of ischemic stroke and what are possible complications?

What are the AHA/ASA inclusion guidelines for fibrinolytic therapy with rt-PA for ischemic stroke?

What are the AHA/ASA inclusion guidelines for fibrinolytic therapy 3-4.5 hours after symptom onset in ischemic stroke?

How effective is fibrinolytic therapy 3-4.5 hours after symptom onset in ischemic stroke?

What is the risk of intracerebral hemorrhage with fibrinolysis therapy for ischemic stroke?

When should caution be used in the administration of fibrinolytic therapy in the treatment of ischemic stroke?

What is the role of ultrasound in fibrinolysis therapy in the treatment of ischemic stroke?

What is the role of intra-arterial delivery of fibrinolytic agents in the treatment for ischemic stroke?

What are the AHA/ASA guidelines for the administration of aspirin in the treatment of ischemic stroke?

What are the benefits of aspirin and other antiplatelet agents in the treatment of ischemic stroke?

What is the role of antihypertensive treatment for ischemic stroke?

What are possible adverse effects of antihypertensive treatment for ischemic stroke?

How effective is oral candesartan in the treatment of ischemic stroke?

How effective is antihypertensive medication in the treatment of ischemic stroke?

What are the guidelines for treatment of hypertension in patients with ischemic stroke who are not candidates for fibrinolytic therapy?

What are the ASA guidelines thresholds for antihypertensive treatment in acute ischemic stroke (AIS) for patients who are not fibrinolysis candidates?

What is an alternative treatment for ischemic stroke when fibrinolysis is ineffective or contraindicated?

What are the AHA/ASA recommendations for the emergency treatment of patients with acute ischemic stroke (AIS)?

How effective is the Mechanical Embolus Retrieval in Cerebral Ischemia (MERCI) Retrieval System for endovascular treatment of ischemic stroke?

How effective is the Penumbra System for the endovascular treatment of acute ischemic stroke (AIS)?

How effective are the Solitaire FR Revascularization Device and Trevo systems for the endovascular treatment of acute ischemic stroke?

When are antipyretics indicated in the treatment of ischemic stroke?

What is role of high-dose acetaminophen in the treatment of ischemic stroke?

What is the occurrence of cerebral edema after ischemic stroke?

What does the presence of ischemia on presentation suggest in ischemic stroke?

What are the treatment options for patients with increased intracranial pressure (ICP) secondary to closed head injury?

What are the AHA/ASA guidelines for the management of cerebral and cerebellar infarction with brain swelling in ischemic stroke?

What is the occurrence of seizures and seizure disorders in ischemic stroke and how are they treated?

What treatment is indicated for a patient with rapidly decompensating ischemic stroke?

What is the role of anticoagulation in the treatment of ischemic stroke?

What is the role of neuroprotective agents in the treatment of ischemic stroke?

What is the role of hypothermia in the early treatment of ischemic stroke?

What are the AHA/ASA guidelines for the primary prevention of ischemic stroke?

What is secondary prevention of ischemic stroke?

What may increase the success of interventions for prevention of ischemic stroke?

When is aspirin recommended for primary prevention of ischemic stroke?

What do the AHA/ASA guidelines emphasize for secondary prevention of stroke?

How effective is dual antiplatelet therapy for secondary prevention of ischemic stroke?

What are the AHA/ASA recommendations for primary prevention in patients at risk for ischemic stroke from asymptomatic carotid artery stenosis?

What are the AHA/ASA recommendations for primary prevention of stroke due to atrial fibrillation (AF)?

What is the role of warfarin in the treatment of atrial fibrillation (AF) in patients at high risk of ischemic stroke?

What are the AAN guidelines for prevention of ischemic stroke in patients with nonvalvular atrial fibrillation (AF)?

What are the AHA and the Brain Attack Coalition recommendations for the establishment of specialized stroke centers?

What is the code stroke ED protocol for treatment of possible ischemic stroke?

What performance measures should be evaluated in hospitals with specialized stroke teams?

What are the benefits of a stroke system for the management of ischemic stroke?

Which specialists should be available in the ED within 15 minutes of the arrival of a patient with a possible ischemic stroke?

Which specialist consultations may be warranted for ischemic stroke?

What dietary guidelines should survivors of ischemic stroke follow?

Guidelines

What are the AHA and ASA treatment guidelines for ischemic stroke?

What are the guidelines for evaluating and managing stroke in patients with coronavirus disease 2019 (COVID-19)?

Medications

Which medications are used in the treatment of ischemic stroke?

What categories of medications are used in the treatment of ischemic stroke?

Which medications in the drug class Vasodilators are used in the treatment of Ischemic Stroke?

Which medications in the drug class Calcium Channel Blockers are used in the treatment of Ischemic Stroke?

Which medications in the drug class ACE Inhibitors are used in the treatment of Ischemic Stroke?

Which medications in the drug class Beta Blockers, Alpha Activity are used in the treatment of Ischemic Stroke?

Which medications in the drug class Analgesics, Other are used in the treatment of Ischemic Stroke?

Which medications in the drug class Anticoagulants, Hematologic are used in the treatment of Ischemic Stroke?

Which medications in the drug class Antiplatelet Agents are used in the treatment of Ischemic Stroke?

Which medications in the drug class Anticonvulsants, Other are used in the treatment of Ischemic Stroke?

Which medications in the drug class Thrombolytics are used in the treatment of Ischemic Stroke?