Guidelines for the management of spontaneous intracerebral hemorrhage: Guidelines for the management of spontaneous intracerebral hemorrhage in adults: Prediction of hemorrhagic transformation in acute ischemic stroke:
Deep vein thrombosis and pulmonary embolism Decubitus ulcer Persistent cognitive or language dysfunction Persistent loss of mobility Spasticity Primary Prevention The American Heart Association and American Stroke Association issued a guideline for the primary prevention of stroke in and one focused on the management of patients with extracranial carotid stenoses inwhich are summarized here.
Each patient should undergo formal assessment of his or her stroke risk Class I, Level A evidence. Hypertension has been well documented to increase the risk of stroke, and current recommendations are to perform regular screening for hypertension a Class I, Level A evidence. Diet and lifestyle should be modified and pharmacologic treatment should be prescribed according to the JNC 7 recommendations.
In these patients, a statin to lower the risk of first stroke is also recommended Class I, Level A evidence. Tight glycemic control is encouraged to reduce microvascular complications, but evidence showing a reduction in stroke risk is lacking. In patients with dyslipidemia, recommendations state that those with known coronary disease and patients at high-risk for coronary disease be treated with lifestyle measures and a statin, even in the presence of a normal LDL Class I, Level A evidence.
In patients with atrial fibrillation, warfarin therapy with a target international normalized ratio of 2. Smoking doubles the risk of ischemic stroke and doubles or quadruples the risk of subarachnoid hemorrhage.
Smoking cessation is recommended Class I, Level B evidence and the use of counseling, nicotine replacement, and oral medications should be considered Class IIa, Level B evidence.
Physical activity is recommended to reduce the risk of stroke Class I, Level B evidence. Adults should engage in 2 hours and 30 minutes of moderate intensity activity each week or one hour and 15 minutes of vigorous intensity aerobic activity each week Class I, Evidence B evidence.
In patients with asymptomatic carotid artery stenosis, screening for other treatable causes of stroke and aggressive control of all risk factors is recommended Class I, Level C evidence.
Aspirin therapy is recommended in the absence of contraindications Class I, Level A evidence. Selection of asymptomatic patients for carotid revascularization should be guided by an assessment of multiple different factors and discussion of risk and benefits of the procedure Class I, Level C evidence.
Prophylactic carotid endarterectomy is reasonable in selected patients with high-grade asymptomatic carotid stenosis if the risk of perioperative complications is low Class IIa, Level A evidence. Carotid artery angioplasty and stenting may be considered in asymptomatic patients, but its effectiveness compared with medical therapy has not been well established Class IIb, Level B evidence.
For both symptomatic and asymptomatic patients with high-grade carotid stenosis who are at high risk of complications with revascularization, the effectiveness of revascularization over medical management is also not established Class IIb, Level B evidence.
Secondary Prevention Following a stroke, lifestyle changes should be made, with particular attention to reducing risk factors for stroke as outlined earlier. In patients with atrial fibrillation, warfarin therapy is recommended for preventing recurrent stroke in the absence of contraindications.
In patients with a history of noncardioembolic ischemic stroke, antiplatelet therapy is recommended. Aspirin, clopidogrel, and dipyridamole in combination with low-dose aspirin have all been shown to be beneficial in reducing the risk of recurrent stroke in multiple clinical trials.
The most recently published study, the PRoFESS trial fromdirectly compared clopidogrel alone and dipyridamole in combination with low-dose aspirin for preventing recurrent stroke. Although the results did not meet the predefined statistical criteria for noninferiority, there was no statistically significant difference between the groups in the primary outcome of recurrent stroke.
However, there was an increase in the rate of intracranial hemorrhage with the dipyridamole and aspirin arm, which was not seen in prior studies evaluating this combination. Currently there is no clear uniform recommendation of one agent over another, and therapy must be tailored to individual patients based on availability, cost, and side-effect profile.
For patients with symptomatic high-grade carotid artery stenosis, carotid endarterectomy is recommended for patients within 6 months of the stroke event if they are at average or low risk Class I, Level A evidence.
Carotid stenting is an alternative to CEA for symptomatic patients at average or low risk Class I, Level B evidence based upon the Carotid Revascularization Endarterectomy versus Stenting Trial CRESTwhich demonstrated no significant difference in the primary outcome of stroke, death, or myocardial infarction, in symptomatic or asymptomatic patients randomized to CEA or stenting.
Considerations in Special Populations In patients with known medical conditions that increase the risk of stroke, such as sickle cell disease, vasculitis, or cardiomyopathy, the approach to stroke prevention should be a coordinated effort among the patient, the primary care physician, and involved specialists.
Often, it is important to aggressively manage the underlying disease state. The risk of ischemic stroke or intracerebral hemorrhage is 2. Focal neurologic signs in this population merits prompt evaluation by a neurologist. Other special considerations include children or young adults with stroke and patients in whom no clear etiology of stroke is determined.
Further workup may include referral to a geneticist for evaluation of potential genetic or metabolic causes of stroke in these populations. Back to Top Outcomes During the hospitalization for an acute stroke, intensive speech, physical, and occupational therapy should be initiated as soon as the patient is stable enough to participate.
Most functional recovery occurs within the first 3 months. After this, further recovery is possible, but it is generally limited. Following a first stroke, the mean survival for persons aged 60 to 79 years ranges from 5.
After age 80 years, the mean survival decreases to 1. Back to Top Summary A stroke is defined as a sudden focal loss of neurologic function due to decreased perfusion of brain tissue.Hereditary hemorrhagic telangiectasia (HHT), also known as Osler–Weber–Rendu disease and Osler–Weber–Rendu syndrome, is a rare autosomal dominant genetic disorder that leads to abnormal blood vessel formation in the skin, mucous membranes, and often in organs such as the lungs, liver, and brain..
It may lead to nosebleeds, acute and chronic digestive tract bleeding, and various. Hemorrhagic Stroke Case Study. Stroke Definition: Case studies may focus on an individual, a group, or an entire community and may utilize a number of data technologies such as life stories, documents, oral histories, in-depth interviews, and participant observation.
Home / Expert Case Studies / Delay in Treatment Causes Patient to Suffer Hemorrhagic Stroke by Cody Porcoro - October 31, This case involves a year-old man with high blood pressure who presented to the hospital with upper abdominal pain. Methods. PubMed was searched in December for cohort studies reporting on the relationship between total cholesterol and coronary heart disease (CHD) and total stroke, separately in .
Jan 22, · The terms intracerebral hemorrhage and hemorrhagic stroke are used interchangeably in this article and are regarded as separate entities from hemorrhagic transformation of ischemic stroke. Hemorrhagic stroke is less common than ischemic stroke (ie, stroke caused by thrombosis or embolism); epidemiologic studies indicate that only % of str.
BackgroundPrevious studies conducted between and estimated that the risk of stroke or an acute coronary syndrome was 12 to 20% during the first 3 months after a transient ischemic attack.