Stroke and Intracranial Hemorrhage

2025 refresher

What rank do strokes hold in causes of death among middle-aged and older adults?

Strokes are the third leading cause of death in middle-aged and older patients.

What are the two main types of strokes?

1. Occlusive strokes

2. Hemorrhagic strokes

What causes an occlusive stroke?

A blockage in a cerebral artery that leads to infarction (tissue death) due to lack of blood supply.

What complications can follow an uncorrected occlusive stroke?

Swelling from necrotic tissue can lead to brain herniation.

What are the two subtypes of occlusive stroke?

1. Embolic

2. Thrombotic

What is an embolic stroke?

Caused by a solid, liquid, or gas embolus traveling to a cerebral vessel, often from the neck or due to atrial fibrillation.

Symptoms occur suddenly, often with a severe headache.

What is a thrombotic stroke?

Caused by a blood clot developing gradually, often due to arterial narrowing. Symptoms occur gradually, usually at night, and may include AMS, speech/language problems, sensory, or motor deficits.

What are the two common categories of hemorrhagic stroke?

1. Intracerebral hemorrhage – bleeding inside the brain

2. Subarachnoid hemorrhage – bleeding on the outer surface

What are common symptoms of hemorrhagic strokes?

• Sudden onset

• Severe headache

• Dilated pupil on side of the bleed

• Eyes may turn away from the paralyzed side

What causes an intracerebral hemorrhage?

A blood vessel ruptures deep in the brain, often in hypertensive patients.

What causes a subarachnoid hemorrhage?

Typically, from trauma or congenital defects like aneurysms.

What are common physical signs of a stroke?

• Facial droop

• Slurred speech

• Headache

• Confusion

• Difficulty/inability to speak (dysarthria, aphasia)

• Vision changes

• Hemiparesis/hemiplegia

• Paresthesia

• Gait issues

• Dizziness

• Incontinence

• Coma

How might the eyes react in a stroke patient with paralysis?

The eyes often turn away from the paralyzed side.

What is the Cincinnati Prehospital Stroke Scale (CPSS)?

• Facial droop (ask to smile)

• Arm drift (hold arms out, palms up)

• Speech (repeat a phrase)

What is the Los Angeles Prehospital Stroke Screen (LAPSS)?

A checklist involving age, symptom onset, seizure history, glucose levels, and physical asymmetry to determine stroke likelihood.

What is a Transient Ischemic Attack (TIA)?

A temporary interruption of blood flow to the brain causing stroke-like symptoms that resolve within 24 hours.

What is the most common cause of a TIA?

Carotid artery disease

What are initial airway steps for stroke patients?

• Use airway adjunct if Altered Mental Status or Level Of Consciousness is present

• Assist with BVM if needed

• Monitor EtCO₂ – avoid overventilation

What should you assess and document in stroke patients?

• Stroke exam results

• Exact symptom onset time

• 12-lead ECG

• Blood glucose

• Conduct thrombolytic checklist, if time permits

How should extremities be handled in paralyzed stroke patients?

Protect the paralyzed limbs during movement or transport.

What is the golden phrase in stroke care?

“Time is brain” – delays in care lead to worse outcomes.

What are key transport criteria for stroke patients?

• Go to a facility with CT scan capability

• Preferably one that can administer thrombolytics

How long after symptom onset can thrombolytics be effective?

Up to 6 hours, but the earlier the better for better outcomes.

What medication might EMS give for stroke-related hypertension?

Labetalol, as per protocol and medical control