C7T1L10 Stroke & TIA (ROSE)

Introduction to Stroke

  • Definition: Stroke is also called a "brain attack" and is classified into two main types: ischemic (the most common type, caused by a blockage) and hemorrhagic (caused by bleeding).

  • Modern Terminology: The term "CVA" (cerebrovascular accident) is outdated and dismissed in today's medical vernacular, as strokes are now understood to have many identifiable causes.

  • Public Concern: Strokes are the second most feared health issue among older adults, only preceded by dementia.

Stroke Epidemiology

  • Prevalence: Stroke remains the fifth leading cause of death in the United States as of 2025, attributed to improved prevention strategies. It is also the primary cause of disability worldwide.

  • Economic Impact: The annual cost of stroke care in the U.S. is approximately $110 billion, encompassing direct medical costs and indirect effects, such as lost productivity due to caregiving.

Objectives of Study

  • Focus Areas: Today's lecture will cover the epidemiology, morbidity and mortality, risk factors, and clinically relevant case studies concerning strokes and transient ischemic attacks (TIAs).

Types of Stroke

Subtypes of Stroke

  1. Ischemic Stroke: Represents about 80% of all strokes, resulting from an obstruction of blood flow to the brain.

    • Categories:

      • Cardioembolic Strokes: Caused by blood clots originating in the heart (approx. 25% of ischemic strokes).

      • Large Vessel Atherosclerosis: Hardening of the arteries leading to blockages (approx. 20%).

      • Lacunar Strokes: Small vessel disease affecting deep brain structures (approx. 20%).

      • Cryptogenic Strokes: Indeterminate cause despite a thorough workup (about 30%).

      • Other Rare Causes: Includes dissections, hypercoagulable states, or vasculitis (approx. 5%).

  2. Hemorrhagic Stroke: Accounts for 15-20% of strokes, caused by bleeding in or around the brain, which can be linked to high blood pressure or blood vessel malformations.

Risk Factors for Stroke

Modifiable Risk Factors:

  • Hypertension: A primary global risk factor.

  • Heart Conditions: Such as atrial fibrillation and other types of cardiac disease.

  • Dyslipidemia: High cholesterol levels contributing to atherosclerosis.

  • Diabetes: Increases overall stroke risk.

  • Lifestyle Factors: Include tobacco use (smoking anything), physical inactivity, and excessive alcohol consumption.

Non-Modifiable Risk Factors:

  • Age, Gender, Race, Genetics: These factors cannot be changed and influence stroke risk.

Signs and Symptoms of Stroke

Overt Symptoms:

  • Hemiparesis: Weakness on one side of the body.

  • Aphasia: Difficulty with speech or understanding language.

  • Visual Disturbances: Including loss of vision in one eye (hemianopsia).

  • Numbness: Complete loss of sensation (not tingling).

Subtle Symptoms:

  • Balance Problems: Vertigo and coordination issues can also indicate a stroke.

  • Differentiation: Migraines, seizures, or infections can mimic stroke symptoms, making accurate assessment crucial.

Diagnosis and Evaluation

  • Rapid assessment in the emergency room is essential:

    • Health History: Establish when symptoms began and prior medical history.

    • Physical Examination: Assess motor function, speech, and coordination to localize neurological deficits.

    • Imaging Studies: A CT scan or MRI is critical in confirming stroke and determining subtype.

Acute Stroke Management

Initial Treatment:

  • TPA (tissue plasminogen activator): A critical clot-busting medication that is effective within 4.5 hours of symptom onset. Its use requires careful blood pressure management to avoid hemorrhagic transformation.

  • Mechanical Thrombectomy: A procedure done by neuro-interventionalists to physically remove clots when TPA is contraindicated or outside the window of administration.

Transient Ischemic Attack (TIA)

  • Definition: A temporary period of symptoms similar to those of a stroke, which resolves within 24 hours. TIAs are serious warning signs, indicating high stroke risk, necessitating immediate medical evaluation and intervention.

  • Risk Factors: Similar to stroke, requiring ongoing risk assessment and management to prevent future strokes.

Conclusion

  • The importance of education and awareness regarding stroke prevention and treatment cannot be overstated, with evolving strategies and research aimed at improving outcomes and reducing mortality.

  • Consider reaching out for further learning and research opportunities in the neurology field or stroke care.