Highlights & Basics
- Ischemic stroke is a leading cause of morbidity and mortality in the world.
- Approximately 85% of strokes are ischemic, caused by arterial occlusion.
- Stroke is a clinical emergency: timely diagnosis, triage, and intervention improves outcomes.
- Care of patients in dedicated stroke units improves survival and function.
- Intravenous thrombolysis with recombinant tissue plasminogen activator (r-tPA) is effective when given within 4.5 hours of stroke onset, and remains the standard of care. Intravenous alteplase may be beneficial when given between 4.5 and 9 hours after stroke onset in patients shown by perfusion imaging to have salvageable brain tissue. Tenecteplase is as effective as alteplase in treating acute ischemic stroke within 4.5 hours of onset.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Images
(A) Noncontrast T1-weighted MRI. (B) Post-contrast T1-weighted MRI showing minimal increase in leptomeningeal vessels over the right frontal region. (C) Diffusion-weighted image (DWI) showing a hyperintense area in the right frontal region. (D) Apparent diffusion coefficient (ADC) map shows hypointense lesion, indicating restricted diffusion that correlates with high intensity on DWI and exponential diffusion. (E) ADC value is 0.22 x 10¯³ mm²/second, corresponding to a hyperacute infarct
(A) T2-weighted MRI image showing hyperintense signal representing prolonged T2. Shows abnormal T2 of 153.38 ms on the left, compared with the normal contralateral side (96 ms). Note that the lesion is located on the ascending frontal gyrus. (B) Gradient echo images detect hemosiderin compounds due to magnetic susceptibility of iron. In this case the result is negative
Noncontrast CT scan of brain showing subacute isolated left basal ganglion infarction with left frontal horn mass effect
Data from DAWN and DEFUSE-3 trials (cerebral blood flow [CBF]; time-to-maximum [Tmax]; internal carotid artery [ICA]; middle cerebral artery [MCA])
Citations
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