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Cerebral Vascular Accident, Emergency Medicine

Reviewed 06/2017
 


Basics

Description

Interruption of blood flow to a specific brain region: 
  • Neurologic findings are determined by specific area affected

  • Onset may be sudden and complete, or stuttering and intermittent

  • Res...

Diagnosis

Signs and Symptoms

History

  • Time of onset (or time last seen at baseline)

  • Trauma/surgery

  • Medications

  • Altered mentation/confusion

  • Headache

  • Vertigo/dizzy

  • Focal neurologic deficits

Physical Exam

  • General:

    • C...

Treatment

Pre-Hospital

  • Patients may have difficulty moving or communicating after cerebral vascular accident

  • Neurologic exam in field is helpful:

    • Should include assessment of consciousness level, Glasgow...

Follow-Up

Disposition

Admission Criteria

  • Patients with acute cerebral vascular accident should be admitted to hospital

  • Indications for ICU:

    • Severely decreased level of consciousness

    • Hemodynamic instability

    • ...

Pearls and Pitfalls

  • Always note pre-hospital observations

  • Onset of symptoms is crucial to determining treatment with tPA

    • Include additional exclusion criteria between 3 and 4.5 hr

  • Avoid aggressive BP cor...

Additional Reading

  • Clinical Policy: Use of intravenous tPA for the management of acute ischemic stroke in the emergency department. Ann Emerg Med.  2013;61:225–243.

  • Freundlich  CL, Cervantes-Arsla...

Codes

ICD9

  • 434.01 Cerebral thrombosis with cerebral infarction

  • 434.11 Cerebral embolism with cerebral infarction

  • 434.91 Cerebral artery occlusion, unspecified with cerebral infarction

  • 431 Intracerebral he...

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