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Stroke, Acute (Cerebrovascular Accident [CVA])

Rachel Ragosta, MCHS, PA-C, CAQ-Hospital, RN and Jeanne M. Cawse-Lucas, MD Reviewed 06/2019
 


BASICS

DESCRIPTION

The sudden onset of a focal neurologic deficit(s) resulting from either infarction or hemorrhage within the brain 
  • Two broad categories: ischemic (thrombotic or embolic) (87%) and hem...

DIAGNOSIS

HISTORY

  • Acute onset of focal arm/leg weakness, facial weakness, difficulty with speech or swallowing, vertigo, visual disturbances, diminished consciousness

  • Assess risk factors.

  • Vomiting and se...

TREATMENT

  • Monitor BP closely in the first 24 hours.

    • Withhold antihypertensives unless systolic BP >220 mm Hg or diastolic BP >120 mm Hg. Goal is to lower BP ~15% in the first 24 hours if treatmen...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

  • Secondary prevention of stroke with aggressive management of risk factors

  • Platelet inhibition using aspirin, clopidogrel, or aspirin plus extended-release dipyrida...

REFERENCES

1
Yew KS, Cheng EM. Diagnosis of acute stroke. Am Fam Physician.  2015;91(8):528–536. [View Abstract on OvidMedline]
2
Hankey GJ. Stroke. Lancet.  2017;389(10069):641–654. [View Abst...

ADDITIONAL READING

CODES

ICD10

  • I63.9 Cerebral infarction, unspecified

  • I61.9 Nontraumatic intracerebral hemorrhage, unspecified

  • I63.50 Cereb infrc due to unsp occls or stenos of unsp cereb artery

  • I60.9 Nontraumatic subarachn...

CLINICAL PEARLS

  • Unless stroke is hemorrhagic or patient is undergoing thrombolysis, do not lower BP acutely. This helps to maintain perfusion of penumbra region.

  • Consider IV thrombolysis in eligible pa...

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