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Stroke, Acute (Cerebrovascular Accident [CVA])

Mark Stephens, MD MS Reviewed 04/2024
 


BASICS

DESCRIPTION

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

DIAGNOSIS

HISTORY

  • Determining time course is critical: Assess onset of symptoms. History from witnesses may be helpful.

  • Acute onset of focal arm/leg weakness, facial weakness, difficulty with speech or ...

TREATMENT

  • Monitor BP closely in the first 24 hrs.

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

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 dipyri...

REFERENCES

1
Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acut...

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.

  • IV thrombolysis (alteplase) is indicate...

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