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Stroke, Acute (Cerebrovascular Accident [CVA])

Scott A. Drummond, Jr., DO, DABR Reviewed 06/2018
 


BASICS

DESCRIPTION

Stroke is 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...

DIAGNOSIS

HISTORY

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

  • Vomiting and severe headache favor ...

TREATMENT

  • Monitor BP closely in the first 24 hours (1)[A].

    • 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...

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
Jauch EC, Saver JL, Adams HPJr, et al; and American Heart Association Stroke Council, Council on Cardiovascular Nursing, Council on Peripheral Vascular Disease, Council on Clinical Cardiol...

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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