Approachtostrokepa-ent!

SuratTanprawate,MD,FRCPT(T)NorthernNeuroscienceCenter

ChiangmaiUniversity!

www.neurologycoffeecup.com

Outlineapproachtopa-ent !Suddenonsetofneurologicaldeficit!

StrokeVSStrokemimicker!

Suspectedstroke!

StrokemimickerTumorInfec-on!

Stroketype!

Ischemicstroke! Hemorrhagicstroke!

PrimaryVSSecondary

Hemorrhagicstroke!

StrokesubtypebyTOAST

classifica-on

Localiza-onoflesion !

Strokemimicker!

13%ini-allydiagnos-cstroke

wasstrokemimicker

Misdiagnosisofstroke:Lancet,1982;1:328‐331!

Unrecognizedseizure!

Syncope!

Toxicandmetabolicdisorder!

Subduralhematoma! Tumor!

Confusionstate!

“strokelocaliza.on:vasculardistribu.onoftheischemiclesion”!

AnteriorVSposteriorcircula-ostroke!

Anteriorcircula-onstroke!

Posteriorcircula-onstroke!

Infarc-onVSHemorrhage!

•  SomecluesfromHx.AndPE•  ICH

– Comaonarrival

– Vomi-ng– Severeheadache– Currentwarfarintherapy– SBP>220mmHg– Glucoselevel>170mg/dLinnon‐diabe-cpa-ent

Stroke1981;12:288‐293ArchInternMed1985;145:1800‐1803!

Classifica-onofischemicstroke“TOASTclassifica-on”!

1. Largearteryatherosclerosis2. Cardioembolism

3. Smallvesselocclusion

4. Strokeofotherdeterminede-ology

5. Strokeofundeterminede-ology!

Problem list

1.  Acute onset quadriparesis with urinary incontinence 2.  Previous episode of transient right hemiparesis 3.  Decreased bilateral carotid pulsations 4.  Bilateral frontal lobe signs 5.  Left parietal cortical impairement

(astereognosis, agraphia) 6.  Right UMN VII 7.  Bilateral pyramidal weakness 8.  Bilateral babinski response

Old R frontal lobe infarction Anterior watershed infarction at left frontal and parietal lobes

Normal

Border-zone ischemia

Ischemia at center of bl supply

Anterior watershed

Posterior watershed

Subcortical watershed

Anterior Watershed Infarction

Moyamoya-“like” disease = “Puff-Of-Smoke”!

Bilateral occlusion of internal carotid arteries

⇒  Fine collateral arteries

Children ⇒ Alternating hemiplegia

Adults ⇒ Subarachnod haemorrhage !

Thankyouforyouraden-on

www.neurologycoffeecup.com