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Ischemic stroke is the third leading cause of death in the United States and the most common cause of neurologic disability in adults. Rapid evaluation of the stroke patient is essential. The time ischemic stroke, stroke, cerebrovascular accident, CVA from arrival to CT scan should be 25 minutes or less, and the time from arrival to treatment (with t-PA) should be 60 minutes.
Clinical Evaluation of the Stroke Patient
A rapid evaluation should determine the time when symptoms started. In patients whose symptoms were present upon awakening, their time of symptom onset is estimated from the last time that the patient's neurological status was known to be normal, or the time just prior to going to sleep. Other diseases that may mimic a stroke, including seizure disorder, hypoglycemia, complex migraine, dysrhythmia or syncope, should be excluded.
Markers of vascular disease such as diabetes, angina, CVA and intermittent claudication are suggestive of ischemic stroke. A history of atrial fibrillation or MI suggests a cardiac embolic stroke.
Physical Examination
Assessment should determine whether the patient's condition is acutely deteriorating or relatively stable. Airway and circulatory stabilization take precedence over diagnostic and therapeutic interventions.
Neurologic Exam. Evaluation should include the level of consciousness, orientation; ability to speak and understand language; cranial nerve function, especially eye movements and pupil reflexes and facial paresis; neglect, gaze preference, arm and leg strength, sensation, and walking ability.
A semiconscious or unconscious patient probably has a hemorrhage. A patient with an ischemic stroke may be drowsy but is unlikely to lose consciousness unless the infarcted area is large.
CT Scanning and Diagnostic Studies
Treatment