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Neurologic Emergencies pp 17–38Cite as

Rule Out Acute Stroke

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Abstract

A 70-year-old retired male with a history of hypertension, hyperlipidemia, and type II diabetes mellitus presented to the emergency department (ED) at the insistence of his wife. His wife had noticed that “he was not talking right.” In addition, he had spilt his coffee that morning, acting clumsier than normal. On further questioning, he endorsed difficulty getting words out and that his right hand seemed weaker than usual. The symptoms started abruptly at breakfast, waxing and waning for the last 2 h. He denied any pain, fever, or chills. His medications included lisinopril, metformin, and simvastatin. He denied current tobacco use (quit about 10 years ago) and drank a few beers socially on the weekends. He had a brother who had a brain tumor. He denied allergies, recent surgical procedures, or using any over-the-counter medications.

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References

  1. Center for Disease Control and Prevention—Stroke. www.dcd.gov/stroke.

  2. Fernandes PM, Whiteley WN, Hart SR, Al-Shahi SR. Strokes: mimics and chameleons. Pract Neurol. 2013;13(1):21–8.

    Article  PubMed  Google Scholar 

  3. Chernyshev O, Martin-Schild S, Albright K, Barreto A, Misra V, Acosta I, et al. Safety of tPA in stroke mimics and neuroimaging-negative cerebral ischemia. Neurology. 2010;74(17):1340–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Liang BA, Zivin JA. Empirical characteristic of litigation involving tissue plasminogen activator and ischemic stroke. Ann Emerg Med. 2008;52(2):160–4.

    Article  PubMed  Google Scholar 

  5. Bruce NT, Neil WP, Zivin JA. Medico-legal aspects of using tissue plasminogen activator in acute ischemic stroke. Curr Treat Options Cardiovasc Med. 2011;13(3):233–9.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Restrepo L, Jacobs MA, Barker PB, Wityk RJ. Assessment of transient ischemic attack with diffusion-and perfusion weighted imaging. AJNR Am J Neuroradiol. 2004;25(10):1645–52.

    PubMed  Google Scholar 

  7. Sehatzadeh S. Is transient ischemic attack a medical emergency? An evidence-based analysis. Ont Health Tecnol Ser. 2015;15(3):1–45.

    Google Scholar 

  8. Cucchiara BL, Messe SR, Taylor RA, Pacelli J, Maus D, Shah Q, Kasner SE. Is the ABCD score useful for risk stratification of patients with acute transient ischemic attack? Stroke. 2006;37(7):1710–4.

    Article  PubMed  Google Scholar 

  9. Stead LG, Suravaram S, Bellolio MF, Enduri S, Rabinstein A, Gilmore RM, Bhagra A, Manivannan V, Decker WW. An assessment of the incremental value of the ABCD2 score in the emergency department evaluation of transient ischemic attack. Ann Emerg Med. 2011;57(1):46–51. doi:10.1016/j.annemergmed.2010.07.001. Epub 2010 Sep 19. PMID: 20855130.

    Article  PubMed  Google Scholar 

  10. Stead LG, Bellolio MF, Suravaram S, Brown RD Jr, Bhagra A, Gilmore RM, Boie ET, Decker WW. Evaluation of transient ischemic attack in an emergency department observation unit. Neurocrit Care. 2009;10(2):204–8. doi:10.1007/s12028-008-9146-z. Epub 2008 Oct 11.PMID: 18850077.

    Article  PubMed  Google Scholar 

  11. Kidwell CS, Chalela JA, Saver JL, et al. Comparison of MRI and CT for detection of acute intracerebral hemorrhage. JAMA. 2004;292(15):1823–30.

    Article  CAS  PubMed  Google Scholar 

  12. Fiebach JB, Schellinger PD, Gass A, et al. Stroke magnetic resonance imaging is accurate in hyperacute intracerebral hemorrhage: a multicenter study on the validity of stroke imaging. Stroke. 2004;35(2):502–6.

    Article  PubMed  Google Scholar 

  13. Winkler DT, Fluri F, Fuhr P, Wetzel SG, Lyrer PA, Ruegg S, Engelter ST. Thrombolysis in stroke mimics: frequency, clinical characteristics, and outcome. Stroke. 2009;40:1522–5.

    Article  PubMed  Google Scholar 

  14. Hedna VS, Stead LG, Bidari S, Patel A, Gottipati A, Favilla CG, Salardini A, Khaku A, Mora D, Pandey A, Patel H, Waters MF. Posterior reversible encephalopathy syndrome (PRES) and CT perfusion changes. Int J Emerg Med. 2012;5:12. doi:10.1186/1865-1380-5-12.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Jauch E, Saver J, Adams H, Bruno A, Connors J, Demaerschalk B, et al. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013;44(3):870–947.

    Article  PubMed  Google Scholar 

  16. Saver J. Time is brain—quantified. Stroke. 2005;37(1):263–6.

    Article  PubMed  Google Scholar 

  17. Adams H, Davis P, Leira E, Chang K, Bendixen B, Clarke W, et al. Baseline NIH stroke scale score strongly predicts outcome after stroke: a report of the trial of org 10172 in acute stroke treatment (TOAST). Neurology. 1999;53(1):126.

    Article  CAS  PubMed  Google Scholar 

  18. Power WJ, Derdeyn CP, Biller J, et al. 2015 American Heart Association/American Stroke Association focused update of 2013 guidelines for the early management of patients with acute ischemic stroke regarding endovascular treatment: a guideline for healthcare professional from the American Heart Association/American Stroke Association. Stroke. 2015;46(10):3020–35.

    Article  Google Scholar 

  19. NIH Stroke Scale [Internet]. National Institute of Neurological Disorders and Stroke. 2016 [cited 1 May 2016]. https://www.ninds.nih.gov/doctors/NIH_Stroke_Scale.pdf.

  20. NINDS (Adapted from Harold Goodglass). The assessment of aphasia and related disorders. Philadelphia, PA: Lea & Febiger; 1972.

    Google Scholar 

  21. Kurz K, Ringstad G, Odland A, Advani R, Farbu E, Kurz M. Radiological imaging in acute ischaemic stroke. Eur J Neurol. 2015;23:8–17.

    Article  Google Scholar 

  22. Alberta Stroke Program Early CT score (ASPECTS)—Role of NCCT [Internet]. Aspectsinstroke.com. 2016 [cited 1 May 2016]. http://www.aspectsinstroke.com/imaging-in-acute-stroke/role-of-ncct/.

  23. Jones J. Hyperdense MCA sign, Radiology Reference Article, Radiopaedia.org [Internet]. Radiopaedia.org. 2016 [cited 2 May 2016]. http://radiopaedia.org/articles/hyperdense-mca-sign.

  24. CT Scan—Basics [Internet]. Slideshare.net. 2016 [cited 2 May 2016]. http://www.slideshare.net/smcmedicinedept/ct-scan-basics Image courtesy of Stanley Medical College.

  25. Gaillard F. CT perfusion in ischaemic stroke, Radiology Reference Article, Radiopaedia.org [Internet]. Radiopaedia.org. 2016 [cited 2 May 2016]. http://radiopaedia.org/articles/ct-perfusion-in-ischaemic-stroke.

  26. Gaillard F. Diffusion weighted MRI in acute stroke, Radiology Reference Article, Radiopaedia.org [Internet]. Radiopaedia.org. 2016 [cited 2 May 2016]. http://radiopaedia.org/articles/diffusion-weighted-mri-in-acute-stroke-1.

  27. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med. 1995;333:1581–8. doi:10.1056/NEJM199512143332401.

    Article  Google Scholar 

  28. Ge F, Lin H, Liu Y, Li M, Guo R, Ruan Z, Chang T. Dual antiplatelet therapy after stroke or transient ischaemic attack—how long to treat? The duration of aspirin plus clopidogrel in stroke or transient ischaemic attack: a systematic review and meta-analysis. Eur J Neurol. 2016;23:1051–7. doi:10.1111/ene.12982.

    Article  CAS  PubMed  Google Scholar 

  29. https://clinicaltrials.gov/ct2/show/NCT02142283. Accessed 19 May 2017.

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Author information

Authors and Affiliations

  1. University of Central Florida College of Medicine (UCF), Orlando, FL, USA

    Aunali S. Khaku M.D.

  2. Aga Khan University Hospital, Nairobi, Kenya

    Sayed K. Ali M.D.

  3. University of Central Florida, College of Medicine, Orlando, FL, USA

    Sayed K. Ali M.D.

Authors
  1. Aunali S. Khaku M.D.
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  2. Sayed K. Ali M.D.
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Corresponding author

Correspondence to Aunali S. Khaku M.D. .

Editor information

Editors and Affiliations

  1. Orlando, Florida, USA

    Latha Ganti

  2. Boston, Massachusetts, USA

    Joshua N. Goldstein

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Khaku, A.S., Ali, S.K. (2018). Rule Out Acute Stroke. In: Ganti, L., Goldstein, J. (eds) Neurologic Emergencies. Springer, Cham. https://doi.org/10.1007/978-3-319-64523-0_2

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  • DOI: https://doi.org/10.1007/978-3-319-64523-0_2

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-64521-6

  • Online ISBN: 978-3-319-64523-0

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