Stroke is one of the most common causes of morbidity and mortality in hospitalized patients in the United States. A proper understanding of stroke mechanisms helps to guide specific case management. The only therapy approved by the US Food and Drug Administration for the management of acute ischemic stroke is initiation of intravenous recombinant tissue plasminogen activator within 3 hours of symptom onset. Other treatment options include intra-arterial recombinant tissue plasminogen activator, mechanical thrombectomy, clot retrieval, or a combination of these approaches. In this article, we provide an evidence-based review of the diagnostic approach for acute ischemic stroke, including recognizing common stroke mimics. We detail the initial medical management of acute stroke and the medical and surgical therapeutic interventions for patients who have sustained acute ischemic stroke.
Deep venous thrombosis (DVT) and pulmonary embolism (PE) are part of the spectrum of venous thromboembolism (VTE). It is one of the most frequent medical complications in stroke patients. The risk of VTE is even higher after hemorrhagic stroke. This article reviews various screening methods, diagnostic techniques, and pharmacologic as well as nonpharmacologic means of preventing VTE after hemorrhagic stroke.
With the advent of modern neuroimaging techniques, transient ischemic attack (TIA) has been redefined as, "a transient episode of neurological dysfunction caused by focal brain, spinal cord or retinal ischemia, without acute infarction." If infarct is evident on neuroimaging, the event is a stroke. It is important to recognize and correctly diagnose TIA and minor stroke because of the substantial early risk of stroke. Much of the early stroke risk is attributable to large artery atherosclerosis. Stroke-risk stratification in TIA patients can be done based on clinical grounds using an ABCD(2) score. There is, however, abundant data to support inclusion of neuroimaging in stroke-risk determination, which can also be combined with a clinical risk assessment. The hybrid ABCDE⊕ score further refines early stroke risk. Rapid assessment and treatment in the emergency department or in specially designed 'TIA clinics' appear to reduce stroke rate.
Background: Bilateral anterior opercular syndrome, or Foix-Chavany-Marie Syndrome (FCMS), is a neurological condition characterized by bilateral anterior opercular lesions. Common presenting symptoms of this rare suprabublar palsy include dysarthria, or slurred speech, as well as paralysis of facial, pharyngeal, lingual, and masticatory voluntary muscles while autonomic function is preserved.1 Most cases of FCMS are bilateral, yet some rare cases have been reported with unilateral opercular lesions with preexisting contralateral white matter lesions.2 In this case report we present a rare case of unilateral FCMS in a patient who had an acute anterior left opercular infarct, as well as a residual right parietal subcortical stroke. Project Methods: The patient we present is a 49 year old African American female with a history of hypertension and previous stroke with residual spastic right hemiplegia who presented to the ED for evaluation of right sided facial droop, right sided weakness, and slurred speech. Patient was evaluated by acute stroke team and was treated with intravenous thrombolysis (Alteplase). On hospital day 2, the patient developed complete disarticulation, unable to produce any speech but able to communicate by appropriate gestures and writing. The patient’s symptoms included anarthria, weakness of bilateral masseters, and lateral/medial pterygoids without dysphagia. Results: The MRI brain showed left insular region/frontal opercular ischemic stroke and a small right parietal subcortical ischemic stroke, likely embolic in nature. Over the hospital stay, the patient’s motor function improved but her anarthria persisted. These radiologic findings along with the symptomology proved consistent with FCMS. She was discharged to home with an NIH stroke scale of 5 and recommended outpatient speech therapy. Conclusion: In this case report, we describe a patient that presents with an extremely rare case of unilateral FCMS, with a preexisting contralateral parietal infarct that could have collectively caused anarthria and masseter weakness. Works Cited 1. Milanlioglu A, Aydın MN, Gökgül A, Hamamcı M, Erkuzu MA, Tombul T. Ischemic Bilateral Opercular Syndrome. Case Reports in Medicine. 2013;2013:1-3. doi:10.1155/2013/513572. 2. Sa F, Cordeiro IM, Mestre S, Nzwalo H. Unilateral opercular infarction presenting with FoixChavany-Marie syndrome. Case Reports. 2014;2014. doi:10.1136/bcr-2014-206439.
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