A cerebrovascular event (stroke) is a clinical syndrome caused by disruption of blood supply to the brain, characterised by rapidly developing signs of focal or global disturbance of cerebral functions, lasting for more than 24 hours or leading to death. A transient ischaemic attack (TIA) refers to a similar presentation that resolves within 24 hours. A stroke results either from ischaemic infarction part of the brain or from intracerebral haemorrhage. Ischaemic infarction may be caused by atheroma or thromboembolism and, more rarely, by trauma, infection or tumours.

• Cerebral infarction accounts for about 85% of strokes.
• Posterior circulation stroke accounts for 20-25% of ischaemic strokes.
• Primary haemorrhage accounts for about 10%.
• Subarachnoid haemorrhage accounts for approximately 5%.
• The remainder are of uncertain type.

The two main types of stroke are not reliably distinguishable clinically but pointers include:

• Haemorrhagic stroke: meningism, severe headache and coma within hours.
• Ischaemic stroke: carotid bruit, atrial fibrillation, past TIA.

Risk factors

• Hypertension.
• Smoking.
• Diabetes mellitus.
• Heart disease (valvular, ischaemic, atrial fibrillation).
• Peripheral arterial disease.
• Post-TIA (TIAs are associated with a high early risk of stroke).
• Polycythaemia vera.
• Carotid artery occlusion; carotid bruit.
• Combined oral contraceptive pill.
• Hyperlipidaemia.
• Excess alcohol.
• Clotting disorders.

Acute stroke management

• Patients should be admitted to hospital (ideally a specialist acute stroke unit for initial care and treatment, unless the diagnosis will make no difference to management - eg, where the optimal management is palliative care).
• Maintenance or restoration of homeostasis:
  • Oxygen therapy; give supplemental oxygen only if oxygen saturation drops below 95%.
  • Blood sugar control; maintain blood glucose concentration between 4 and 11 mmol/L. Provide optimal insulin therapy with intravenous insulin and glucose, for people with diabetes.
  • Blood pressure control:
    • Blood pressure reduction to 185/110 mm Hg or lower should be considered in people who are candidates for intravenous thrombolysis.
    • There is currently insufficient evidence to reliably evaluate the effect that altering blood pressure has on the outcome after acute stroke.
    • For people with acute intracerebral haemorrhage who present within six hours and have a systolic blood pressure of 150-220 mm Hg (unless there is a structural cause for the haemorrhage or they have a poor expected prognosis or Glasgow Coma Scale score of below 6), offer rapid blood pressure lowering, aiming for systolic pressure of 130-140 mm Hg maintained for at least seven days.
    • Give antihypertensive treatment only if there is a hypertensive emergency with one or more of the following:
      • Hypertensive encephalopathy.
      • Hypertensive nephropathy.
      • Hypertensive cardiac failure/myocardial infarction.
      • Aortic dissection.
      • Pre-eclampsia/eclampsia.
      • Intracerebral haemorrhage with systolic blood pressure >200 mm Hg.
• People with acute stroke should have their swallowing screened before being given any oral food, fluid or medication. Also screen for malnutrition

Media Contact:

John Mathews

Journal Manager

Current Trends in Cardiology

Email: cardiologyres@eclinicalsci.com