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Source: Fagan SC, Hess DC. Stroke. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, eds. Pharmacotherapy: A Pathophysiologic Approach. 10th ed. New York, NY: McGraw-Hill; 2017. Accessed May 8, 2017.


  • Apoplexy.

  • Cerebrovascular accident (CVA)


  • Interruption of blood flow to area of brain, causing death of brain cells in area.


  • Local thrombus formation (eg, cerebral atherosclerosis)

  • Emboli from intra- or extracranial arteries that occlude cerebral artery.

  • Unknown causes.


  • Carotid atherosclerosis: Ruptured plaques lead to thrombus formation that may cause local occlusion or dislodge and travel distally, eventually occluding cerebral vessel.

  • Cardiogenic embolism: Stasis of blood flow in atria or ventricles leads to formation of clots that dislodge and travel through aorta to cerebral circulation.

  • Resulting arterial occlusion decreases cerebral blood flow and causes ischemia and infarction distal to occlusion.


  • Stroke (including ischemic and hemorrhagic types) leading cause of adult disability in United States.

  • African Americans have stroke rates twice those of whites.

  • Some states in southeastern United States have stroke mortality rates 40% higher than the national average.


  • Preventive measures directed toward reducing or eliminating modifiable risk factors for stroke.


  • Nonmodifiable risk factors:

    • Age.

    • Race.

    • Low birth weight.

    • Genetics.

  • Modifiable, well documented:

    • Cigarette smoking.

    • Hypertension.

    • Diabetes.

    • Asymptomatic carotid stenosis.

    • Dyslipidemia.

    • Atrial fibrillation.

    • Sickle cell disease.

    • Poor diet.

    • Obesity.

    • Physical inactivity.

    • Other cardiac diseases (coronary heart disease, heart failure, PAD)

  • Potentially modifiable, less well documented:

    • Migraine.

    • Metabolic syndrome.

    • Drug and alcohol abuse.

    • Inflammation and infection.

    • Elevated Lp(a)

    • Homocysteinemia.

    • Sleep-disordered breathing.


  • May need to obtain medical history from family members or others because cognitive or language deficits may preclude patient from giving reliable history.


  • Symptoms:

    • Weakness on one side of body.

    • Inability to speak.

    • Loss of vision.

    • Vertigo.

    • Falling.

    • Headache.

  • Signs of neurologic dysfunction depend on brain area involved.

    • Hemi- or monoparesis and hemisensory deficits common.

    • Posterior circulation involvement may present with vertigo and diplopia.

    • Anterior circulation strokes result in aphasia.

    • Other potential signs:

      • Dysarthria.

      • Visual field defects.

      • Altered levels of consciousness may be present.



  • Obtain tests for hypercoagulable states (protein C, protein S, antithrombin III) only when cause cannot be determined based on review of risk factors.

  • Obtain antiphospholipid antibodies in patients younger than age 50 and those who have had multiple thrombotic events or livedo reticularis.


  • Computed tomography (CT) head scan.


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