Neuro

• Stroke was defined by WHO as a rapidly progressive neurological deficit (focal or global) of vascular origin, lasting longer than 24 hours or leading to death within 24 hours
• AHA/ASA re-defined stroke as a rapidly progressive neurological deficit as a result of focal brain, spinal or retinal infarction or due to a focal collection of blood within the brain parenchyma which is not due to trauma
• In Nigeria, the incidence of stroke was reported as 26/100,000 person years in 1977 in Ibadan and 25.2/100,000 person years in a more recent study in Lagos
• The incidence of stroke is 246/100,000 person years in the U.S, 238/100,000 person years in the UK, and 330/100,000 person years in Taiwan
• The proportion of ischaemic stroke ranges from 80-91% in the U.S, while the proportion of haemorrhagic stroke in the U.S ranges from 9 to 20%
• Modifiable risk factors for stroke include hypertension, physical inactivity, poor diet, smoking, cardiac causes, and diabetes mellitus
• Other modifiable risk factors are alcohol consumption, stress, dyslipidaemia, obesity, TIA, carotid stenosis, hyperhomocystinaemia, illicit drug use, and oral contraceptive use/post-menopausal hormone use
• Non-modifiable risk factors for stroke include advanced age, race, gender, ethnicity, and heredity
• New stroke risk factors include electronic cigarette use and obstructive sleep apnea
• Acute ischaemia results from vascular occlusion secondary to thrombo-embolic disease or atherosclerosis, leading to necrotic core formation
• Haemorrhagic stroke is due to bleeding into the brain parenchyma or ventricular system from damaged blood vessels, aneurysms, bleeding diathesis, anticoagulation, thrombolysis, or cocaine abuse
• Clinical features of stroke include facial weakness, arm weakness, speech difficulty, headache, loss of consciousness, seizures, nausea/vomiting, ACA syndrome, MCA syndrome, and posterior circulation symptoms
• Differential diagnosis of stroke includes stroke mimics like SOL, Todd’s paralysis, subdural hematoma, and epidural hematoma
• Neuro-imaging for stroke includes brain CT scan as the investigation of choice, with brain MRI being better than CT in posterior circulation stroke
• Management of stroke involves protecting the penumbra, improving cerebral perfusion pressure, not giving anti-hypertensives unless specific criteria are met, using mannitol for raised ICP, and specific treatments like IV thrombolysis, mechanical embolectomy, aspirin therapy, carotid endarterectomy, and endovascular treatments
• Stroke care involves stroke recognition, hyperacute stage (<24 hours), acute stage (>24 hours), stroke rehabilitation, secondary prevention, and long-term recovery
• Stroke biomarkers include NSE, GFAP, S100B, MBP, NMDA-R-Ab, CRP, IL-6, TNF-alpha, VCAM 1, and ICAM 1