Stroke Overview
Relative Risk of Strokes
  • Age: increases 10 times each 20 yrs.
    • 1/100,000 at age 20
    • 10/100,000 at age 40
    • 100/100,000 at age 60 etc
  • HTN: 6 x
  • CVA/TIA: 10 x
  • Asymptomatic Carotid Bruit - 3 x
  • Diabetes - 3 x
  • Smoke - 2 x
  • Rheumatic Atrial Fibrillation - 17 x
  • Atrial Fibrillation - 6 x
  • Obesity - 1.5 x
  • Lipid - 2 x
Risk of stroke after TIA
  • 1st month: 4-8%
  • 1st year: 12%
  • 5 years: 24-29%
Types of  stroke by etiology
  • Atherothrombotic: sudden, gradual, stepwise or fluctuating
  • Cardiac embolus: Sudden onset
    • High risk: atrial fibrillation, prosthetic valve, left ventricular thrombus, left atrial thrombus, dilated caridomyopathy, sick sinu syndrome, myocardial infarction in past 4 weeks
    • Moderate risk: congestive heart failure, atrial flutter, mitral valve prolapse, atrial septal defect, bioprosthetic valve, ventricular hypokinesia, MI between 4-6 weeks
  • Lacunar: abrupt or gradual onset.
    • history of diabetes or hypertension
    • CT, MRI < 1.5 cm
Prevention
Carotid Endarterectomy
  • Carotid endarterectomy for symptomatic patients: (NASCET)
    • stenosis > 70%
    • Surgical group 9% ipsilateral stroke in 2 yrs
    • Medical group 26% ipsilateral stroke in 2 years
    • Complication rate higher for ages> 75, hypertension, CAD
  • Asymptomatic carotid artery stenosis (ACAS):
    • Stenosis > 60%
    • Surgical group: 5% ipsilateral stroke in 5 yrs, complication rate 2.4%
    • Medical group: 11% ipsilateral stroke in 5 yrs
  • More information

Stroke information center