Stroke for the Physician Assistant Licensing Exam

• Ischemic Stroke: Caused by an obstruction within a blood vessel supplying blood to the brain, which can be thrombotic (local occlusion) or embolic (occlusion from a clot formed elsewhere) - 85% of strokes.
• Hemorrhagic Stroke: Results from a ruptured blood vessel in the brain - 15% of strokes.

• Pathophysiology:
• Thrombotic Stroke: Often associated with atherosclerosis in cerebral arteries.
• Embolic Stroke: Typically originates from the heart, as with atrial fibrillation, or from carotid artery plaques.

• Modifiable: Hypertension, diabetes, smoking, hyperlipidemia, obesity, physical inactivity, and atrial fibrillation.
• Non-modifiable: Age, heredity, race, and gender.

• Common Symptoms: Sudden numbness or weakness of the face, arm, or leg, especially on one side; confusion or trouble speaking; trouble seeing in one or both eyes; trouble walking, dizziness, loss of balance or coordination; severe headache with no known cause.
• FAST: Facial drooping, Arm weakness, Speech difficulties, Time to call emergency services.

For details regarding stroke patterns, see Stroke Syndromes

• Imaging:
• CT Scan: First step to differentiate between ischemic and hemorrhagic stroke and to identify early ischemic changes.
• MRI: More sensitive and specific for detecting ischemic stroke, especially in the posterior brain regions.
• Other Diagnostics:
• CTA/MRA Head & Neck or Carotid Ultrasound: To assess for carotid stenosis.
• Echocardiography: To identify potential cardiac sources of emboli.

• Acute Ischemic Stroke:
• Thrombolytic Therapy: Administer IV alteplase (or tenecteplase (TNK)) if within 4.5 hours of onset and no contraindications exist.
• Mechanical Thrombectomy: Considered for patients with large artery occlusions.
• Supportive Care: Blood pressure management, hydration, fever control, and prevention of complications like aspiration.
• Secondary Prevention:
• Antiplatelet Agents: Aspirin or clopidogrel for long-term prevention.
• Anticoagulation: For patients with atrial fibrillation.
• Statins: To manage dyslipidemia.
• Lifestyle Modifications: Smoking cessation, diet, exercise.

• Rapid Assessment and Intervention: Recognizing symptoms quickly and initiating appropriate treatment protocols to minimize brain damage.
• Differentiation of Stroke Types: Understanding the different causes and appropriate treatments for ischemic versus hemorrhagic strokes.
• Long-Term Management: Focusing on rehabilitation, prevention of secondary strokes, and managing chronic conditions that increase stroke risk.