Title your presentation “Noon Conference”
Prevents inadvertently giving away the case.
NIHSS:
Based on observational cohort study (Kothari R, Hall K, Brott T, Broderick J. Early stroke recognition: developing an out-of-hospital NIH Stroke Scale. Acad Emerg Med. 1997;4(10):986–990), presence of 3 items - facial paresis, arm drift, and abnormal speech – identified patients with stroke at 100% sensitivity and 88% specificity
NIHSS:
Based on observational cohort study (Kothari R, Hall K, Brott T, Broderick J. Early stroke recognition: developing an out-of-hospital NIH Stroke Scale. Acad Emerg Med. 1997;4(10):986–990), presence of 3 items - facial paresis, arm drift, and abnormal speech – identified patients with stroke at 100% sensitivity and 88% specificity
Qualifier: 4 findings + persistent, focal neurologic deficit of acute onset during previous week
Source: von Arbin M, Britton M, De Faire U, Helmers C, Miah K, Murray V. Validation of admission criteria to a stroke unit. J Chronic Dis. 1980;33(4):215–220.
Abulia = lack of willpower/inability to act decisively
Anosognosia = lack of insight
Image: Smit EJ, et al. Timing-invariant CT angiography derived from CT perfusion imaging in acute stroke: a diagnostic performance study. American Journal of Neuroradiology. Oct 2015, 36 (10): 1834-1838.
Diagram: Tanaka H, et al. Relationship between variations in the circle of willis and flow rates in internal carotid and basilar arteries determined by means of magnetic resonance imaging with semiautomated lumen segmentation: reference data from 125 healthy volunteers. American Journal of Neuroradiology. Sep 2006, 27: 1770-1775.
Ischemic Stroke subtypes:
Large artery atherosclerosis
Cardioembolism
Small vessel occlusion
Stroke of other, unusual, determined etiology
Stroke of undetermined etiology
**60% of all new ischemic strokes are classified as large-artery atherosclerosis, cardioembolic, or small-vessel diseases
Modifiable risk factors (ischemic stroke): HTN, diabetes, smokers <55, afib
Epi data:
Grysiewicz RA, Thomas K, Pandey D. Epidemiology of ischemic and hemorrhagic stroke: incidence, prevalence, mortality, and risk factors. Neurology Clinics. 26 (4): 871-895
Coagulopathy panel:
Lupus anticoagulant (3% pretest probability)
Anticardiolipin Ab (17%)
Activated protein C resistance/Factor V (7%)
Prothrombin mutation (5%)
Recommend anti-phospholipid Ab testing in those with SLE
