Diagnosis of Cerebrovascular accident
Cerebrovascular accident Diagnosis: Book Excerpts
Diagnosis of Cerebrovascular accident: medical news summaries:
The following medical news items
are relevant to diagnosis and misdiagnosis issues for Cerebrovascular accident:
Diagnostic Tests for Cerebrovascular accident: Online Medical Books
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for more information about diagnostis of Cerebrovascular accident.
Flank Pain/CVA Tenderness:
Differential Diagnosis
(In a Page: Signs and Symptoms)
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Degenerative disk disease and/or disk herniation is the most frequent cause of pain
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Muscle spasm or cramping
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Trauma
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Nephrolithiasis/urolithiasis (renal or ureteral calculi or stones) is the most common urinary tract etiology
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Pyelonephritis (acute or chronic)
–E. coli is the most common cause of upper and lower urinary infections, followed by
Staphylococcus saprophyticus
–Acute pyelonephritis is usually a
complication of a lower UTI
–Chronic pyelonephritis is usually associated with obstruction
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Perirenal (kidney) abscess
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Acute pancreatitis
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Glomerulonephritis
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Herpes zoster
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Bacterial cystitis
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Polycystic kidney disease
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Renal infarction or trauma
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Papillary necrosis
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Duodenal ulcer
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Cholecystitis or biliary colic
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Pneumonia
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Appendicitis
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Obstructive uropathy
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Ectopic pregnancy
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Cervicitis
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Renal or bladder cancer
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Leaking or ruptured abdominal aortic aneurysm
Workup and Diagnosis
- History should include onset, duration, quality, intensity, and location of pain; radiation; associated symptoms (e.g., nausea/vomiting, fever, dysuria, hematuria, rash); history of recent trauma or illness; and family history of renal disease or cancer
- Exam should include complete cardiovascular, pulmonary, abdominal, and genitourinary exam, and pelvic exam if suspect cervicitis or ectopic pregnancy
–Turner's sign (bluish discoloration at flank) and/or Cullen's sign (bluish discoloration at the umbilicus) indicate retroperitoneal hemorrhage and may be present in cases of pancreatitis or ruptured AAA
–Initial labs may include CBC, ESR, electrolytes, BUN/creatinine, calcium, amylase/lipase, liver function tests, pregnancy test, blood cultures, urinalysis, and urine culture
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Urine cytology, cystoscopy, and biopsy may be indicated if renal or bladder cancer is suspected
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Renal or abdominal ultrasound or abdominal CT scan
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Spiral CT scan without contrast is the gold standard to diagnose stones and urinary tract obstruction
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Intravenous pyelography has high sensitivity/specificity for stones, urinary tract obstruction, and renal cysts
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Voiding cystourethrography
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Lumbosacral X-ray may be indicated to evaluate for degenerative joint disease
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Lumbosacral MRI may be indicated to evaluate for disk disease
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Stroke:
History
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
A. Characteristics of the stroke. What is the duration of the deficit? Is the problem acute and lasting several hours? Impaired consciousness can occur in all types of stroke. More specific symptom may help localize the area of stroke:
1. Carotid circulation: symptoms of hemiplegia, hemianesthesia, aphasia, visual field defects, and loss of spatial function; occasionally, seizures, headache, amnesia, and confusion.
2. Vertebrobasilar circulation: symptoms of diplopia, vertigo, ataxia, facial paresis, Horner’s syndrome, dysphagia, dysarthria, quadraparesis
(a component of bilateral arms or legs), and crossed sensory symptoms (ipsilateral face and contralateral body). Cerebellar lesions often display headache, nausea or vomiting, and ataxia.
B. Past history. A history of trauma, migraine, vasculitis, seizure, and hypoglycemia could produce a condition that can mimic stroke. Fever or infection may suggest abscess. A prior history of stroke or TIA often precedes the presentation of a new stroke. A history of valvular heart disease, atrial fibrillation, or MI is relevant.
C. Risk factors. Patients need to be assessed for hypertension, cardiac disease (specifically atrial fibrillation), smoking, diabetes mellitus, hypercoagulable states, and hormonal therapy.
D. Hospitalization. This may be necessary for patients with transient or ongoing ischemic deficits. TIAs can herald a high-grade carotid stenosis or occult left atrial thrombus.
Physical examination (PE)
A. General examination. This should include vital signs (notably blood pressure), Mini-Mental Status Examination, and an examination of the eyes, including funduscopic. A screening neurologic examination of cranial nerves, coordination, muscle strength, sensation, deep tendon, reflexes, and gait is recommended.
B. Additional PE. Evaluate the heart (arrhythmia, mitral stenosis) and vascular system (carotid bruits), and palpate the scalp and neck (trauma and migraine) and superficial temporal arteries (arteritis).
» READ BOOK EXCERPT ONLINE »
Source: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter, 2000
Stroke Syndromes:
Differential Overview
(Field Guide to Bedside Diagnosis)
TIA/Stroke
❑ Middle cerebral artery stroke
❑ Anterior cerebral artery stroke
❑ Posterior cerebral artery stroke
❑ Watershed stroke
❑ Thalamic lacune
❑ Vertebrobasilar ischemia
❑ Pontine lacune
❑ Pontine stroke
❑ Midbrain stroke
❑ Pure motor hemiplegia
❑ Ataxic hemiparesis
❑ Lateral medullary stroke
❑ Temporal lobe stroke
Hemorrhage
❑ Subarachnoid hemorrhage
❑ Cerebellar hemorrhage
❑ Thalamic hemorrhage
❑ Pontine hemorrhage
❑ Putaminal hemorrhage
Diagnostic Approach
Brain ischemia leading to stroke may be due to embolism from carotid or cardiac sources, systemic hypoperfusion, or in situ thrombosis. Embolic strokes occur suddenly with maximal focal deficits at the onset. Rapid improvement favors an embolic TIA. Thrombosis symptoms fluctuate in a stepwise pattern. Intracerebral hemorrhage progresses gradually over minutes to hours. Aneurysmal subarachnoid hemorrhage occurs in an instant, and focal brain dysfunction is usually absent. Strokelike symptoms due to migraine are recognized by a headache, epiphenomena such as anorexia/nausea and photophobia, and occurrence in younger patients.
A TIA proceeds to stroke in 10% to 40%. Risk is especially high in “crescendo TIA,” which is usually caused by an ulcerated carotid plaque. Amaurosis fugax (“a shade coming down” or transient monocular loss of vision) is a classic presentation. Amaurosis fugax, an anterior circulation event, should be distinguished from transient hemianopsia, a posterior circulation event. An asymptomatic carotid bruit is an imperfect indicator of carotid stenosis and subsequent stroke risk, with an annual risk of an ipsilateral stroke not preceded by a TIA of 1% to 3% per year.
Examination of the optic fundus may reveal a cholesterol crystal, white platelet-fibrin or red clot emboli. Subhyaloid hemorrhage often accompanies a subarachnoid or intracerebral hemorrhage. A red patch with a white center (Roth spot) may be seen in bacterial endocarditis. With occlusion of the carotid artery, the iris may appear speckled and the ipsilateral pupil dilated and poorly-reactive.
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Stroke:
Diagnosis
(Handbook of Diseases)
Confirmation of stroke is based on symptoms, a history of risk factors, and the results of diagnostic tests.
❑ Computed tomography scan shows evidence of hemorrhagic stroke immediately but may not show evidence of thrombotic infarction for 48 to 72 hours.
❑ Magnetic resonance imaging may help identify ischemic or infarcted areas and cerebral swelling.
UNDER STUDY: Positron emission tomography can quantify cerebral blood flow. Single-photon emission tomography, computed tomography perfusion, and magnetic resonance perfusion techniques report relative blood flow and are research tools.
❑ Ophthalmoscopy may show signs of hypertension and atherosclerotic changes in retinal arteries.
❑ Angiography outlines blood vessels and pinpoints atherosclerotic plaques, vessel occlusion, or the rupture site.
❑ EEG helps to localize the damaged area.
Other baseline laboratory studies include urinalysis, coagulation studies, complete blood cell count, serum osmolality, and electrolyte, glucose, triglyceride, creatinine, and blood urea nitrogen levels.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
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