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Related Concept Videos

Ischemic Stroke l: Introduction01:15

Ischemic Stroke l: Introduction

Ischemic stroke is an acute cerebrovascular condition in which blood flow to a brain region is suddenly interrupted, leading to tissue infarction. Neurons depend on continuous oxygen and glucose supply, so even brief reductions in perfusion cause energy failure, ionic imbalance, and irreversible injury. Ischemic strokes are classified into thrombotic and embolic types based on their underlying mechanisms.Thrombotic MechanismsThrombotic stroke develops when a clot forms within a cerebral artery.
Hemorrhagic Stroke l: Introduction01:17

Hemorrhagic Stroke l: Introduction

A hemorrhagic stroke is an acute neurological event that occurs when a weakened cerebral blood vessel ruptures, allowing blood to accumulate within or around the brain. The sudden release of blood forms a focal hematoma that increases intracranial pressure, displaces neural tissue, and can obstruct cerebrospinal fluid pathways. These effects may be compounded by intraventricular extension of the hemorrhage, cerebral edema, or compression of adjacent structures, all of which contribute to...
Transient Ischemic Attack l: Introduction01:26

Transient Ischemic Attack l: Introduction

A transient ischemic attack (TIA) is a brief episode of neurological dysfunction caused by a temporary, focal reduction in cerebral blood flow. Although symptoms resemble those of an ischemic stroke, the interruption in perfusion is short-lived and does not cause permanent infarction. TIAs are clinically important because they often serve as early warning events for future stroke.Mechanisms of Transient Cerebral IschemiaTransient cerebral ischemia may arise through several mechanisms. One...
Traumatic Brain Injury l: Introduction01:28

Traumatic Brain Injury l: Introduction

DefinitionTraumatic brain injury, or TBI, is a disturbance of normal brain function induced by an external mechanical force, such as a direct blow to the head or a penetrating injury. It can affect both brain structure and function, producing a wide range of clinical outcomes. TBI is a heterogeneous condition, meaning its effects may differ based on the type, location, and severity of the injury.Basis of ClassificationTBI is classified based on severity, injury mechanism, or pathophysiology. In...
Dementia l: Introduction01:22

Dementia l: Introduction

Dementia is an acquired, progressive syndrome characterized by a decline in multiple cognitive domains severe enough to impair daily functioning and reduce independence. Although memory loss is a central feature, the diagnosis requires additional deficits involving language, executive function, visuospatial skills, judgment, calculation, or abstract reasoning. These cognitive impairments reflect underlying neurodegenerative or vascular processes that gradually disrupt neuronal networks...
Hepatic Encephalopathy01:29

Hepatic Encephalopathy

DefinitionHepatic encephalopathy is a reversible neurologic syndrome that results from advanced liver dysfunction or portosystemic shunting. It leads to disturbances in cognition, behavior, and motor function due to the brain’s exposure to gut-derived toxins that the liver fails to detoxify.EtiologyThis condition develops either in the setting of acute fulminant hepatitis or progressively during chronic liver disease, such as cirrhosis and portal hypertension. Portosystemic shunting—including...

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Semi-quantitative Assessment Using [18F]FDG Tracer in Patients with Severe Brain Injury
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Is this patient having a stroke?

Larry B Goldstein1, David L Simel

  • 1Department of Medicine, Duke Center for Cerebrovascular Disease, Durham, NC 27710, USA. golds004@mc.duke.edu

JAMA
|May 19, 2005
PubMed
Summary
This summary is machine-generated.

Accurate stroke assessment relies on neurological examination findings. Focusing on facial paresis, arm drift, and speech can improve diagnostic accuracy for stroke and transient ischemic attack.

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Area of Science:

  • Neurology
  • Diagnostic Accuracy
  • Clinical Examination

Background:

  • Accurate assessment of suspected stroke or transient ischemic attack (TIA) is crucial for timely treatment and secondary prevention.
  • A previous systematic review from 1994 highlighted the importance of clinical evaluation.

Purpose of the Study:

  • To systematically review and update the evidence on the accuracy and reliability of clinical symptoms and neurological examination findings for diagnosing stroke and TIA.
  • To provide updated diagnostic accuracy data for clinicians managing patients with suspected cerebrovascular events.

Main Methods:

  • A comprehensive literature search was conducted for articles published between 1994 and 2005.
  • Selected studies provided primary data on the accuracy (sensitivity, specificity, likelihood ratios) and/or reliability (kappa statistics) of clinical findings for stroke diagnosis.
  • Final diagnosis in included studies was confirmed by neuroimaging and laboratory tests.

Main Results:

  • The presence of acute facial paresis, arm drift, or abnormal speech significantly increases the likelihood of stroke (LR+ = 5.5).
  • Absence of these three findings decreases stroke likelihood (LR- = 0.39).
  • Specific symptoms like sudden speech changes, visual loss, and weakness showed high diagnostic agreement (kappa = 0.60); standardized scales like the NIH Stroke Scale can improve reliability.

Conclusions:

  • Clinical history and neurological examination remain fundamental for evaluating patients with suspected stroke.
  • A focused assessment of facial paresis, arm drift, and speech abnormalities can enhance diagnostic accuracy and reliability in stroke evaluation.