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Printable Handouts
Navigable Slide Index
- Introduction
- Stroke subtypes – plan of presentation
- Subtype diagnosis
- Dramatis personae
- Ischemic stroke
- Thrombotic strokes
- Subarachnoid hemorrhage
- Aneurysmal subarachnoid hemorrhage
- Intracerebral hemorrhage
- Hypertensive intracerebral hemorrhage
- Ischemic strokes
- Stroke - evaluation
- Clinical diagnosis – step 1
- History – the what diagnosis
- History – the where diagnosis
- Making hypotheses about the diagnoses
- Case example
- What diagnoses
- Where diagnoses
- Planning the examinations
- Queries to test during the exam
- Case example - examination
- Revise the what and where diagnoses
- Planning the investigations
- Potential alternative causes
- Blood tests
- Importance of a detailed diagnosis
- Stroke is a cerebrovascular disease
- Data needed to logically treat stroke patients
- Obtain brain and vascular imaging
- MRI can be used as the only brain imaging
- Using CT and MRI for vascular lesions
- Case study – CT scan
- Obtain vascular imaging
- Perfusion CT using RAPID
- B-mode neck ultrasound
- Transcranial doppler (TCD)
- Triphasic CT perfusion
- MRA and cerebral angiography results
- Sources of emboli in the heart and aorta
- Transesophageal echocardiogram
- Final diagnosis
- Reviewing the history and examination
- Planning treatment
- Treatment considerations include many items:
- Thank you for listening
Topics Covered
- Description of stroke subtypes
- Ischemic stroke
- Brain embolism
- Extra and intracranial large artery disease
- penetrating artery disease
- Hemorrhagic stroke
- Intracerebral and subarachnoid hemorrhage
- Clinical diagnosis methodology
- Imaging and laboratory tests
- Planning treatment
Links
Series:
Categories:
Therapeutic Areas:
Talk Citation
Caplan, L. (2022, January 31). Clinical diagnosis of stroke and subtypes [Video file]. In The Biomedical & Life Sciences Collection, Henry Stewart Talks. Retrieved December 7, 2024, from https://doi.org/10.69645/EZAX5528.Export Citation (RIS)
Publication History
Financial Disclosures
- There are no commercial/financial matters to disclose.
A selection of talks on Clinical Practice
Transcript
Please wait while the transcript is being prepared...
0:00
This is Dr. Louis Caplan.
I'm dictating from Boston, Massachusetts.
I'm a clinical neurologist at
the Beth Israel Deaconess Medical Center in
Boston and professor of neurology at Harvard Medical School.
Today, I'm going to be talking about the clinical diagnosis of stroke and stroke subtypes.
0:22
The plan of the presentation is to first begin
by describing the nature of the subtypes and their importance,
how we make a diagnosis, and imaging evaluations.
One of the ways we do this is inductive reasoning.
That is, we try to acquire information first,
listening to the patient from the history about what kinds of
pathology it is and where it's located in the nervous system.
Then having thought about potential questions,
we do hypothesis directed questioning to answer those.
After we finish the history,
we generate probabilities of the pathology and stroke subtype.
Then, take time, think,
and plan the general neurological examinations to test
those hypotheses and then we revise the probabilities after the examination.
Finally, we plan the investigations to determine the diagnosis.
1:27
What is the importance of subtype diagnosis?
Well, the evaluation and also the treatment
differ dramatically between the different stroke subtypes.
The evaluation and management depend on the subtype and the nature,
location, and extent of the brain and vascular abnormalities.
Diagnosis is based either on
inductive reasoning which we just described or on pattern-matching.
If we have a friend named John and we know what John looks like,
when someone comes up,
we just match the pattern of John in our heads with what that person looks like.
The same with stroke subtypes if we know what the usual subtype is,
we match the patients finding with that
or we go through an inductive reasoning process.
Actually in many cases we do both.