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  • Stroke 08.25.2010

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    Emily Eresuma
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    This document discusses arterial ischemic stroke. It notes that the prevalence is 2-6 per 100,000 people and lists several predisposing conditions including congenital heart malformations, hemolytic anemias, collagen vascular diseases, infection, and vasculopathy. Prothrombotic disorders are present in around 50% of cases. Presentation includes altered mental status, acute neurologic deficits affecting things like vision, speech, movement, and balance. Several inherited thrombophilias are listed as risk factors for stroke including deficiencies of antithrombin, protein C/S, and mutations of the MTHFR and prothrombin genes. One study found the MTHFR mutation in 27

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    This document discusses arterial ischemic stroke. It notes that the prevalence is 2-6 per 100,000 people and lists several predisposing conditions including congenital heart malformations, hemolytic anemias, collagen vascular diseases, infection, and vasculopathy. Prothrombotic disorders are present in around 50% of cases. Presentation includes altered mental status, acute neurologic deficits affecting things like vision, speech, movement, and balance. Several inherited thrombophilias are listed as risk factors for stroke including deficiencies of antithrombin, protein C/S, and mutations of the MTHFR and prothrombin genes. One study found the MTHFR mutation in 27

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    37 views6 pages

    Stroke 08.25.2010

    Uploaded by

    Emily Eresuma
    This document discusses arterial ischemic stroke. It notes that the prevalence is 2-6 per 100,000 people and lists several predisposing conditions including congenital heart malformations, hemolytic anemias, collagen vascular diseases, infection, and vasculopathy. Prothrombotic disorders are present in around 50% of cases. Presentation includes altered mental status, acute neurologic deficits affecting things like vision, speech, movement, and balance. Several inherited thrombophilias are listed as risk factors for stroke including deficiencies of antithrombin, protein C/S, and mutations of the MTHFR and prothrombin genes. One study found the MTHFR mutation in 27

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    of 6

    Ischemic Stroke

    Kevin E. Nelson
    Morning Report
    August 25, 2010
    Arterial Ischemic Stroke
     Prevalence 2-6/100,000
     Predisposing conditions
     Congenital heart malformations
     Hemolytic anemias
     Collagen vascular diseases
     Infection

     Vasculopathy (e.g. arterial dissection ~20%)


     Smoking, drug use
     Prothrombotic disorders in 50%
    Presentation
     Altered mental status
     Acute neurologic deficit
     Paresis

     Vision changes - visual loss, field deficits, diplopia


     Dysarthria

     Ataxia

     Vertigo

     Aphasia
    Inherited Thrombophilias

    Antithrombin
    Deficiency
    Prothrombin OR 3.29 (CI 0.70–15.48)
    G20210A
    OR 2.60 (CI 1.66-4.08)

    Factor V
    Leiden
    OR 3.70 (CI 2.82-4.85)

    Protein C/S
    Deficiency
    OR 11.0 (CI 5.13-23.59)
    Protein C

    MTHFR homozygous mutation (OR 1.58, CI 1.20-2.08)


    Hyperhomocysteinemia Adapted from cotch.net/images/blood_clotting_2.png
    MTHFR and childhoold Stroke
     Prevalence 27%, arterial ischemic stroke
     No cases tested had hyperhomocysteinemia
     Not a proven risk factor for ischemic stroke
     Lack of adequately powered studies

    Morita, Donaldson, Butterfield, Benedict, Bale, 2010


    References
    1. Becker JU, Wira CR, Arnold JL, «Stroke, Ischemic»
    Emedicine, available at
    http://emedicine.medscape.com/article/793904-overview

    2. Kenet G, et. al, Circulation 2010;121:1838–1847.

    3. Morita DC, Donaldson A, Butterfield RJ, Benedict SL, Bale JF,


    Pediatr Neurol 2009;41:247-249.

    4. Hypercoagulable States – Thrombophilia. Available at


    http://www.arupconsult.com/Topics/Thrombophilia.html#

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