Clinical Presentation of Stroke: Pathophysiology & Key Differences 🧠💥

Hey future doctors! 👋 Strokes are a medical emergency, and understanding their pathophysiology, clinical presentation, and key differences is crucial for rapid diagnosis and treatment. Let’s break it down in detail! 🕵️‍♂️📚

1. What is a Stroke? 🧠⚡

A stroke occurs when blood flow to part of the brain is interrupted, leading to neuronal injury. There are two main types: 

• Ischaemic Stroke (87% of cases): Caused by a blockage in a blood vessel. 🚫🩸
• Haemorrhagic  Stroke (13% of cases): Caused by bleeding into or around the brain. 💥

2. Classic Stroke Symptoms: Think FAST! ⏩🚨

The FAST acronym is a quick way to remember the most common signs:

• Face: Sudden facial drooping or asymmetry (ask the patient to smile). 😬👈
• Arms: Weakness or numbness in one arm (ask them to raise both arms). 💪🆘
• Speech: Slurred speech or difficulty understanding language (ask them to repeat a simple phrase). 🗣️🤔
• Time: Call emergency services immediately! ⏰🚑 

3. Beyond FAST: Other Key Symptoms 🧠🔍

Strokes can present in many ways depending on the affected brain region:

• Motor Deficits: Weakness or paralysis on one side of the body (hemiparesis/hemiplegia). 
• Sensory Deficits: Numbness or tingling on one side of the body. 🤚🦵
• Visual Disturbances: Sudden loss of vision in one eye (amaurosis fugax) or double vision (diplopia). 👁️‍🗨️👀
• Ataxia: Loss of coordination or balance, often due to cerebellar involvement. 🎯🤹
• Aphasia: Difficulty speaking or understanding language (Broca’s or Wernicke’s area affected). 🗣️🧠
• Neglect: Ignoring one side of the body or environment (often seen in right parietal lobe strokes). 🚶‍♂️👈 

4. Pathophysiology of Ischaemic Stroke 🧠🔬

Mechanism: A thrombus or embolus obstructs blood flow to part of the brain, leading to ischemia (lack of oxygen) and infarction (tissue death). 🚫🩸

Core vs. Penumbra:

• Core: The central area of severe ischemia where neurons die within minutes. ☠️🧠
• Penumbra: The surrounding area at risk of infarction but potentially salvageable with timely intervention. 🕒💉

Cellular Events:

• Loss of ATP → failure of Na+/K+ pumps → cytotoxic oedema . ⚡🧪
• Glutamate excitotoxicity → calcium influx → cell death. ☠️🧬
• Inflammation and free radicals further damage neurons. 🔥🧠

5. Pathophysiology of Haemorrhagic  Stroke 🧠💥

Mechanism: Rupture of a blood vessel leads to bleeding into the brain parenchyma (intracerebral haemorrhage) or surrounding spaces (subarachnoid haemorrhage ). 💥🩸

Primary Injury:

• Physical damage from the expanding hematoma compresses brain tissue. 🧠💢
• Increased intracranial pressure (ICP) can lead to herniation. ⬆️🧠

Secondary Injury:

• Blood breakdown products (e.g., iron, haem) cause oxidative stress and inflammation. 
• Vasospasm (common in subarachnoid haemorrhage ) can cause further ischemia. 🌀🧠

6. Clinical Differences: Ischaemic vs. Haemorrhagic  Stroke 🧠⚖️

7. Why Timing Matters ⏰🧠

Ischaemic Stroke:

• tPA (thrombolytics): Must be given within 4.5 hours of symptom onset. 💉⏳
• Thrombectomy: Effective up to 24 hours in select patients. 🕒🔧

Haemorrhagic  Stroke:

Rapid neurosurgical intervention (e.g., clot evacuation, aneurysm clipping/coiling) can be life-saving. 🏥💥

8. Case Challenge! 🧠❓

A 70-year-old patient with atrial fibrillation presents with sudden right-sided weakness and slurred speech. Symptoms started 2 hours ago. BP is 180/100 mmHg.

What’s the most likely type of stroke?

What’s the first imaging modality you’d use?

Drop your answers in the comments! 🚀👇

9. Pro Tip: 🧠💡

Always ask “When was the patient last known well?” This helps determine eligibility for time-sensitive treatments. ⏳🕵️‍♂️

10. Spread the Word! 📢🧠

Remember, time is brain—every second counts! ⏰🧠

Keep learning, future neurologists! 🧠💪

#MedSchool #StrokeAwareness #Neurology #ClinicalSkills #FutureDoctors