Overview
Paralytic stroke, also known as ischemic stroke, involves the sudden loss of neurological function due to obstruction of cerebral blood flow, leading to cell death in brain tissue. It is a significant cause of morbidity and mortality, often associated with modifiable risk factors such as hypertension and obesity 1.Diagnosis
Clinical Presentation: Sudden onset of focal neurological deficits (e.g., weakness, paralysis, sensory loss) 1.
Imaging: Non-contrast head CT to rule out hemorrhagic stroke; MRI may be used for detailed assessment 1.
Laboratory Tests: Blood glucose, coagulation profile, lipid panel 1.
Risk Factor Assessment: Evaluate for hypertension, diabetes, smoking, and obesity (waist-to-hip ratio) 1.Management
Acute Phase:
- Thrombolysis: IV tissue plasminogen activator (tPA) within 4.5 hours of symptom onset (dose: 0.9 mg/kg, max 90 mg) 1.
- Endovascular Therapy: Consider for large vessel occlusions in eligible patients 1.
Secondary Prevention:
- Antiplatelet Therapy: Aspirin (81 mg daily) or clopidogrel (75 mg daily) 1.
- Blood Pressure Control: Target BP <140/90 mmHg; individualized based on patient profile 1.
- Lipid Management: Statins for cholesterol reduction 1.
- Diabetes Management: Tight glycemic control 1.Special Populations
Elderly: Hypertension and diabetes remain significant risk factors; careful management of comorbidities essential 1.
Obesity: Elevated waist-to-hip ratio increases stroke risk; lifestyle modifications and weight management recommended 1.Key Recommendations
Screen and Manage Hypertension: Regular monitoring and treatment to target BP <140/90 mmHg to reduce stroke risk (Evidence: Moderate) 1.
Evaluate Waist-to-Hip Ratio: Assess body fat distribution in stroke risk stratification, particularly in women aged 55-69 years (Evidence: Moderate) 1.
Promote Lifestyle Modifications: Encourage smoking cessation, healthy diet, and physical activity to mitigate stroke risk factors (Evidence: Expert opinion) 1.References
1 Folsom AR, Prineas RJ, Kaye SA, Munger RG. Incidence of hypertension and stroke in relation to body fat distribution and other risk factors in older women. Stroke 1990. link