Stroke syndromes OCSP Etiology TOAST

Aug 26, 2023

Stroke syndromes OCSP Etiology TOAST

This is a Learning in 10 voice annotated presentation (VAP) on Stroke syndromes OCSP Etiology TOAST

To learn more about Learning in 10 (LIT), please visit learningin10.com.

—
Learning in 10 (LIT) Reviews is a collection of 10-minute, user-friendly video lectures covering topics in the United States Medical Licensing Exam (USMLE) Step 2CK examination. LIT Reviews can be used by medical students to supplement their lecture materials. LIT Reviews have been created by world-class clinical faculty and each video undergoes a peer-review process to ensure accuracy of information.

Content

0 ->

1.02 -> Good morning, people.

2.029 -> Welcome to this presentation

3.63 -> by STRIPE on stroke syndromes

5.4 -> and etiology.

6.49 -> I'm Chee Keong, and LiQing is

7.92 -> my fellow presenter.

9.345 ->

11.96 -> Stroke, as defined by the WHO,

14.22 -> is a "clinical syndrome

15.54 -> with disturbance

16.39 -> of cerebral function

17.43 -> from a vascular cause."

19.21 -> It can be

19.76 -> either ischemic or hemorrhagic.

22.397 -> Ischemic stroke, which comprises

23.73 -> the majority, can be further

25.43 -> classified according

26.49 -> to their underlying etiology

28.24 -> or clinical presentations.

31.02 -> The two common views are OCSP

34.56 -> and TOAST classification.

36.24 ->

39.26 -> The Oxfordshire Community Stroke

40.93 -> Project studied a population

42.82 -> of patients

43.42 -> with a first-ever stroke

44.68 -> in an English county.

46.24 -> Patients with ischemic strokes

47.59 -> are divided into four subtypes

49.101 -> based

49.6 -> on their presenting clinical

50.766 -> signs and symptoms, and this was

52.57 -> correlated with the site

53.86 -> of the vascular occlusion

55.27 -> and the size of the infarct.

56.95 -> Namely, there are lacunar

58.33 -> infarcts, total anterior

60.09 -> circulation infarcts,

61.69 -> partial anterior circulation

63.1 -> infarcts, and posterior

64.62 -> circulation infarcts.

65.59 ->

69.02 -> Lacunar infarcts-- patients were

70.84 -> put into this category

72.16 -> in the study if they came in

73.92 -> with a well-defined lacunar

75.51 -> stroke syndrome.

77.11 -> The most common ones were

78.59 -> pure motor, where they presented

80.29 -> with contralateral hemiparesis,

82.85 -> pure sensory,

83.69 -> where they had

84.43 -> contralateral sensory loss,

86.47 -> sensory-motor, a combination

88.54 -> of the above two,

90.78 -> ataxic hemiparesis,

92 -> with contralateral weakness

93.36 -> and incoordination,

95.04 -> and finally clumsy hand

96.39 -> dysarthria

96.89 -> or dysarthria clumsy hand

98 -> syndrome.

98.5 ->

101.62 -> Total anterior circulation

102.925 -> infarct--

104.2 -> patient presenting with all

105.6 -> three of the following,

108.07 -> higher cerebral dysfunction,

109.65 -> which includes dysphagia,

111.36 -> dyscalculia,

112.65 -> and visual spatial disorder--

115.26 -> ipsilateral motor

116.65 -> or sensory deficit involving

118.83 -> at least two of the following,

120.88 -> face, arm, and leg.

122.71 -> Lastly, they also presented

124.41 -> with homonymous visual field

126.49 -> defect.

126.99 ->

130.3 -> Partial anterior circulation

132.04 -> infarct--

132.9 -> it comprises two of three

134.86 -> components of the TACI syndrome.

136.615 ->

139.93 -> Finally, posterior circulation

141.71 -> infarcts--

142.65 -> these are patients with any

144.13 -> of the following,

145.71 -> an ipsilateral cranial nerve

147.4 -> palsy with a contralateral motor

150.07 -> or sensory deficit,

151.78 -> a bilateral motor

152.92 -> or sensory deficit,

154.72 -> or patients with disorders

155.99 -> of conjugate gaze.

157.83 -> They can also be patients

158.89 -> of cerebellar dysfunction

160.63 -> without ipsilateral long tract

162.25 -> deficits.

163.729 -> They can also be patients

164.77 -> of isolated homonymous

166.03 -> visual field defects.

167.08 ->

170.68 -> We now come

171.19 -> to the etiologic TOAST

172.66 -> classification.

173.745 -> Now, TOAST classification

175.48 -> actually originated

176.56 -> from a clinical trial

177.82 -> investigating the use

178.96 -> of a low-molecular-weight

180.28 -> heparinoid in acute stroke

181.74 -> patients.

183.1 -> Now, although that trial did not

184.45 -> show a benefit for patients

185.68 -> with an heparinoid,

187.51 -> its etiology classification

189.07 -> of stroke remains widely

191.04 -> used today.

192.28 -> And these are, namely, one,

194.05 -> small-vessel occlusion;

195.95 -> secondly,

196.66 -> large-vessel atherosclerosis;

199.16 -> thirdly, cardioembolic,

200.5 -> followed

201.25 -> by other determine etiology;

203.47 -> and finally,

204.28 -> undetermined etiology

205.39 -> or cryptogenic stroke.

206.86 ->

209.95 -> Small-vessel occlusion

211.34 -> is defined

212.02 -> by a clinical syndrome

213.1 -> and the size of the infarct.

214.95 -> A patient should have one

216.22 -> of the clinical lacular

217.81 -> syndromes and thus not

219.07 -> present with any evidence

220.75 -> of cortical signs.

222.846 -> CT scan or MRI scan imaging

225.21 -> demonstrate the lesion should be

226.68 -> less than 1.5 cm.

229.19 -> In order to categorize a patient

231.14 -> under small vessel occlusion,

233.19 -> we will need to exclude

234.75 -> potential cardiac sources

236.31 -> for embolism.

238.26 -> An evaluation

239.16 -> of the last extracranial artery

241.93 -> should not

242.43 -> be demonstrative of stenosis

244.47 -> more than 50%

246.2 -> in an ipsilateral artery.

248.13 ->

251.63 -> Large-artery atherosclerosis--

254.192 -> now, this patient should have

255.4 -> clinical evidence

256.29 -> of a cortical impairment

258.17 -> or either brainstem

259.36 -> or cerebellar dysfunction.

261.574 -> On imaging, they should have

262.74 -> at least a 50% stenosis

264.155 -> or an occlusion of a major brain

266.49 -> artery or a branch cortical

268.02 -> artery, and cardioembolism

270.31 -> should be excluded.

271.31 ->

274.43 -> Cardioembolic-- the largest

276.26 -> source of embolus

277.35 -> arise from the heart.

279.21 -> Imaging and clinical findings

280.79 -> are similar with large vessel

282.15 -> disease.

282.65 -> Years Cardiac sources are

284.84 -> divided

285.35 -> into high-risk and medium-risk.

287.967 ->

290.944 -> TOAST has one other category

292.11 -> called "other determined

293.54 -> etiology."

294.55 -> These are for the rare causes

295.83 -> of stroke.

297.19 -> The more common ones would be

298.71 -> nonatheroschlerotic

299.97 -> vasculopathies, patients

301.69 -> of hypercoagulable states,

303.33 -> or hematologic disorders.

305.51 -> It is important,

306.25 -> though, that cardiac sources

307.65 -> of embolism and large-artery

309.34 -> atherosclerosis

310 -> are excluded before putting

311.37 -> patients into this category.

313.04 ->

315.68 -> Finally, the last category

317.39 -> is for strokes

318.26 -> of undetermined etiology.

320.16 -> This happens when researchers

321.39 -> or doctors cannot determine

323.06 -> the etiology of a stroke with

324.38 -> any degree of confidence.

326.18 -> Either there is no likely

327.7 -> etiology determined after very

329.77 -> thorough evaluation,

331.48 -> the evaluation was incomplete,

333.44 -> or perhaps during the course

334.82 -> of investigations,

336.2 -> they found two or more

337.2 -> potential causes of stroke

338.406 -> and it is not certain which

339.53 -> is the underlying cause.

340.64 ->

343.71 -> These are just two of the more

345.36 -> common stroke classifications

346.93 -> used today.

348.39 -> Though imperfect,

349.43 -> they help to streamline

350.6 -> communication between health

351.82 -> care workers.

353.22 -> It may also affect the type

354.937 -> of treatments prescribed

356.16 -> for secondary stroke prevention.

358.24 -> We hope it will help

359.23 -> in your daily work.

362.03 ->

Source: https://www.youtube.com/watch?v=FS--6_6zLqU