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Stroke och TIA

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Definition:
Stroke är ett samlingsnamn för akuta neurologiska symtom (plötsligt insättande fokalt eller globalt bortfall av kroppsfunktioner), som orsakas av rubbningar i hjärnans blodcirkulation. Stroke delas in i intracerebrala blödningar (inklusive subaraknoidalblödning) och ischemisk stroke. TIA är ett övergående bortfall av kroppsfunktioner inom 24 timmar.
Förekomst:
25 000–30 000/år personer i stroke och 10 000/år i TIA.
Symtom:
Akut (sekunder–minuter) uppkomst av fokala neurologiska symtom (ibland efter uppvaknande) är den viktigaste uppgiften i anamnesen. Vanliga symtom är svaghet i arm/ben och egenrapporterad språkstörning.
Fynd:
Unilateral pares i arm/ben, språkstörning (dysfasi, dysartri) och ataxi är vanligast som fynd.
Diagnostik:
Vid misstanke om stroke/TIA bör patienter remitteras direkt till akutsjukhus. Radiologisk undersökning är en viktig del av diagnostiken. Utredning av eventuell orsak till stroke/TIA görs på sjukhus.
Behandling:
Vid ischemisk stroke trombolys/trombektomi, vid intracerebral blödning blodtryckssänkning och eventuellt korrektion av blödningsbenägenhet. Sekundärprofylax. Strokerehabilitering.
  1. Hatano S. Experience from a multicentre stroke register: a preliminary report. Bull WHO 1976; 54: 541-53. PubMed  
  2. Socialstyrelsen (2020). Nationella riktlinjer för vård vid stroke - stöd för styrning och ledning. www.socialstyrelsen.se  
  3. Martin R, Bogousslavski J. Embolic versus non-embolic causes of ischemic stroke. Cerebrovasc Dis 1995; 5: 70-4. PubMed  
  4. Hart RG. Cardiogenic embolism to the brain. Lancet 1992; 339: 589-94. PubMed  
  5. Adams HP, Bendixen BH, Kappelle LJ. Classification of subtypes of acute ischemic stroke. Definitions for use in a multicenter clinical trial. Stroke 1993; 24: 35-41. Stroke  
  6. Bamford J, Clinical examination in diagnosis and subclassification of stroke. Lancet 1992; 339: 400-2. PubMed  
  7. Socialstyrelsen. Fortsatt nedåtgående trend för stroke. 2019-12-04 (Hämtad 2019-12-28). www.socialstyrelsen.se  
  8. Hankey GJ. Secondary stroke prevention. Lancet Neurol. 2014 Feb;13(2):178-94. PMID: 24361114. PubMed  
  9. Socialstyrselen. Antalet strokefall fortsätter att minska. 2018-12-19. www.socialstyrelsen.se  
  10. RiksStroke. Årsrapport Stroke och TIA 2016. www.riksstroke.org  
  11. Rafay MF, Pontigon A-M, Chiang J, et al. Delay to diagnosis in acute pediatric arterial ischemic stroke. Stroke 2009; 40: 58-64. Stroke  
  12. Fieschi C, Argentino C, Lenzi GL, Sacchetti ML, Toni D, Bozzao L. Clinical and instrumental evaluation of patients with ischemic stroke within the first six hours. J Neurol Sci 1989; 91: 311-22. PubMed  
  13. American Heart Association. Guidelines for the management of aneurysmal subarachnoidal haemorrhage. Stroke 1994; 2592-605.
  14. Easton JD, Albers GW, Caplan LR, et al. Discussion: Reconsideration of TIA terminology and definitions. Neurology. 2004; 62: 29-34. PubMed  
  15. Sposato LA, Cipriano LE, Saposnik G, et al. Diagnosis of atrial fibrillation after stroke and transient ischaemic attack: a systematic review and meta-analysis. Lancet Neurol 2015. pmid: 25748102 PubMed  
  16. O'Donnell MJ, Xavier D, Liu L, et al. Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case control study. Lancet 2010; 376: 112-23. PubMed  
  17. Wood AM, Kaptoge S, Butterworth AS et al. Risk thresholds for alcohol consumption: combined analysis of individual-participant data for 599 912 current drinkers in 83 prospective studies. Lancet 2018; 391: 1513–23.
  18. Strazzulo P, D'Elia L, Kandala N-B, Cappuccio FP. Salt intake, stroke, and cardiovascular disease: a meta-analysis of prospective studies. BMJ 2009; 339: b4567. BMJ (DOI)  
  19. Pan A, Sun Q, Okereke OI, et al. Depression and risk of stroke morbidity and mortality: a meta-analysis and systematic review. JAMA 2011; 306: 1241-9. Journal of the American Medical Association  
  20. Kernan WN, Viscoli CM, Brass LM, Broderick JP et al. Phenylpropanolamine and the risk of hemorrhagic stroke. N Engl J Med 2000; 343: 1826-32. New England Journal of Medicine  
  21. Schmidt M, Hováth-Puhó E, Christiansen CF, et al. Preadmission use of non-aspirin nonsteroidal anti-inflammatory drugs and 30-day stroke mortality. Neurology 2014; 83: 2013-22. doi:10.1212/WNL.0000000000001024 DOI  
  22. Bath PMW, Gray LJ . Association between hormone replacement therapy and subsequent stroke: a meta-analysis. BMJ 2005; 330: 342. PubMed  
  23. Bénard-Laribière A, Hucteau E, Debette S, Kirchgesner J, Bezin J, Pariente A. Risk of first ischaemic stroke and use of antidopaminergic antiemetics: nationwide case-time-control study. BMJ. 2022;376:e066192. PMID:35321876. PubMed  
  24. Cleary P, Shorvon S, Tallis R. Late-onset seizures as a predictor of subsequent stroke. Lancet 2004; 363: 1184-6. PubMed  
  25. Smeeth L, Thomas SL, Hall AJ et al. Risk of myocardial infarction and stroke after acute infection and vaccination. N Engl J Med 2004; 351: 2611-8. New England Journal of Medicine  
  26. Minassian C, D'Aiuto F, Hingorani AD, Smeeth L. Invasive dental treatment and risk for vascular events: a self-controlled case series. Ann Intern Med 2010; 153: 499-506. Annals of Internal Medicine  
  27. Kivimäki M, Jokela M, Nyberg ST, et al. Long working hours and risk of coronary heart disease and stroke: a systematic review and meta-analysis of published and unpublished data for 603 838 individuals. The Lancet, Volume 386 , Issue 10005 , 1739 – 1746. PMID: 26298822. PubMed  
  28. Arbetsmiljöns betydelse för hjärt-kärlsjukdom – exponering för kemiska ämnen. SBU utvärderar. Rapport 261/2017. www.sbu.se  
  29. Bang OY, Ovbiagele B, Kim JS. Nontraditional Risk Factors for Ischemic Stroke: An Update. Stroke 2015. pmid:26514189 PubMed  
  30. Jenkins DJA, Spence JD, Giovannucci EL, et al. Supplemental Vitamins and Minerals for CVD Prevention and Treatment. J Am Coll Cardiol. 2018 Jun 5;71(22):2570-2584. PubMed  
  31. Abdelhamid AS, Brown TJ, Brainard JS, et al. Omega-3 fatty acids for the primary and secondary prevention of cardiovascular disease. Cochrane Database Syst Rev 2018; 7: CD003177. doi:10.1002/14651858.CD003177.pub3 DOI  
  32. Mozaffarian D, Benjamin EJ, Go AS, et al. Heart disease and stroke statistics--2016 update: a report from the American Heart Association. Circulation 2016;133:e38-e360. pmid:26673558. PubMed  
  33. SBU rapporterar om arbetsmiljöns betydelse för hjärt-kärlssjukdom, augusti 2015 www.sbu.se  
  34. Blum CA, Kasner SE. Transient Ischemic Attacks Presenting with Dizziness or Vertigo. Neurol Clin 2015. pmid:26231276 PubMed  
  35. Hov MR, Larsen K, Bakke I, Sandset EC. Hjerneslag hos kvinner gir andre symptomer enn hos menn. Tidsskriftet 2022; 16; 142: 1375-6. doi:10.4045/tidsskr.22.0576 DOI  
  36. Shajahan S, Sun L, Harris K, et al. Sex differences in the symptom presentation of stroke: A systematic review and meta-analysis. Int J Stroke. 2022 Apr 12:17474930221090133. Epub ahead of print. PMID: 35411828 PubMed  
  37. Ali M, van Os HJA, van der Weerd N et al. Sex Differences in Presentation of Stroke: A Systematic Review and Meta-Analysis. Stroke 2022; 53: 345–54. PMID: 34903037 PubMed  
  38. Sveriges regioner i samverkan. Stroke och TIA. Personcentrerat och sammanhållet vårdförlopp. 2020-05-15 (Hämtad 2020-11-23). nationelltklinisktkunskapsstod.se  
  39. Kerber KA, Brown DL, Lisabeth LD, et al. Stroke among patients with dizziness, vertigo, and imbalance in the emergency department: a population-based study. Stroke 2006; 37: 2484–7. PMID:16946161. PubMed  
  40. Tsang BKT, Chen ASK, Paine M. Acute evaluation of the acute vestibular syndrome: differentiating posterior circulation stroke from acute peripheral vestibulopathies.. Intern Med J 2017; 47(12): 1352-60. pmid:28696571 PubMed  
  41. Ohle R, Montpellier RA, Marchadier V, et al. Can Emergency Physicians Accurately Rule Out a Central Cause of Vertigo Using the HINTS Examination? A Systematic Review and Meta-analysis. Acad Emerg Med. 2020. PMID: 32167642. pubmed.ncbi.nlm.nih.gov  
  42. European Stroke Initiative Executive Commiteee and Writing Committee. Recommendations for stroke management. Cerebrovasc Dis 2003; 16: 311-8. PubMed  
  43. Adams H jr, Adams RJ, Brott T, et al. Guidelines for the early management of patients with ischemic stroke. a scientific statement from the Stroke Council of The American Stroke Association. Stroke 2003; 34: 1056-83. Stroke  
  44. Gladstone DJ, Spring M, Dorian P, et al. Atrial fibrillation in patients with cryptogenic stroke. N Engl J Med. 2014; 370: 2467-77. doi: 10.1056/NEJMoa1311376 DOI  
  45. Janusinfo (Region Stockholm). Farmakologisk behandling av stroke hos vuxna. 2020-04-03 (Hämtad 2020-04-20). janusinfo.se  
  46. Magnusson P, Lyren A, Mattsson G. Diagnostic yield of chest and thumb ECG after cryptogenic stroke, Transient ECG Assessment in Stroke Evaluation (TEASE): an observational trial. BMJ Open. 2020;10(9):e037573. PMID:32973062. PubMed  
  47. Duca A, Jagoda A. Transient Ischemic Attacks: Advances in Diagnosis and Management in the Emergency Department. Emerg Med Clin North Am. 2016 Nov;34(4):811-835. PMID: 27741990. PubMed  
  48. Rothwell PM, Giles MF, Chandratheva A, et al. Effect of urgent treatment of transient ischaemic attack and minor stroke on early recurrent stroke (EXPRESS study): a prospective population-based sequential comaprison. Lancet 2007; 370: 1432-42. www.ncbi.nlm.nih.gov  
  49. Luengo-Fernandez R, Gray AM, Rothwell PM. Effect of urgent treatment for transient ischaemic attack and minor stroke on disability and hospital costs (EXPRESS study): a prospective population-based sequential study. Lancet Neurol 2009; 8: 235-43. www.ncbi.nlm.nih.gov  
  50. Chan DK, Cordato D, O'Rourke F, et al. Comprehensive stroke units: a review of comparative evidence and experience. Int J Stroke. 2013 Jun;8(4):260-4. PMID: 22813237. PubMed  
  51. Stroke Unit Trialists' Collaboration.Organised inpatient (stroke unit) care for stroke. Cochrane Database Syst Rev. 2013 Sep 11;9:CD000197. doi: 10.1002/14651858.CD000197.pub3. DOI  
  52. Indredavik B, Fjærtoft H, Ekeberg G, Løge A, Mørch B. Benefit of an extended stroke unit service with early supported discharge. A randomized controlled trial. Stroke 2000; 31: 2989-94. Stroke  
  53. Ahmed N, Wahlgren N, Grond M, et al. Implementation and outcome of thrombolysis with alteplase 3-4,5 h after an acute stroke: an updated analysis from SITS-ISTR. Lancet Neurol 2010; 9: 866-74. PubMed  
  54. Emberson J, Lees KR, Lyden P, et al. Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials. Lancet. 2014 Nov 29;384(9958):1929-35. doi: 10.1016/S0140-6736(14)60584-5. dx.doi.org  
  55. Prabhakaran S, Ruff I, Bernstein RA. Acute stroke intervention: a systematic review. JAMA. 2015 Apr 14;313(14):1451-62. doi: 10.1001/jama.2015.3058. dx.doi.org  
  56. Nogueira RG, Jadhav AP, Haussen DC, et al. Thrombectomy 6 to 24 Hours after Stroke with a Mismatch between Deficit and Infarct. N Engl J Med 2018; 378: 11-21. pmid:29129157 PubMed  
  57. Sandercock PA1, Counsell C, Tseng MC, et al. Oral antiplatelet therapy for acute ischaemic stroke. Cochrane Database Syst Rev. 2014 Mar 26;3:CD000029. Cochrane (DOI)  
  58. Siemieniuk RAC, Chu DK, Kim LH, et al. Oxygen therapy for acutely ill medical patients: a clinical practice guideline. BMJ 2018; 363: k4169. pmid:30355567 www.ncbi.nlm.nih.gov  
  59. Bennett MH, Weibel S, Wasiak J, et al. Hyperbaric oxygen therapy for acute ischaemic stroke. Cochrane Database Syst Rev. 2014 Nov 12;11:CD004954. Cochrane (DOI)  
  60. Hajat C, Hajat S, Sharma P. Effects of poststroke pyrexia on stroke outcome: a meta-analysis of studies in patients. Stroke 2000; 31: 410-4. Stroke  
  61. Bath PM, Krishnan K. Interventions for deliberately altering blood pressure in acute stroke. Cochrane Database Syst Rev. 2014 Oct 28;10:CD000039. doi: 10.1002/14651858.CD000039.pub3. DOI  
  62. Mulla SM, Wang L, Khokhar R et al. Management of Central Poststroke Pain: Systematic Review of Randomized Controlled Trials. Stroke 2015; Oct;46(10): 2853-60. pmid:26359361 PubMed  
  63. Rothwell PM, Algra A, Chen Z, et al. Effects of aspirin on risk and severity of early recurrent stroke after transient ischaemic attack and ischaemic stroke: time-course analysis of randomised trials. Lancet. 2016;388(10042):365–375. PMID:27209146. PubMed  
  64. Gouya G, Arrich J, Wolzt M, et al. Antiplatelet treatment for prevention of cerebrovascular events in patients with vascular diseases: a systematic review and meta-analysis. Stroke 2014 Feb;45(2):492-503. PubMed  
  65. Diener H-C, Bogousslavsky J, Brass LM, et al. Aspirin and clopidogrel compared with clopidogrel alone after recent ischaemic stroke or transient ischaemic attack in high-risk patients (MATCH): randomised, double-blind, placebo-controlled trial. Lancet 2004; 364: 331-7. PubMed  
  66. Davis KA, Miyares MA, Dietrich E. Dual antiplatelet therapy with clopidogrel and aspirin after ischemic stroke: A review of the evidence. Am J Health Syst Pharm 2015; Oct 1;72(19): 1623-9. pmid:26386103 PubMed  
  67. Bath PM, Woodhouse LJ, Appleton JP. Antiplatelet therapy with aspirin, clopidogrel, and dipyridamole versus clopidogrel alone or aspirin and dipyridamole in patients with acute cerebral ischaemia (TARDIS): a randomised, open-label, phase 3 superiority trial. Lancet 2018; 391(10123): 850-859. pmid:29274727 PubMed  
  68. RESTART Collaboration. Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial. Lancet 2019. Epub ahead of print. PMID:31128924. PubMed  
  69. Diener HC, Sacco RL, Easton JD, et al. Dabigatran for Prevention of Stroke after Embolic Stroke of Undetermined Source. N Engl J Med. 2019 May 16;380(20):1906-1917. doi: 10.1056/NEJMoa1813959 DOI  
  70. FOCUS Trial Collaboration. Effects of fluoxetine on functional outcomes after acute stroke (FOCUS): a pragmatic, double-blind, randomised, controlled trial. Lancet 2018. PMID: 30528472 PubMed  
  71. Jørgensen HS, Nakayma H, Raaschou HO, Vive-Larsen J, Støier M, Olsen TS. Outcome and time course of recovery in stroke. part 1. Outcome. The Copenhagen Stroke Study. Arch Phys Med Rehabil 1995; 76: 399-405. PubMed  
  72. Jørgensen HS, Nakayma H, Raaschou HO, Vive-Larsen J, Støier M, Olsen TS. Outcome and time course of recovery in stroke. part 2. Time course of recovery. The Copenhagen Stroke Study. Arch Phys Med Rehabil 1995; 76: 406-12. PubMed  
  73. Snaphaan L, de Leeuw FE. Poststroke memory function in nondemented patients: a systematic review on frequency and neuroimaging correlates. Stroke 2007; 38: 198-203. Stroke  
  74. Jongbloed L. Prediction of function after stroke. a critical view. Stroke 1986; 17: 765-76. Stroke  
  75. Kwakkel G, Wagenaar RC, Kollen B, Lankhorst GJ. Predicting disability in stroke:a critical review on the literature. Age Ageing 1996;25:479-89. PubMed  
  76. Kumar S, Selim MH, Caplan LR. Medical complications after stroke. Lancet Neurol 2010; 9: 105-18. pmid:20083041 PubMed  
  77. Batchelor F, Hill K, Mackintosh S, et al. What works in falls prevention after stroke?: a systematic review and meta-analysis. Stroke 2010; 41: 1715-22. Stroke  
  78. Robinson RG, Jorge RE, Moser DJ et al. Escitalopram and Problem-Solving Therapy for Prevention of Poststroke Depression. JAMA 2008; 299: 2391-2400. PubMed  
  79. Jorge RE, Robinson RG, Arndt S, Starkstein S. Mortality and poststroke depression: a placebo-controlled trial of antidepressants. Am J Psychiatry 2003; 160: 1823-9. PubMed  
  80. Choi-Kwon S, et al. Fluoxetine treatment in poststroke depression, emotional incontinence, and anger proneness: a double-blind, placebo-controlled study. Stroke. 2006; 37: 156-61. PubMed  
  81. Jorge RE, Acion L, Moser D, et al. Escitalopram and enhancement of cognitive recovery following stroke. Arch Gen Psychiatry 2010; 67: 187-96. PubMed  
  82. Chollet F, Tardy J, et al. Fluoxetine for motor recovery after acute ischaemic stroke (FLAME): a randomised placebo-controlled trial.. Lancet Neurol. 2011. www.ncbi.nlm.nih.gov  
  83. Oldenbeuving AW, de Kort PL, Jansen BP, et al. Delirium in the acute phase after stroke: Incidence, risk factors, and outcome. Neurology 2011; 76: 993-9. Neurology  
  84. Pendlebury ST, Rothwell PM, Oxford Vascular Study. Incidence and prevalence of dementia associated with transient ischaemic attack and stroke: analysis of the population-based Oxford Vascular Study. Lancet Neurol 2019; 18: 248-58. pmid:30784556 PubMed  
  85. Levine DA, Galecki AT, Langa KM, et al. Trajectory of cognitive decline after incident stroke. JAMA 2015; 314: 41-51. doi:10.1001/jama.2015.6968 DOI  
  86. Zelano J. Epilepsi och stroke – nya rön om diagnos, behandling och prognos. Läkartidningen. 2017;114:EMMH www.lakartidningen.se  
  87. James P, Ellis CJ, Whitlock RML et al. Relation between troponin T concentration and mortality in patients presenting with an acute stroke: observational study. BMJ 2000; 320:1502-4. British Medical Journal  
  88. Bruins Slot K, Berge E, Dorman P et al. Impact of functional outcome at six months on long term survival in patients with ischaemic stroke: prospective cohort studies. BMJ 2008; E-pub ahead of print.
  89. Hallström B, Jönsson AC, Nerbrand C, Norrving B, Lindgren A.. Stroke incidence and survival in the beginning of the 21st century in southern Sweden: comparisons with the late 20th century and projections into the future.. Stroke 2008. www.ncbi.nlm.nih.gov  
  90. Lindgren A, Norrving B, Thörnqvist M. Ökad risk för stroke efter TIA. Läkartidningen 2004; 101: 1102-6.
  91. Johnston SC, Gress DR, Browner WS, Sidney S. Short-term prognosis after emergency department diagnosis of TIA. JAMA 2000; 284: 2901-6. PubMed  
  92. Lovett JK, Dennis MS, Sandercock PAG, Bamford J, Warlow CP, Rothwell PM. Very early risk of stroke after a first transient ischemic attack. Stroke 2003; 34: 138-40. PubMed  
  93. Lisabeth LD, Ireland JK, Risser JMH, et al. Stroke risk after transient ischemic attack in a population-based setting. Stroke 2004; 35: 1842-6. Stroke  
  94. Sennfält S. Kartläggning av långtidsprognos efter stroke visar på stora skillnader. Lakartidningen.se 2020-10-01. lakartidningen.se  
  • Remy Waardenburg, specialist i allmänmedicin, Vårdcentralen Hökarängen