A condition affecting the blood vessels that supply blood to the brain. When the vessel is blocked by an embolism or thrombus, it is called an ischemic stroke, and when the lesion is secondary to a rupture of the vessel, it is called a hemorrhagic stroke.
In this case, it occurs at the level of the midbrain, which is the upper structure of the brain stem.
Older age, family history, high blood pressure, smoking, diabetes and heart disease are factors that increase the risk of having a stroke.
Symptoms may include difficulty looking up (partial paralysis of vertical gaze), double vision (diplopia), unsteadiness, drooping of one eyelid, dilated pupil in one eye, and decreased strength on the contralateral side.
Diagnosis is made clinically by interview and physical examination. A computed tomography scan should be performed.
Treatment for ischemia should be administered within three hours of symptom onset to avoid sequelae as it is considered a medical emergency. Medication is given to try to break up the thrombus or clot that is blocking the blood vessel. In selected cases, endovascular treatment may be used to open the blocked vessel from the inside. Patients with bleeding have a poorer prognosis and may require surgery.
- Louis R Caplan, MD. Overview of the evaluation of stroke. UpToDate. Apr 12, 2016.
- Jamary Oliveira Filho, MD, MS, PhD,Michael T Mullen, MD. Initial assessment and management of acute stroke. UpToDate. Aug 15, 2016.
- Demaerschalk BM, Kleindorfer DO, Adeoye OM, et al. Scientific Rationale for the Inclusion and Exclusion Criteria for Intravenous Alteplase in Acute Ischemic Stroke: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2016; 47:581.
- Hemphill JC 3rd, Greenberg SM, Anderson CS, et al. Guidelines for the Management of Spontaneous Intracerebral Hemorrhage: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2015; 46:2032.
- Jauch EC, Saver JL, Adams HP Jr, et al. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2013; 44:870.
- Johnston SC, Easton JD. Enfermedades cerebrovasculares. Manual de diagnóstico y terapéutica médica Hospital Universitario 12 de octubre. 6ª edición. 2007. 59:66.
