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Introduction to Ischemic and Hemorrhagic Stroke (2025)

Title: Introduction to Ischemic and Hemorrhagic Stroke This video is intended to serve as an introduction to ischemic and hemorrhagic stroke for the neurology clerks. We discuss the stroke code protocol, major treatment goals and the mechanisms for each type of stroke. We also review stroke prevention strategies. 00:00 - Introduction 01:06 - OBJECTIVES 02:40 - CASE 05:35 - STROKE CODE 06:10 - The Seven "Esses" of the Stroke Code 08:02 - Transient Ischemic Attack and ABCD2 Score 13:01 - Back To The Case: MCA Territory 17:07 - Primary Goal of Acute Ischemic Stroke Treatment: Remoooving Obstruction 18:56 - Intravenous Fibrinolysis versus Mechanical Thrombectomy 21:30 - Indications and Contraindications for Intravenous Fibrinolysis 28:27 - Indications for Thrombectomy 32:56 - Back To The Case: Deciding on Intervention 36:00 - MANAGEMENT AFTER REPERFUSION: PREVENTING SECONDARY INJURY, PREVENTING RECURRENCE 38:44 - DIAGNOSIS AND MECHANISMS OF ISCHEMIC STROKE 39:05 - Confirming Acute Ischemia: DWI/ADC 41:12 - Intro to Mechanisms of Ischemic Stroke 44:25 - Mechanisms of Ischemic Stroke: Small Vessel Disease 47:25 - Mechanisms of Ischemic Stroke: Large Vessel Disease 51:36 - Mechanisms of Ischemic Stroke: Cardioembolism 56:24 - Mechanisms of Ischemic Stroke: Hypercoagulability 58:40 - Relative Risks of Stroke Recurrence for Various Ischemic Stroke Mechanisms 59:55 - Diagnostic Work-up for Ischemic Stroke 01:02:11 - Back To The Case: Results of Work-up 01:04:32 - PREVENTION THERAPIES FOR ISCHEMIC STROKE 01:04:43 - Stroke Prevention: Small Vessel Disease 01:07:13 - Stroke Prevention: Large Vessel Disease 01:10:58 - Stroke Prevention: Cardioembolism Vessel Disease 01:12:23 - Stroke Prevention: Hypercoagulability 01:14:54 - SUMMARY: MANAGEMENT AND PREVENTION OF ISCHEMIC STROKE 01:22:43 - WHAT IF: CASE OF HEMORRHAGIC STROKE 01:25:46 - EARLY MANAGEMENT OF ACUTE HEMORRHAGIC STROKE 01:27:16 - Controlling BP, Correcting Coagulopathy 01:29:33 - Surgical Hematoma Evacuation: MISTIE and ENRICH 01:32:23 - MECHANISMS AND PREVENTION OF HEMORRHAGIC STROKE 01:34:05 - Diagnostic Work-up for Hemorrhagic Stroke 01:35:32 - Mechanisms of Hemorrhagic Stroke: SAH 01:37:16 - Mechanisms of Hemorrhagic Stroke: AVM 01:39:51 - Mechanisms of Hemorrhagic Stroke: Vasculopathy 01:42:00 - Mechanisms of Hemorrhagic Stroke: Small Vessel Disease 01:43:52 - Mechanisms of Hemorrhagic Stroke: Malignancy 01:45:53 - Neuroimaging Classification of Hemorrhages 01:49:15 - Relative Risks of Stroke Recurrence for Various Hemorrhagic Stroke Mechanisms 01:50:32 - Back To the Case: Results of Work-up 01:51:23 - SUMMARY: MANAGEMENT AND PREVENTION OF ISCHEMIC STROKE CREATED AND NARRATED BY: Igor Rybinnik MD CONTENT EXPERT: Deviyani Mehta, MD Department of Neurology Rutgers Robert Wood Johnson Medical School MEDICAL STUDENT REVIEWERS: Kelsey Briscese and Audrey Abend Rutgers Robert Wood Johnson Medical School IMAGES ADAPTED FROM: Gaillard F, Radiopaedia.org, rID: 10814 Staessens S, et al. Haematologica 2020;105(2):498-507 Saver JL. Stroke 2006;37(1):263 Matthew Holt Gijsen FJH et al. Stroke 2015;46(8):2124-28 Carotid atherosclerosis. John Bavosi, 2014, Science Photo Library. silkroadmed.com Solomon RA, Connolly ER. NEJM 2017;376:1859-66 Nicolas Kostelecky MD, Pathologyoutlines.com O'Carroll CB, et al. Thematic review on neurovascular diseases 2021;96(6):1639-1654 Magaki S, et al. Modern Path (2021);34:2109-21 REFERENCES: Staessens S, et al. Haematologica 2020;105(2):498-507 Desilles JP, et al. Front Neurol 2022;13:1-10 Alhazzani A, et al. ESO J 2024;9(3):521-529 Kaesmacher J, et al. JAMA 2024;331(9):764-777. Hacke W, et al. NEJM 2008;359(13):1317-29 Thomalla G, et al. NEJM 2018;379(7):611-22 Ma H, et al. NEJM 2019;380(19):1795-1803 Wang J, et al. Stroke 2022;53(10):3047-54 Kleindorfer DO, et al. Stroke 2021;52(7):e364-e467 Khairani CD, et al. JACC 2023;81(1):16-30 Hanley DF, et al. Lancet 2019;393(10175): 1021-32 Pradilla G, et al. NEJM 2024;390:1277-89 Morris NA, Jindal G, Chaturvedi S. Stroke 2023;54(5):1457-61 Powers WJ, et al. Stroke 2019;50(12):e344-e418 Greenberg SM, et al. Stroke 2022;53(7):e282-e361 MUSIC, SOUNDS: "Bitmaster" by Lupus Nocte (Epidemic Sound) "Fresh Pastries" by Lofive (Epidemic Sound) "Fugent" by Lupus Nocte (Epidemic Sound) "I'll Never Die (Instrumental Version)" by Daniel Gunnarsson (Epidemic Sound) Beck, Laura Karpman. What If...? Main Title. Marvel's What If...? Original Soundtrack, Marvel Music & Hollywood Records, 2021. DISCLAIMER: Please note that this material was simplified for educational purposes. For patient management, please review your clinical society's guidelines and engage expert consultation where appropriate. Also, the opinions of the presenters do not necessarily reflect those of Rutgers Robert Wood Johnson Medical School, Robert Wood Johnson University Hospital, RWJBarnabus Health, or Rutgers University as a whole.