Clinical features
The hallmark of the embolic stroke is the rapidity of onset. Typically, without warning, the patient collapses to the floor, conscious, but hemiplegic. Seizures are common. Headache and vomiting are rare.
Emboli lodged in the junction of the vertebral arteries results in brain stem infarction. Entrapment at the upper end of the basilar artery produces unilateral or bilateral visual disturbance.
Look for:
- visual loss - permanent or transient eg. amaurosis fugax
- hemisensory and hemimotor disturbance
- disturbance of higher function eg. dysphasia
- focal or generalised seizures
- aortic emboli may involve both hemispheres and produce bilateral signs
- more precise effects depend upon the area occluded
Reference
- National Institute for Health and Care Excellence. Stroke and transient ischaemic attack in over 16s: diagnosis and initial management. NG 128. April 2022 [internet publication].
- Royal College of Physicians; Scottish Intercollegiate Guidelines Network; Royal College of Physicians of Ireland. National clinical guideline for stroke for the United Kingdom and Ireland. April 2023 [internet publication].
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