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.