General Medicine
Cerebrovascular Accident (Stroke)
Stroke for MBBS: ischaemic versus haemorrhagic types, urgent imaging, thrombolysis and thrombectomy, localisation and secondary prevention, mapped to NMC codes IM18.1 to IM18.17.
MedNext Academy | 3 min read
Cerebrovascular Accident (Stroke)
Stroke for MBBS: ischaemic versus haemorrhagic types, urgent imaging, thrombolysis and thrombectomy, localisation and secondary prevention, mapped to NMC codes IM18.1 to IM18.17.
This chapter covers cerebrovascular accident, its classification into ischaemic and haemorrhagic types, and the localisation of deficits by clinical examination. It emphasises urgent imaging, acute reperfusion for ischaemic stroke, blood pressure management, secondary prevention and rehabilitation.
High-yield: Cerebrovascular Accident (Stroke)
- Stroke is a sudden focal neurological deficit of vascular origin, divided into ischaemic and haemorrhagic types.
- Ischaemic stroke accounts for the majority of cases and results from arterial occlusion.
- Urgent brain imaging is required to distinguish ischaemic from haemorrhagic stroke before treatment.
- A non-contrast computed tomography reliably detects acute haemorrhage and excludes it before thrombolysis.
- Time is brain, so rapid assessment and imaging are essential in the acute phase.
- Intravenous thrombolysis is given for ischaemic stroke within the approved time window after excluding haemorrhage.
- Mechanical thrombectomy benefits selected patients with large-vessel occlusion in an extended window.
- Aspirin is started after haemorrhage is excluded and thrombolysis timing allows.
- An upper motor neuron pattern with brisk reflexes and an extensor plantar response localises the lesion above the anterior horn cell.
- Aphasia points to dominant hemisphere involvement, usually the left in right-handed people.
- Blood pressure is managed carefully, being lowered cautiously in ischaemic stroke and more actively in haemorrhage.
- Young stroke warrants a search for cardioembolism, vasculitis, thrombophilia and dissection.
- Atrial fibrillation is a major source of cardioembolic stroke and needs anticoagulation for prevention.
- Secondary prevention combines antiplatelets or anticoagulation, statins and risk factor control.
- Early multidisciplinary rehabilitation improves functional recovery after stroke.
Stroke essentials
- **Types:** Ischaemic (majority, from occlusion) versus haemorrhagic; imaging separates them urgently.
- **Acute therapy:** Thrombolysis within the window after excluding haemorrhage; thrombectomy for large-vessel occlusion.
- **Localisation:** Upper motor neuron signs above the anterior horn; aphasia in dominant hemisphere lesions.
- **Prevention:** Anticoagulate atrial fibrillation; antiplatelets, statins and risk factor control otherwise.
NMC competencies in this chapter
- **IM18.2:** Classification, aetiology, risk factors and pathogenesis
- **IM18.5:** General and neurologic examination in stroke
- **IM18.6:** Upper versus lower motor neuron and lesion localisation
- **IM18.9:** Diagnostic and imaging tests for lesion anatomy and cause
- **IM18.11:** Initial supportive management of acute stroke
- **IM18.12:** Acute therapy of non-haemorrhagic stroke and thrombolysis
- **IM18.14:** Initial management of haemorrhagic stroke
- **IM18.16:** Multidisciplinary rehabilitation after stroke
Frequently Asked Questions
Why is imaging needed before treating stroke?
Urgent non-contrast computed tomography distinguishes ischaemic from haemorrhagic stroke, because thrombolysis is only safe once haemorrhage has been excluded.
When is thrombolysis given in stroke?
Intravenous thrombolysis is given for ischaemic stroke within the approved time window after haemorrhage is excluded, and mechanical thrombectomy benefits selected large-vessel occlusions.
How is atrial fibrillation relevant to stroke?
Atrial fibrillation is a major source of cardioembolic stroke, so anticoagulation is used for prevention in suitable patients based on their risk score.
How does this chapter help for NEET-PG?
Ischaemic versus haemorrhagic distinction, thrombolysis timing, lesion localisation and secondary prevention are common exam themes that map directly to questions.
Continue reading
MBBSAll General Medicine chapters
Continue through the General Medicine chapter map.
Continue studying General Medicine
Explore clinician-written learning resources, structured revision and practice across the MedNext platform.
Open in the MedNext appSee plans

