Ch: usually non-hemorrhagic, but most hemorrhagic strokes are embolic
Loc: MCA (75%)
Sx: sudden onset, without warning (no collaterals developed), reaches peak deficit quickly
Dx: ECG (20% of MIs are silent), TTE, carotid doppler U/S, and CT (30% become hemorrhagic)
Pr: 20% have 2nd emoblus within 10 days. 80% develop subsequent stroke.
Tx: tPA or urokinase if onset of deficit < 3 hrs Anticoagulation (IfMI, A-fib, or prosthetic valve, ↓ stroke rate from 5.5 → 2%/yr) Wait 4 d before starting anticoagulation- longer if larger stroke, or poorly controlled HTN (do NOT anticoagulate with SBE) Rheurmatic heart ds: valvuloplasty or lesion removal