Stroke: a scoping review




Ischemic stroke; Hemorrhagic stroke; Cerebral infarction.


Stroke is a disease with a high burden of morbidity and mortality nationally and globally. In the United States, it is the fifth leading cause of death, with an overall prevalence of 2.6% in the period between 2009 and 2012. In Brazil, there are an estimated 2,231,000 people with stroke and 568,000 with severe disability. This article seeks to describe characteristics of this acute injury to assist health professionals in finding important information related to this pathology. Risk factors such as hypertension, diabetes, dyslipidemia, atrial fibrillation and carotid stenosis have been associated with increased risk of stroke, with hypertension being the most important. Although clinical signs and symptoms are important, neuroimaging is fundamental to differentiate ischemic stroke from hemorrhagic stroke to guide the most appropriate treatment. Some of the differential diagnoses of stroke are transient ischemic attack (TIA), seizures, headache, hypoglycemia, tumors, vertigo and altered mental status. Some medical complications after stroke are dysphagia, urinary incontinence, pulmonary embolism, deep vein thrombosis (DVT), pneumonia, depression, and pressure ulcers. The correct and early diagnosis of stroke is extremely important to avoid the sequelae of this acute event and the adequate treatment of hypertension, diabetes mellitus and dyslipidemia are of great importance to reduce the high prevalence of stroke.


Abbott, A. L. (2009). Medical (Nonsurgical) Intervention Alone Is Now Best for Prevention of Stroke Associated With Asymptomatic Severe Carotid Stenosis. Stroke, 40(10).

Andrews, C. M., Jauch, E. C., Hemphill, J. C., Smith, W. S., & Weingart, S. D. (2012). Emergency Neurological Life Support: Intracerebral Hemorrhage. Neurocritical Care, 17(S1), 37–46.

Barer, D. H. (1989). The natural history and functional consequences of dysphagia after hemispheric stroke. Journal of Neurology, Neurosurgery & Psychiatry, 52(2), 236–241.

Barthels, D., & Das, H. (2020). Current advances in ischemic stroke research and therapies. Biochimica et Biophysica Acta (BBA) - Molecular Basis of Disease, 1866(4), 165260.

Beckett, N. S., Peters, R., Fletcher, A. E., Staessen, J. A., Liu, L., Dumitrascu, D., Stoyanovsky, V., Antikainen, R. L., Nikitin, Y., Anderson, C., Belhani, A., Forette, F., Rajkumar, C., Thijs, L., Banya, W., & Bulpitt, C. J. (2008). Treatment of Hypertension in Patients 80 Years of Age or Older. New England Journal of Medicine, 358(18), 1887–1898.

Bensenor, I. M., Goulart, A. C., Szwarcwald, C. L., Vieira, M. L. F. P., Malta, D. C., & Lotufo, P. A. (2015). Prevalence of stroke and associated disability in Brazil: National Health Survey - 2013. Arquivos de Neuro-Psiquiatria, 73(9), 746–750.

Brandstater, M. E., Roth, E. J., & Siebens, H. C. (1992). Venous thromboembolism in stroke: literature review and implications for clinical practice. Archives of Physical Medicine and Rehabilitation, 73(5-S), S379-91.

Brocklehurst, J. C., Andrews, K., Richards, B., & Laycock, P. J. (1985). Incidence and Correlates of Incontinence in Stroke Patients. Journal of the American Geriatrics Society, 33(8), 540–542.

Broderick, J., Connolly, S., Feldmann, E., Hanley, D., Kase, C., Krieger, D., Mayberg, M., Morgenstern, L., Ogilvy, C. S., Vespa, P., & Zuccarello, M. (2007). Guidelines for the management of spontaneous intracerebral hemorrhage in adults: 2007 update: a guideline from the American Heart Association/American Stroke Association Stroke Council, High Blood Pressure Research Council, and the Quality of Care and Out. Circulation, 116(16).

Camm, A. J., Kirchhof, P., Lip, G. Y. H., Schotten, U., Savelieva, I., Ernst, S., Van Gelder, I. C., Al-Attar, N., Hindricks, G., Prendergast, B., Heidbuchel, H., Alfieri, O., Angelini, A., Atar, D., Colonna, P., De Caterina, R., De Sutter, J., Goette, A., Gorenek, B., & Zupan, I. (2010). Guidelines for the management of atrial fibrillation. EP Europace, 12(10), 1360–1420.

Caplan, L. R. (2020). Etiology, classification, and epidemiology of stroke.

Carota, A., Berney, A., Aybek, S., Iaria, G., Staub, F., Ghika-Schmid, F., Annable, L., Guex, P., & Bogousslavsky, J. (2005). A prospective study of predictors of poststroke depression. Neurology, 64(3), 428–433.

Clissold, B., Phan, T. G., Ly, J., Singhal, S., Srikanth, V., & Ma, H. (2020). Current aspects of TIA management. Journal of Clinical Neuroscience, 72, 20–25.

Cordonnier, C., Girot, M., Dorp, E., Rimetz, P., Bouillaguet, S., Hénon, H., Lucas, C., Godefroy, O., & Leys, D. (2000). Stroke Units from Scientific Evidence to Practice: The Experience of the Lille Stroke Unit. Cerebrovascular Diseases, 10(4), 17–20.

Cordonnier, C., Oppenheim, C., Lamy, C., Meder, J.-F., & Mas, J.-L. (2005). Serial diffusion and perfusion-weighted MR in transient hypoglycemia. Neurology, 65(1), 175–175.

Cucchiara, B., & Kasner, S. E. (2011). Transient Ischemic Attack. Annals of Internal Medicine, 154(1), ITC1.

Endres, M. (2005). Statins and Stroke. Journal of Cerebral Blood Flow & Metabolism, 25(9), 1093–1110.

Falavigna, A., Teles, A. R., Vedana, V. M., Kleber, F. D., Mosena, G., Velho, M. C., Mazzocchin, T., Silva, R. C. da, Lucena, L. F., Santin, J. T., & Roth, F. (2009). Awareness of stroke risk factors and warning signs in southern Brazil. Arquivos de Neuro-Psiquiatria, 67(4), 1076–1081.

Fernandes, P. M., Whiteley, W. N., Hart, S. R., & Al-Shahi Salman, R. (2013). Strokes: mimics and chameleons. Practical Neurology, 13(1), 21–28.

Giles, M. F., Albers, G. W., Amarenco, P., Arsava, M. M., Asimos, A., Ay, H., Calvet, D., Coutts, S., Cucchiara, B. L., Demchuk, A. M., Johnston, S. C., Kelly, P. J., Kim, A. S., Labreuche, J., Lavallee, P. C., Mas, J.-L., Merwick, A., Olivot, J. M., Purroy, F., & Rothwell, P. M. (2010). Addition of brain infarction to the ABCD2 Score (ABCD2I): a collaborative analysis of unpublished data on 4574 patients. Stroke, 41(9), 1907–1913.

Gordon, C., Hewer, R. L., & Wade, D. T. (1987). Dysphagia in acute stroke. BMJ, 295(6595), 411–414.

Hacke, W., Kaste, M., Bluhmki, E., Brozman, M., Dávalos, A., Guidetti, D., Larrue, V., Lees, K. R., Medeghri, Z., Machnig, T., Schneider, D., von Kummer, R., Wahlgren, N., & Toni, D. (2008). Thrombolysis with Alteplase 3 to 4.5 Hours after Acute Ischemic Stroke. New England Journal of Medicine, 359(13), 1317–1329.

Hackett, M. L., Yapa, C., Parag, V., & Anderson, C. S. (2005). Frequency of depression after stroke: a systematic review of observational studies. Stroke, 36(6), 1330–1340.

Halliday, A., Mansfield, A., Marro, J., Peto, C., Peto, R., Potter, J., & Thomas, D. (2004). Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms: randomised controlled trial. The Lancet, 363(9420), 1491–1502.

Helbok, R., Kurtz, P., Schmidt, J. M., Stuart, R. M., Fernandez, L., Malhotra, R., Presciutti, M., Ostapkovich, N. D., Connolly, E. S., Lee, K., Badjatia, N., Mayer, S. A., & Claassen, J. (2011). Effect of mannitol on brain metabolism and tissue oxygenation in severe haemorrhagic stroke. Journal of Neurology, Neurosurgery & Psychiatry, 82(4), 378–383.

Hemphill, J. C., Greenberg, S. M., Anderson, C. S., Becker, K., Bendok, B. R., Cushman, M., Fung, G. L., Goldstein, J. N., Macdonald, R. L., Mitchell, P. H., Scott, P. A., Selim, M. H., & Woo, D. (2015). Guidelines for the Management of Spontaneous Intracerebral Hemorrhage. Stroke, 46(7), 2032–2060.

Howard, V. J., McCLure, L. A., Meschia, J. F., Pulley, L., Orr, S. C., & Friday, G. H. (2006). High Prevalence of Stroke Symptoms Among Persons Without a Diagnosis of Stroke or Transient Ischemic Attack in a General Population. Archives of Internal Medicine, 166(18), 1952.

Jahan, R., Saver, J. L., Schwamm, L. H., Fonarow, G. C., Liang, L., Matsouaka, R. A., Xian, Y., Holmes, D. N., Peterson, E. D., Yavagal, D., & Smith, E. E. (2019). Association Between Time to Treatment With Endovascular Reperfusion Therapy and Outcomes in Patients With Acute Ischemic Stroke Treated in Clinical Practice. JAMA, 322(3), 252.

Johnston, K. C., Li, J. Y., Lyden, P. D., Hanson, S. K., Feasby, T. E., Adams, R. J., Faught, R. E., & Haley, E. C. (1998). Medical and Neurological Complications of Ischemic Stroke. Stroke, 29(2), 447–453.

Kamalian, S., & Lev, M. H. (2019). Stroke Imaging. Radiologic Clinics of North America, 57(4), 717–732.

Kamphuisen, P. W., Agnelli, G., & Sebastianelli, M. (2005). Prevention of venous thromboembolism after acute ischemic stroke. Journal of Thrombosis and Haemostasis, 3(6), 1187–1194.

Kamphuisen, P. W., & Agnelli, G. (2007). What is the optimal pharmacological prophylaxis for the prevention of deep-vein thrombosis and pulmonary embolism in patients with acute ischemic stroke? Thrombosis Research, 119(3), 265–274.

Kelly, J., Hunt, B. J., Lewis, R. R., Swaminathan, R., Moody, A., Seed, P. T., & Rudd, A. (2004). Dehydration and venous thromboembolism after acute stroke. QJM : Monthly Journal of the Association of Physicians, 97(5), 293–296.

Kelly, J., Rudd, A., Lewis, R., & Hunt, B. J. (2001). Venous thromboembolism after acute stroke. Stroke, 32(1), 262–267.

Kerber, K. A., Brown, D. L., Lisabeth, L. D., Smith, M. A., & Morgenstern, L. B. (2006). Stroke Among Patients With Dizziness, Vertigo, and Imbalance in the Emergency Department. Stroke, 37(10), 2484–2487.

Krishnamurthi, R. V, Feigin, V. L., Forouzanfar, M. H., Mensah, G. A., Connor, M., Bennett, D. A., Moran, A. E., Sacco, R. L., Anderson, L. M., Truelsen, T., O’Donnell, M., Venketasubramanian, N., Barker-Collo, S., Lawes, C. M. M., Wang, W., Shinohara, Y., Witt, E., Ezzati, M., Naghavi, M., & Murray, C. (2013). Global and regional burden of first-ever ischaemic and haemorrhagic stroke during 1990–2010: findings from the Global Burden of Disease Study 2010. The Lancet Global Health, 1(5), e259–e281.

Kumar, S., Selim, M. H., & Caplan, L. R. (2010). Medical complications after stroke. The Lancet Neurology, 9(1), 105–118.

Kvistad, C. E., Novotny, V., Næss, H., Hagberg, G., Ihle-Hansen, H., Waje-Andreassen, U., Thomassen, L., & Logallo, N. (2019). Safety and predictors of stroke mimics in The Norwegian Tenecteplase Stroke Trial (NOR-TEST). International Journal of Stroke, 14(5), 508–516.

Landi, G., D’Angelo, A., Boccardi, E., Candelise, L., Mannucci, P. M., Morabito, A., & Orazio, E. N. (1992). Venous thromboembolism in acute stroke. Prognostic importance of hypercoagulability. Archives of Neurology, 49(3), 279–283.

Liberman, A. L., & Prabhakaran, S. (2017). Stroke Chameleons and Stroke Mimics in the Emergency Department. Current Neurology and Neuroscience Reports, 17(2), 15.

Lodigiani, C., Iapichino, G., Carenzo, L., Cecconi, M., Ferrazzi, P., Sebastian, T., Kucher, N., Studt, J.-D., Sacco, C., Bertuzzi, A., Sandri, M. T., & Barco, S. (2020). Venous and arterial thromboembolic complications in COVID-19 patients admitted to an academic hospital in Milan, Italy. Thrombosis Research, 191, 9–14.

Lu, J., Kanji, S., Aggarwal, R., Das, M., Joseph, M., Wu, L.-C., Mao, H.-Q., Pompili, V. J., Hadjiconstantinou, M., & Das, H. (2013). Hematopoietic stem cells improve dopaminergic neuron in the MPTP-mice. Frontiers in Bioscience (Landmark Edition), 18, 970–981.

Merkler, A. E., Parikh, N. S., Mir, S., Gupta, A., Kamel, H., Lin, E., Lantos, J., Schenck, E. J., Goyal, P., Bruce, S. S., Kahan, J., Lansdale, K. N., LeMoss, N. M., Murthy, S. B., Stieg, P. E., Fink, M. E., Iadecola, C., Segal, A. Z., Cusick, M., … Navi, B. B. (2020). Risk of Ischemic Stroke in Patients With Coronavirus Disease 2019 (COVID-19) vs Patients With Influenza. JAMA Neurology, 77(11), 1366.

Morgenstern, L. B., & Frankowski, R. F. (1999). Brain tumor masquerading as stroke. Journal of Neuro-Oncology, 44(1), 47–52.

Morgenstern, L. B., Hemphill, J. C., Anderson, C., Becker, K., Broderick, J. P., Connolly, E. S., Greenberg, S. M., Huang, J. N., Macdonald, R. L., Messé, S. R., Mitchell, P. H., Selim, M., & Tamargo, R. J. (2010). Guidelines for the Management of Spontaneous Intracerebral Hemorrhage. Stroke, 41(9), 2108–2129.

Morris, P. L., Shields, R. B., Hopwood, M. J., Robinson, R. G., & Raphael, B. (1994). Are there two depressive syndromes after stroke? The Journal of Nervous and Mental Disease, 182(4), 230–234.

Moulin, S., & Leys, D. (2019). Stroke mimics and chameleons. Current Opinion in Neurology, 32(1), 54–59.

Mozaffarian, D., Benjamin, E. J., Go, A. S., Arnett, D. K., Blaha, M. J., Cushman, M., Das, S. R., de Ferranti, S., Després, J.-P., Fullerton, H. J., Howard, V. J., Huffman, M. D., Isasi, C. R., Jiménez, M. C., Judd, S. E., Kissela, B. M., Lichtman, J. H., Lisabeth, L. D., Liu, S., & Turner, M. B. (2016). Heart Disease and Stroke Statistics—2016 Update. Circulation, 133(4).

Mulley, G. P. (1982). Avoidable complications of stroke. Journal of the Royal College of Physicians of London, 16(2), 94–97.

Nakayama, H., Jørgensen, H. S., Pedersen, P. M., Raaschou, H. O., & Olsen, T. S. (1997). Prevalence and Risk Factors of Incontinence After Stroke. Stroke, 28(1), 58–62.

Ng, F. C., Coote, S., Frost, T., Bladin, C., & Choi, P. M. (2017). CT perfusion predicts tissue injury in TIA and minor stroke. Journal of Neurology, 264(4), 802–803.

Nor, A. M., Davis, J., Sen, B., Shipsey, D., Louw, S. J., Dyker, A. G., Davis, M., & Ford, G. A. (2005). The Recognition of Stroke in the Emergency Room (ROSIER) scale: development and validation of a stroke recognition instrument. The Lancet Neurology, 4(11), 727–734.

Organização Mundial da Saúde. (2005). Enfoque passo a passo da OMS para a vigilância de acidentes vascular cerebrais.

Patel, M., Coshall, C., Rudd, A. G., & Wolfe, C. D. A. (2001). Natural History and Effects on 2-Year Outcomes of Urinary Incontinence After Stroke. Stroke, 32(1), 122–127.

Pereira A. S. et al. (2018). Metodologia da pesquisa científica. UFSM.

Prabhakaran, S., Ruff, I., & Bernstein, R. A. (2015). Acute Stroke Intervention. JAMA, 313(14), 1451.

Redgrave, J. N. E., Coutts, S. B., Schulz, U. G., Briley, D., & Rothwell, P. M. (2007). Systematic review of associations between the presence of acute ischemic lesions on diffusion-weighted imaging and clinical predictors of early stroke risk after transient ischemic attack. Stroke, 38(5), 1482–1488.

Rordorf, G., & McDonald, C. (2021). Spontaneous intracerebral hemorrhage: Treatment and prognosis.

Sarikaya, H., Ferro, J., & Arnold, M. (2015). Stroke Prevention - Medical and Lifestyle Measures. European Neurology, 73(3–4), 150–157.

Smithard, D. G., O’Neill, P. A., England, R. E., Park, C. L., Wyatt, R., Martin, D. F., & Morris, J. (1997). The Natural History of Dysphagia following a Stroke. Dysphagia, 12(4), 188–193.

Trejo-Gabriel-Galán, J. M. (2020). Ictus como complicación y como factor pronóstico de COVID-19. Neurología, 35(5), 318–322.

Tricco, A. C., Lillie, E., Zarin, W., O’Brien, K. K., Colquhoun, H., Levac, D., Moher, D., Peters, M. D. J., Horsley, T., Weeks, L., Hempel, S., Akl, E. A., Chang, C., McGowan, J., Stewart, L., Hartling, L., Aldcroft, A., Wilson, M. G., Garritty, C., & Straus, S. E. (2018). PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Annals of Internal Medicine, 169(7), 467–473.

Trounson, A., & McDonald, C. (2015). Stem Cell Therapies in Clinical Trials: Progress and Challenges. Cell Stem Cell, 17(1), 11–22.

Vos, T., Barber, R. M., Bell, B., Bertozzi-Villa, A., Biryukov, S., Bolliger, I., Charlson, F., Davis, A., Degenhardt, L., Dicker, D., Duan, L., Erskine, H., Feigin, V. L., Ferrari, A. J., Fitzmaurice, C., Fleming, T., Graetz, N., Guinovart, C., Haagsma, J., & Murray, C. J. (2015). Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. The Lancet, 386(9995), 743–800.

Wade, D. T., & Hewer, R. L. (1987). Functional abilities after stroke: measurement, natural history and prognosis. Journal of Neurology, Neurosurgery & Psychiatry, 50(2), 177–182.

Walker, M. D., Marler, J. R., Goldstein, M., Grayd, P. A., Toole, J. F., Baker, Wi. H., Castaldo, J. E., & Chambless, L. E. (1995). Endarterectomy for asymptomatic carotid artery stenosis. Executive Committee for the Asymptomatic Carotid Atherosclerosis Study. JAMA, 273(18), 1421–1428.

Whittaker, A., Anson, M., & Harky, A. (2020). Neurological Manifestations of COVID‐19: A systematic review and current update. Acta Neurologica Scandinavica, 142(1), 14–22.

Wilson, P. W. F., Hoeg, J. M., D’Agostino, R. B., Silbershatz, H., Belanger, A. M., Poehlmann, H., O’Leary, D., & Wolf, P. A. (1997). Cumulative Effects of High Cholesterol Levels, High Blood Pressure, and Cigarette Smoking on Carotid Stenosis. New England Journal of Medicine, 337(8), 516–522.

Zappella, N., Merceron, S., Nifle, C., Hilly-Ginoux, J., Bruneel, F., Troché, G., Cordoliani, Y.-S., Bedos, J.-P., Pico, F., & Legriel, S. (2014). Artery of Percheron Infarction as an Unusual Cause of Coma: Three Cases and Literature Review. Neurocritical Care, 20(3), 494–501.



How to Cite

DARWICHE, M.; FRONZA, D. Stroke: a scoping review. Research, Society and Development, [S. l.], v. 10, n. 13, p. e33101319904, 2021. DOI: 10.33448/rsd-v10i13.19904. Disponível em: Acesso em: 27 jan. 2022.



Health Sciences