Stroke (Apoplexy): Medical History

Medical history (history of illness) represents an important component in the diagnosis of apoplexy (stroke). Family history

• Are there frequent cardiovascular diseases, neurological diseases in your family?

Social history

• Is there any evidence of psychosocial stress or strain due to your family situation?

Current medical history/systemic history (somatic and psychological complaints).

• Was there any loss of consciousness? * (extraneous anamnesis)
• Did you notice symptoms such as paralysis, loss of sensation, dizziness, visual disturbances, or speech disturbances? *
• Do you have any symptoms such as nausea and vomiting?
• Do you have any other complaints, if any, such as.
  • Headache
  • Dizziness
  • Eye tremor with slow movement in one direction followed by faster movement in the opposite direction
  • Gait unsteadiness*
• If yes, how long have these symptoms been present? *
• Have these symptoms occurred before? *

Vegetative anamnesis incl. nutritional anamnesis.

• Are you overweight? Please tell us your body weight (in kg) and height (in cm).
• Do you have a balanced diet?
  • Do you eat a diet high in salt? (Salt as a flavoring agent, salty snacks, smoked and cured foods, prepared foods, restaurant food, canned foods, sausage, cheese).
  • Do you eat a lot of foods that contain saturated fats? (animal fats, contained in sausage, meat, cheese).
  • Do you eat a lot of sugary foods?
• Do you get enough exercise every day?
• Do you smoke? If so, how many cigarettes, cigars or pipes per day?
• Do you drink alcohol? If yes, what drink(s) and how many glasses per day?
• Do you use drugs? If yes, which drugs (amphetamines, cannabis, cocaine) and how often per day or per week?

Self history incl. drug history.

• Pre-existing conditions (cardiovascular disease, cardiac arrhythmias (atrial fibrillation), diabetes mellitus, dyslipidemia).
• Operations (percutaneous coronary intervention (PCI) → ischemic strokes after PCI/procedure used to dilate stenosed (narrowed) or completely occluded coronaries (arteries that surround the heart in a wreath shape and supply the heart muscle with blood) (= post-PCI strokes) (relatively rare complication)).
• Allergies

Medication history

• Alpha blockers:
  • In the first 21 days after the first prescription of alfuzosin, doxazosin, tamsulosin, or terazosin, there was a 40% increase in ischemic apoplexy (stroke) events
  • Patients taking another antihypertensive (blood pressure-lowering drug) concomitantly with an alpha blocker had no increased risk of apoplexy in the postexposure 1 period ( ≤ 21 days thereafter), and the incidence in the postexposure 2 period (22-60 days thereafter) decreased even further (IRR 0.67)Conclusion Normotensives may be more sensitive to the first-dose effect of alpha blockers.
  • ALLHAT study:Doxazosin patients had a higher risk of stroke and combined cardiovascular disease than chlorthalidone patients. The risk of CHD was doubled.
• Nonsteroidal anti-inflammatory drugs (NSAIDs; e.g., ibuprofen, diclofenac) including COX-2 inhibitors (synonyms: COX-2 inhibitors; commonly: coxibs; e.g. Celecoxib, etoricoxib, parecoxib) – increased risk with current use of rofecoxib and diclofenac; increased risk of ischemic infarction with use of diclofenac and aceclofenac up to 30 days before the event.
• Aceclofenac, similar to diclofenac and the selective COX-2 inhibitors, is associated with an increased risk of arterial thrombotic events.
• Paracetamol (group of nonacidic analgesics), when used as pain therapy in nursing home residents (N = 5,000; 2,200 subjects took paracetamol daily, mean dose was 2,400 mg), increased the rate of apoplexy a mean of 3-fold.
• Use of new-generation oral contraceptives (birth control pills) are associated with an increased risk of first-time cerebral infarction.Hormonal contraceptives with lower estrogen concentrations had a lower risk of cerebral infarction compared with those with normal estrogen concentrations.All four generations of progestins were associated with an increased risk of ischemic stroke. The risk of ischemic stroke appeared to be slightly lower among fourth-generation users than among those on the precursor generations of progestins.Note: Transdermal estrogen therapy (patch therapy) does not increase the risk of ischemic cerebrovascular events.
• Regadenoson (selective coronary vasodilator), which may be used for diagnostic purposes only (stress trigger for myocardial perfusion imaging; myocardial perfusion imaging, MPI), increases the risk of apoplexy; contraindications (contraindications): history of atrial fibrillation or existing risk of severe hypotension (low blood pressure); caveat. Aminophylline is not recommended for termination of regadenoson-related seizures!
• Recombinant growth hormone (STH) therapy in childhood – in adulthood: factor 3.5 to 7.0 increased incidence rate of hemorrhagic stroke; factor 5.7 to 9.3 increased rate of subarachnoid hemorrhage.

Environmental history

• Noise:
  • Road noise: compared with road noise < 55 db, road noise > 60 db increases the risk of apoplexy by a significant 5% in adults and by a significant 9% in those over 75 years of age
  • Aircraft noise: increase in average noise level by 10 decibels increases stroke risk by 1.3
• Air pollutants: particulate matter from the environment, household (from coal stove and stove).
• Smog (particulate matter, nitrogen dioxide, sulfur dioxide).
• Temperature drops (risk increase; risk remains elevated for 2 more days; temperature drop of about 3 °C each increases apoplexy risk by 11%).
• Rapid change in humidity as well as atmospheric pressure.
• Heavy metals (arsenic, cadmium, lead, copper).

Literature on environmental anamnesis see below causes.

* If this question has been answered with “Yes”, an immediate visit to the doctor is required! (Information without guarantee)