Classic phrase for embolic stroke

Q: Stroke precipitated with a history of "getting up at night to urinate" is classic of which kind of stroke?

A) Intracerebral hemorrhage (ICH)
B) Subarachnoid hemorrhage (SAH)
C) Thrombotic stroke
D) Embolic stroke
E) Transient ischemic attack (TIA)


Answer: D

In contrast to ICH/SAH which are classic to precipitate secondary to sexual or physical activity, embolic stroke is classic with the history of precipitated by "getting up at night to urinate".  Some patients may report activity like forceful sneezing or cough. Also, embolic strokes in contrast to thrombotic strokes are described with three of the following characteristics:

• tends to occur suddenly 
• maximal at onset
• rapid recovery

Beside general risk factors for atherosclerosis like age, smoking, diabetes mellitus, etc., history of valvular heart disease or atrial fibrillation is more common in this subgroup of stroke.