sabrina mameli skullbase

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  • sabrina mameli skullbase

    1. 1. ISCHEMIC STROKE
    2. 2. A 62 year old female presents to the ED with right sided weakness and severe aphasia.No history of similar symptoms in past, no known risk factors, no recent illness. Notrauma or syncope.The patient appeared slightly sonnolent and was able to slowly respond to simplecomands and verbal stimuliBP 116/63, pulse oximetry showed 99% saturationThe physical examination showed: The patient was approximate GCS=13 Right mouth droop Right hemiparesis NIHSS=18 Positive babinski sign Lost vision on the right Ischemic Stroke?
    3. 3. Background The ischemic stroke is the rapid loss of cerebral functions due to the blockage of blood supply to the brain
    4. 4. Causes
    5. 5. Epidemiology Stroke is one of the most common cause of disability and third leading cause of death in USA More than 700,000 persons per year suffer a first-time stroke in United States, with 20% of these individuals dying within the first year after the stroke 62.8 cases per 100,000 59 cases per 100,000 Risk of stroke increases in patient older than 64 years
    6. 6. AnatomyThe ACA supplies the medial frontal and parietal lobes The MCA supplies the The PCA supplies the thalami, lateral frontal, parietal and occipital and inferior temporal anterior temporal lobes lobes
    7. 7. Pathophysiology The loss of blood flow cause an ischemic cascade Because of the activation of several degradative molecules, such as free radicals, arachidonic acid and NO, the cell membrane and other essential neuronal structures are destroyied
    8. 8. Symptoms • Hemiparesis • Hemisensory loss • Complete or partial hemianopsia, monocular or binocular visual loss, diplopia • Aphasia • Ataxia • Sudden loss of consciousness
    9. 9. Laboratory Evaluation• Complete Blood Cell Count• Basic Chemistry Panel• Coagulation Studies• Cardiac Biomarkers• Toxicology Screening• Arterial Blood Gas Analysis
    10. 10. Imaging in Stroke 757547515451428 MRI CT scanning
    11. 11. • Conventional Angiography It’s the Gold Standard
    12. 12. Medical Treatment Establishing the time at which stroke symptoms first occurred is of paramount importance when considering patients for possible thrombolytic therapy The central goal of therapy in acute ischemic stroke is to limit the severity of ischemic injury and to reduct the duration of ischemiaRecanalization strategies include rt-PA and intrarterial approaches
    13. 13. Thrombolytic Therapy restore the cerebral blood flowand may lead to improvement or resolution ofneurologic deficitsUnfortunately thrombolytics can cause symptomaticintracranial hemorrage The most common used antiplatelet agent is the aspirin which reduces the risk of early stroke recurrenceNeuroprotective factors are under investigationMany studies demonstrate the usefulness ofhypothermia
    14. 14. Carotid endarterectomy Is the removal of material on the inside of the artery
    15. 15. Carotid Stenting It consists in treding a catheter through the femoral artery, up to the aorta then inflating a balloon to dilatate the carotid artery
    16. 16. Decompressive Craniectomyis a neurosurgical procedure in which part of theskull is removed to allow a swelling brain to expandThe removed part is called “bone flap”
    17. 17. Bypass
    18. 18. Prognosis The prognosis after acute ischemic stroke depends on: • Severity of the stroke • Patient’s premorbid condition • Age • Poststroke Complications In USA 20% of individuals die within the first year after a first-time stroke
    19. 19. Patient Education The american Stroke Association advices the public to be aware of the symptoms of stroke that are easily recognized and call 911
    20. 20. ConclusionsStroke is a very common disease which need an immediate menagementThe indication for surgical treatment is when the theraphy had not success In february 2011 AHA/ASA guidelines for the primary prevention of the stroke were publishedThe guideline emphasizes the importance of lifestyle changes to reduce modifiable risk factors
    21. 21. Thank You

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