stroke N beyond on world stroke day


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stroke N beyond on world stroke day

  1. 1. ‘I was having a great day at work andnothing seemed unusual.Suddenly the lights went out.Seven hours later I woke up inhospital. I couldn’t move my right side,andmy speech had gone.’
  2. 2. Common believe It is heart disease It is not curable It is not preventable Etiology (reason ) not known
  3. 3. Reality of stroke It is brain attack Prevention is better than cure There is some curative treatment Outcome good Pathogenesis is known (reason)
  4. 4. 1in6
  5. 5. 1ini6
  6. 6. 1in People world wide will have a stroke6 in their life time It could be you.
  7. 7. 1in People world wide will have a stroke6 But stroke can be prevented
  8. 8. 1in People world wide will have a stroke6 Ensure quality care and support after stroke
  9. 9. 1 Every 2 seconds, someone in the world suffers a stroke Every 6 seconds,in someone dies Every 6 seconds, someone’s quality of life will forever be6 changed – they will permanently be physically disabled
  10. 10. 1in Every 6 seconds, regardless of age or gender –6 Someone somewhere will die from stroke
  11. 11. Every 6 seconds,stroke kills some oneEvery other secondstroke attacks a person15 millions peopleexperience a stroke each year6 million of them do not survive
  12. 12. PreventableandTreatableCatastrophe
  13. 13. About 30 million peoplehave had a strokemost have residual disabilitiesBehind thesenumbers arereal life
  14. 14. Second cause of death above 605th – people 15- 59Also attack childrenMore death each yearthan AIDS TB malaria put together Is indiscriminate &does not respect borders
  15. 15. FAST
  16. 16. FAST
  17. 17. FAST
  18. 18. FAST
  19. 19. FAST
  20. 20. FAST
  21. 21. Sudden confusion, trouble speaking orunderstandingSudden trouble seeingSudden trouble walking, dizziness,loss of balance or coordinationl fb l di tiSudden, severe headache with no known cause
  22. 22. Whereas; stroke is a global epidemicthat threatens lives, health and quality of lifeWhereas; much can be done to prevent andtreat stroke, and rehabilitate those who sufferfrom one Whereas; professional and publicawareness is the first step to action.
  23. 23. Stroke - a non-communicable disease Attacks 15 million people worldwide every year Claims a life every six seconds –Can be beaten - effectively
  24. 24. Regardless of age, stroke canstrike anyone at any timeStroke can be preventedStroke survivors can regaintheir quality of lifewith appropriate care andlong-term support
  25. 25. Reduce the number of people whoare affected by strokeReduce the number who dieIncreased the number who recoverIncrease the QOL of those who became disable
  26. 26. The lifetime risk ofstroke is1 in 5 for women,1 in 6 for menThe Lancet Neurology 6(12), 1106-14
  27. 27. Increase understanding of thesolutions that existKnowledgeHealthy environment /Healthy behaviorRaise awareness
  28. 28. Translate knowledge into actionTransdisciplinary teamEvidence > PracticeEstablish simple but comprehensivestroke units
  29. 29. Generate a movementthat stimulates collective responsibilityand action
  30. 30. 1. Whereas; stroke is a global epidemic that threatens lives, health and quality of life.2. Whereas; much can be done to prevent and treat stroke, and rehabilitate those who suffer from one.3. Whereas; professional and public awareness is the first step to action.
  31. 31. The growing epidemic Growing epidemic > Preventable Joint forces to prevent stroke p The same few risk factors accounts for the health problems Ensure what we know becomes what is done
  32. 32. The growing epidemic Recognized the uniqueness of stroke Tx & prevent VCI Build Transdisciplinary team
  33. 33. The growing epidemicStroke isPREVENTABLEBut risingGloballyAging, unhealthy diets, tobacco use,and physical inactivityfuel a growing epidemic >>
  34. 34. 1ini6
  35. 35. 1ini6
  36. 36. 1ini6
  37. 37. The growing epidemic High BP High Cholesterolof >> Obesity Diabetes stroke Heart disease VCI
  38. 38. A treatable and preventable catastrophe
  39. 39. o1 Here are 6 steps anyone can take to reduce the risk and the danger of stroke g 1. Know your personal risk factors - BP - Diabetes - Cholesterol
  40. 40. o1 Here are 6 steps anyone can take to reduce the risk and the danger of stroke g 2. Be physically active and exercise regularly 3. Avoid obesity by keeping to a healthy diet 4. Limit alcohol consumption
  41. 41. o1 Here are 6 steps anyone can take to reduce the risk and the danger of stroke g 5. Avoid cigarette smoke, if you smoke, seek help to stop now 6. Learn to recognized the warning signs of stroke
  42. 42. o2 Time lost is Brain function lost Time window of opportunity to treat stroke short once symptoms appears any one having a stroke immediately
  43. 43. o2 Time lost is Brain function lost Call local Emergency phone no. Go to nearest hospital Even symptoms disappear It may the last opportunity to prevent a potentially forthcoming major stroke
  44. 44. o3 Disability in adult worldwide Physiotherapy Occupational therapy Rehab
  45. 45. Transient ischaemic attacks (TIAs) offer a greatopportunity to initiatetreatments that prevent strokes
  46. 46. Typical symptoms Hemiparesis Hemisensory loss Dysarthria D th i Diplopia Monocular blindness Ataxia
  47. 47. Following are NOT Typical symptoms Altered consciousness or syncope Dizziness, wooziness, or giddiness Impaired vision (“grey out”) with alteration of I i d i i (“ t”) ith lt ti f consciousness Amnesia or confusion alone Tonic and/or clonic motor activity Purely sensory symptoms,
  48. 48. Following are NOT Typical symptoms Sensory march Focal positive neurological symptoms Bowel or bladder incontinence B l bl dd i ti Vertigo, diplopia, dysphagia, or dysarthria
  49. 49. PX are not benignStroke and TIA are both serious conditionsboth are markers of current or impendingdisability and a risk of death10 to 20% of patients have a stroke in the next 90 days,In 50% stroke within the first 24 to 48 hours
  50. 50. PX are not benignBetween 30% and 50% of TIA patients who undergobrain MRI with diffusion- weighted imaging
  51. 51. D/DXNon-Focal symptoms Loss of consciousness Faintness Generalised weakness Vertigo only Drop attacks Episodes of ‘confusion’
  52. 52. Risk scoreABCD2 Age ≥ 60 years (1 point) BP≥ 140/90 mmHg (1 point) g( p ) Unilateral weakness (2 points) Speech impairment (1 point) Duration ≥ 60 minutes (2 points) or 10–59 minutes (1 point) Diabetes mellitus (1 point)
  53. 53. Risk scoreABCD2 Low risk (0–3 points) Moderate risk (4–5 points) ( p ) High risk (6–7 points
  54. 54. Back to theB k – t - th - wall llemergency
  55. 55. Australia
  56. 56. MI v StrokeExtreme pain, fear of death No pain, Sx are played down pPt screams for help Pt does not ask for HelpRapid alarm for EMS Bypass of EMS, primary care PhysicianGood Mx structure & logistic Structure in development
  57. 57. Imaging guidelineSuspected TIA or stroke, urgent cranial CT(Class I), oralternatively MRI (Class II), Level A)If MRI - DWI and T2*-weighted(Class II, Level A)TIA, minor stroke, or early spontaneous recovery,Ultrasound, CTA, or MRA (Class 1I, Level A)
  58. 58. ESO | AHA/ASAguidelines do not separate the management of TIA fromischaemic stroke.Loading dose of aspirin (160-325 mg) within 48hours of ischaemic stroke(ESO Class I, Level A).No other antiplatelets or combinations(Class III, Level C)Aspirin 50-325 mg/d, aspirin andextended-release dipyridamole,and clopidogrel monotherapy(AHA/ESO Class I, Level A).
  59. 59. ESO | AHA/ASAguidelines do not separate the management of TIA fromischaemic stroke.The combination of aspirin and extended-releasedipyridamole over aspirin alone (Class I, Level B)Clopidogrel is recommended over aspirin aloneCl id li d d ii l(Class IIb, Level B),For patients allergic to aspirin(Class IIa, Level B)
  60. 60. IV rt-PA within 4.5 hours(Class I, Level A)BP of 185/110 mmHg or higherIA rTPA acute MCA occlusion within a 6-hourIV streptokinase - not recommended
  61. 61. Acute Stroke | GeneralIV - rTPA 3-4.5HIA - <6 HAnticoagulationAntiplateletsAspirin should not be considered a substitute for otheracute interventions
  62. 62. In acute settingSecondary preventionDrug Tx
  63. 63. Acute setting 140 – 180mgSecondary preventionHbA1C < 7
  64. 64. Anti lipidStatin / Niacin
  65. 65. X
  66. 66. BMI 18.5 – 25.4Waist : <35 F and < 40 M
  67. 67. physical activity,at least 30 minutes
  68. 68. Interventional approachStroke > 6 month with 70-90% stenosis> CEARecent stroke with 50-69% stenosis> CEA<50% Med Tx
  69. 69. Interventional approachICAS with symptomsStent / angioplasty unceretain
  70. 70. CardioEmbolicAF – AnticoagulationMI with mural thrombusAnticoagulation ( 9-12 months)ASA for MICardiomyopathy > anticoagulation / ASAValvular heart disease with or without AF> Anticoagulation without ASA
  71. 71. CardioEmbolicMAC with regurgiation with or without AF> Antiplatelet or AnticoagulationProsthetic valves> anticoagulation
  72. 72. NonCardioEmbolic> AntiplateletArterial dissectionAnticoagulation – 3-6 m or AntiplateletBeyond 6 m > AntiplateletPFOAntiplatelet
  73. 73. NonCardioEmbolic> CVT with or without HgAnticoagulation for 3-6 months followedbyAntiplatelet only
  74. 74. NonCardioEmbolic> Hyperhomocysteinemia B6 B12 & FolateHypercoagulable stateInherited ThrombophiliasCVT > AntiplateletRecurrent > Anticoagulation
  75. 75. NonCardioEmbolic> APL Ab > Antiplatelet> APL syndrome > Anticoagulation
  76. 76. lower-risk > UFH / LMWH1st trimester > ASA low doseHigh risk PGUFH throughout
  77. 77. After ICH SAH Sub Hg > Allanticoagulant – stopped for 1-2 wkResume 3-4 wkHemorrhagic transformation of InfarctAnticoagulation may be >>
  78. 78. CAMNo current recommendation ofneuroprotectivesubstances (Class I, Level A)
  79. 79. Q&A
  80. 80. Drop your QUERY >