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Stroke treatment for 12th oct 00
- 3. Cerebral Ischaemia - Threshold Normal flow, normal function Synaptic transmission failure Membrane pump failure 20 50 10 0 Time in hours CBF (ml/100g brain) Low flow, raised O2 extraction, normal function 1 2 3 4 5
- 5. Falling cerebral perfusion Cerebral perfusion pressure Cerebral blood volume O 2 extraction fraction Cerebral blood flow Cerebral metabolic rate of O 2 Autoregulation, no symptoms Exhausted reserve Ischaemic symptoms
- 9. NA, Dopamine Ca2+ i Ischaemic Brain Injury Ischaemia - 02 glucose Anoxic depolarisation lactate Glutamate Hi Free Fe2+ Free radicals Lipolysis NO synthase Proteolysis
- 15. Stroke types Al 35-44 yr Infarct 80% 42% Athero-thrombo-embolism 50% Intracranial small vessel 25% Cardioembolic 20% Rare 5% PICH 10% 10% SAH 5% 38% Unknown 5% 10% 75%
- 20. Platelet aggregation Platelet aggregation Thrombus in lumen ADP platelet membrane receptor Clopidrogel Aspirin Thromboxane Dipyridamole Increase Cyclic AMP and GMP
- 32. “ Patients who have improved neurologically but have a persistent neurologic deficit when seen, should be managed as a recent stroke ”
- 33. “ Role of Neuro-protection in Stroke is not clear and not recommended routinely ”
- 41. Thrombolysis in acute stroke Within 3 hour of Stroke Small Vessel Medium Vessel IV rTPA/URK Large Vessel IA rTPA/URK Stop
- 45. Age Sex Distribution 13 2 11 60-80 35 7 28 Total 17 5 12 40-59 5 - 5 20-39 Total Female Male Age
- 47. Outcome and Agent used 35 5 21 9 Total 9 2 4 3 Death 7 1 4 2 Dependent 19 2 13 4 Independent Total rTPA URK STK Recovery
- 48. Outcome and Arterial Territory Unc Con Unc Con 35 7 2 10 16 Total 9 2 - 6 1 Death 7 1 - 3 3 Dep 19 4 2 1 12 Ind Total PCA ACA Recovery
- 49. Outcome and Timing of Treatment 35 21 5 9 Total 9 6 - 3 Death 7 6 1 - Dep 19 9 4 6 Ind Total 3-6h 1-3h <1h Outcome
- 50. Outcome and CT scan 32 6 26 Total 9 3 6 Death 7 2 5 Dependent 16 1 15 Independent Total Early Normal Outcome
- 51. Complication of therapy 8 2 5 2 Toxic edema 1 - 1 - IC bleed 1 - 1 - IC spasm 1 - - 1 Hem trans 1 - 1 - Urinary bleed 3 - 1 2 Gastric bleed 2 1 1 - Gum bleed 2 1 1 - Anaphylaxis 2 1 1 - Bronchospasm 1 - 1 - Skin Rash Total rTPA URK STK Complication
- 53. Right middle cerebral artery block following coronary angiogram
- 57. Dec 31 st 1999 Jan 21 st 2000 Feb 11 th 2000 Emergency Carotid Endarterectomy DOA 5 th Feb 00