Cerebrovascular disease2
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Cerebrovascular disease2

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Cerebrovascular disease2 Cerebrovascular disease2 Presentation Transcript

  • Cerebrovascular Disease (simple introduction) Lecture class Pratap Sagar Tiwari, MD, Lecturer, NGMC
  • Cerebrovascular disease ? Stroke
  • Definition of Stroke • A stroke or Cerebrovascular accidents is defined by abrupt onset of a neurological deficit that is attributable to a focal vascular cause. • Stroke is the third most common cause of death in the developed world after cancer and ischaemic heart disease, and is the most common cause of severe physical disability. References : Harrison 18th ed
  • Stroke types • Stroke is classified into two major types: 1. Ischemic stroke: Brain ischemia due to thrombosis, embolism, or systemic hypoperfusion 2. Hemorrhagic stroke: Brain hemorrhage due to intracerebral hemorrhage or subarachnoid hemorrhage. • Approximately 80 % of strokes are due to ischemic cerebral infarction and 20 % to brain hemorrhage.
  • Stroke types ?
  • BRAIN ISCHEMIA 1 • Thrombosis generally refers to local in situ obstruction of an artery. • Embolism refers to particles of debris originating elsewhere that block arterial access to a particular brain region . • Systemic hypoperfusion is a more general circulatory problem, manifesting itself in the brain and perhaps other organs. • References 1: Caplan LR. Basic pathology, anatomy, and pathophysiology of stroke. In: Caplan's Stroke: A Clinical Approach, 4th ed, Saunders Elsevier, Philadelphia 2009. p.22.
  • Hemorrhagic stroke
  • Hemorrhagic stroke: types 1. Intracerebral hemorrhage refers to bleeding directly into the brain parenchyma 2. Subarachnoid hemorrhage refers to bleeding into the cerebrospinal fluid within the subarachnoid space that surrounds the brain • Note: Hemorrhage is characterized by too much blood within the closed cranial cavity, while ischemia is characterized by too little blood to supply an adequate amount of oxygen and nutrients to a part of the brain.1 • Reference 1: Caplan LR. Intracranial branch atheromatous disease: a neglected, understudied, and underused concept. Neurology 1989; 39:1246.
  • Diagnosis ? • Clinical • Investigation
  • Clinical ? • Is there any neurological deficit ? • Is there any risk factor for vascular disease ?
  • STROKE RISK FACTORS • • • • • Age Gender (male > female) Race (Afro-Caribbean > Asian > European) Heredity Previous vascular event, e.g. MI, stroke or peripheral embolism • High fibrinogen
  • STROKE RISK FACTORS • High blood pressure • Heart disease (atrial fibrillation, HF, endocarditis) • Diabetes mellitus • Hyperlipidaemia • Smoking, Excess alcohol consumption • Polycythaemia • Oral contraceptives
  • • Cerebral infarction is mostly due to thromboembolic disease secondary to atherosclerosis in the major extracranial arteries (carotid artery and aortic arch). • About 20% of infarctions are due to embolism from the heart, and a further 20% are due to intrinsic disease of small perforating vessels (lenticulostriate arteries), producing so-called 'lacunar' infarctions.
  • Hemorrhagic stroke : Risk Factor
  • Cincinnati Prehospital Stroke Scale 1. Facial droop: Have the person smile or show his or her teeth. •Normal: Both sides of face move equally •Abnormal: One side of face does not move as well as the other (or at all) 2. Arm drift: •Normal: Both arms move equally or not at all •Abnormal: One arm does not move, or one arm drifts down compared with the other side 3. Speech:  •Normal: Patient uses correct words with no slurring •Abnormal: Slurred or inappropriate words or mute Patients with 1 of these 3 findings as a new event have a 72% probability of an ischemic stroke. If all 3 findings are present the probability of an acute stroke is more than 85% Hurwitz AS, Brice JH, Overby BA, Evenson KR (2005). "Directed use of the Cincinnati Prehospital Stroke Scale by laypersons". Prehosp Emerg Care 9 (3): 292–6
  • Investigations ? • Imaging
  • 7 questions ? 1. Is this a vascular lesion ? CT/MRI
  • CT HEAD • Imaging
  • 7 questions ? 2. Is it ischaemic or haemorrhagic? CT/MRI
  • 7 questions ? 3. Is it a subarachnoid haemorrhage? CT/MRI
  • SubArachnoid Hemorrhage
  • 7 questions ? 4. Is there any cardiac source of embolism? ECG/ECHO
  • ECG: Afib
  • 7 questions ? 5. What is the underlying vascular disease? • • Duplex ultrasound of carotids Magnetic resonance angiography(MRA) • CT angiography (CTA) • Contrast angiography
  • 7 questions ? 6. What are the risk factors? Full blood count Cholesterol Blood glucose
  • 7 questions ? 7. Is there an unusual cause? Rule out Bleeding Disorders/ ESR
  • References • • • • Harrison’s 18th edition Davidsons 20th ed Uptodate 20.3 Emedicine.com