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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 ...
Stroke types
• Stroke is classified into two major types:
1. Ischemic stroke: Brain ischemia due to thrombosis,
embolism, ...
Stroke types ?
BRAIN ISCHEMIA 1
• Thrombosis generally refers to local in situ obstruction of an artery.
• Embolism refers to particles o...
Hemorrhagic stroke
Hemorrhagic stroke: types
1. Intracerebral hemorrhage refers to bleeding directly into
the brain parenchyma
2. Subarachnoi...
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 vascu...
STROKE RISK FACTORS
• High blood pressure
• Heart disease (atrial fibrillation, HF,
endocarditis)
• Diabetes mellitus
• Hy...
• Cerebral infarction is mostly due to
thromboembolic disease secondary to
atherosclerosis in the major extracranial
arter...
Hemorrhagic stroke : Risk Factor
Cincinnati Prehospital Stroke Scale
1. Facial droop: Have the person smile or show his or her teeth.
•Normal: Both sides o...
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 angiograp...
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
Cerebrovascular disease2
Cerebrovascular disease2
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Transcript of "Cerebrovascular disease2"

  1. 1. Cerebrovascular Disease (simple introduction) Lecture class Pratap Sagar Tiwari, MD, Lecturer, NGMC
  2. 2. Cerebrovascular disease ? Stroke
  3. 3. 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
  4. 4. 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.
  5. 5. Stroke types ?
  6. 6. 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.
  7. 7. Hemorrhagic stroke
  8. 8. 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.
  9. 9. Diagnosis ? • Clinical • Investigation
  10. 10. Clinical ? • Is there any neurological deficit ? • Is there any risk factor for vascular disease ?
  11. 11. 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
  12. 12. STROKE RISK FACTORS • High blood pressure • Heart disease (atrial fibrillation, HF, endocarditis) • Diabetes mellitus • Hyperlipidaemia • Smoking, Excess alcohol consumption • Polycythaemia • Oral contraceptives
  13. 13. • 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.
  14. 14. Hemorrhagic stroke : Risk Factor
  15. 15. 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
  16. 16. Investigations ? • Imaging
  17. 17. 7 questions ? 1. Is this a vascular lesion ? CT/MRI
  18. 18. CT HEAD • Imaging
  19. 19. 7 questions ? 2. Is it ischaemic or haemorrhagic? CT/MRI
  20. 20. 7 questions ? 3. Is it a subarachnoid haemorrhage? CT/MRI
  21. 21. SubArachnoid Hemorrhage
  22. 22. 7 questions ? 4. Is there any cardiac source of embolism? ECG/ECHO
  23. 23. ECG: Afib
  24. 24. 7 questions ? 5. What is the underlying vascular disease? • • Duplex ultrasound of carotids Magnetic resonance angiography(MRA) • CT angiography (CTA) • Contrast angiography
  25. 25. 7 questions ? 6. What are the risk factors? Full blood count Cholesterol Blood glucose
  26. 26. 7 questions ? 7. Is there an unusual cause? Rule out Bleeding Disorders/ ESR
  27. 27. References • • • • Harrison’s 18th edition Davidsons 20th ed Uptodate 20.3 Emedicine.com
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