Stroke

1. Presented by : Gunpreet
Singh
Roll no. 19064
Old Final Year
Approach to Stroke

2. Definition and Types
Stroke is defined as sudden global or focal neurological deficit
resulting from spontaneous hemorrhage or infarction of central
nervous system with objective evidence of infarction/
haemorrhage irrespective of duration of clinical symptoms
Types of stroke :
1. ISCHEMIC STROKE - a) Thrombotic stroje
b) Embolic stroke
2. HAEMORRHAGIC STROKE- a) Intra cerebral haemorrhage
b) Sub Arachnoid haemorrhage

3. Risk Factors for Stroke
Modifiable :
Hypertension
Heart Disease (atrial
fibrillation)
Endocarditis
Diabetes Mellitus
Hyperlipidemia
Smoking
Excessive alcohol
Oral contraceptives
Non Modifiable :
Age
Gender (M>F)
Heredity
Previous vascular
event like MI,
peripheral embolism
High fibrinogen

4. Ischemic - Thrombotic Stroke
Etiologies : Lacunar Stroke
Large vessel thrombosis
Hypercoagulable disorders
Atherosclerosis is the most common pathology leading to
thrombotic occlusion of blood vessels
Hypercoagulable disorders are among uncommon cause
- antiphospholipid syndrome
- sickle cell anaemia
- polycythemia vera
_ homocysteinemia
Vasculitis : PAN, Wegner’s Granulomatosis

5. Ischemic- Embolic stroke
Cardioembolic stroke:
embolus from the heart gets lodged into intracranial vessels
Middle cerebral artery is thw most commonly affected
Atrial fibrillation is the most common cause
Artery to artery embolism:
Thrombus formed on atherosclerotic plaques gets embolized to
intracranial vessels
Carotid bifurcation atherosclerosis is the most common source of
emboli
Ischemia leads to formation of ischemic core and later on ischemic
penumbra and finally leading to the deatn of the brain tissue

6. Haemorrhagic- Intracerebral
Result of chronic hypertension
Small arteries are damaged due to hypertension
In advanced stages vessel wall is disrupted and leads to leakage
Other causes are amyloid angiopathy, anticoagulant therapy,
cavernous hemangioma, cocaine and amphetamines
Haemorrhagic- Subarachnoid
Most common cause is rupture of saccular or Berry aneurysms
Other causes are arteriovenous malformations, angiomas,
mycotic aneurysmal rupture
Associated with extremely severe headache

7. Pathophysio of hemorrhagic stroke
. Explosive entry of blood into the brain parenchyma structurally
disrupts neurons
. White matter fibre tracts are split
. Immediate cessation of neuronal function
. Expanding hemorrhage can act as a mass lesion and cause
further progression of neurological deficits
. Large hemorrhages can cause transtentorial coning and rapid
death

8. Clinical features and History taking
Ask for onset and progression of symptoms- completed stroke or
stroke in evolution
History of previous TIA’s and amaurosis fugax
History of chronic hypertension and diabetes mellitus
History of heart conditions like arrhythmias, RHD, and prosthetic
valves
History of seizures and migraine
History of any anticoagulant therapy
History of any hypercoagulable dis. Like sickle cell anaemia
Substance abuse like cocaine or amphetamines

9. Signs and symptoms of MCA stroke
Paralysis of contra lateral face, arm, amd leg along with sensory
impairment of the same area
Motor aphasia
Central aphasia
Conduction aphasia
Homonymous hemianopia
Paralysis of conjugate gaze to the opposite side

10. If stroke occurs prior to the anterior communicating artery it is
usually well tolerated secondary to collateral circulation
Paralysis of contralateral foot and leg
Sensory loss in contralateral foot and leg
Left sided strokes may develop transcortical motor aphasia
Gait apraxia
Urinary incontinence which usually occurs with bilateral damage
in acute phase
Signs and symptoms of ACA stroke

11. THANK YOU !!!