STROKE
DEFINITION <ul><li>Stroke is defined as abrupt onset of a neurologic deficit that is attributable to a focal vascular caus...
INTRODUCTION <ul><li>Stroke is second leading killer worldwide </li></ul><ul><li>Stroke is a neurological damage caused by...
EPIDEMIOLOGY <ul><li>It is occurs in more than 70,00000 individuals per year and results in 1,50000 deaths. </li></ul><ul>...
Classification <ul><li>Stroke </li></ul><ul><li>Hemorrhage  (12%)  </li></ul><ul><li>intraparenchymal </li></ul><ul><li>su...
ETIOLOGY <ul><li>1)  Non modifiable risk factors   </li></ul><ul><ul><li>Age </li></ul></ul><ul><ul><li>Gender </li></ul><...
<ul><li>3)  Potentially modifiable   </li></ul><ul><ul><li>Oral contraceptives </li></ul></ul><ul><ul><li>Migraine </li></...
P athophysiology Ishemic stroke <ul><li>Carotid atherosclerosis </li></ul><ul><li>Progressive accumulation of lipids and i...
<ul><li>Local occlusion </li></ul><ul><li>thrombus formation </li></ul><ul><li>arterial occlusion </li></ul><ul><li>decrea...
<ul><li>leads to depolarization of  the cell  </li></ul><ul><li>influx  of Ca ions </li></ul><ul><li>(+) lipases ,protease...
Haemorrhage stroke <ul><li>Presence of blood in the brain parenchyma ,neurotoxicity of the blood </li></ul><ul><li>Damage ...
SIGNS AND SYMPTOMS <ul><ul><li>Sudden numbness or weakness of face ,arm or leg especially affecting only one side of the b...
DIAGNOSIS <ul><li>EEG,ECG( Atrial fibrillation) </li></ul><ul><li>MRI </li></ul><ul><li>CT Scan-hyperintensity (white) –he...
Management  <ul><li>1)  Pharmacological  </li></ul><ul><li>Acute ischemic stroke </li></ul><ul><ul><li>plasminogen activat...
<ul><li>2)  Non pharmacological treatment </li></ul><ul><li>Speech therapy </li></ul><ul><li>Psychological therapy </li></...
Patient counselling <ul><li>Educate about symptoms that might indicate stroke and other brain disease </li></ul><ul><li>Av...
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Stroke

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Stroke

  1. 1. STROKE
  2. 2. DEFINITION <ul><li>Stroke is defined as abrupt onset of a neurologic deficit that is attributable to a focal vascular cause. </li></ul>
  3. 3. INTRODUCTION <ul><li>Stroke is second leading killer worldwide </li></ul><ul><li>Stroke is a neurological damage caused by reduction of blood flow to the brain .The part of the brain damaged from loss of oxygen is called infarct </li></ul><ul><li>It is also called brain attack </li></ul>
  4. 4. EPIDEMIOLOGY <ul><li>It is occurs in more than 70,00000 individuals per year and results in 1,50000 deaths. </li></ul><ul><li>75% of stroke occurs in elderly patients of age more than 65 years </li></ul>
  5. 5. Classification <ul><li>Stroke </li></ul><ul><li>Hemorrhage (12%) </li></ul><ul><li>intraparenchymal </li></ul><ul><li>subarachnoidal </li></ul><ul><li>Ishemic stroke(88%) </li></ul><ul><li>Atherosclerotic penetrating artery cardiogenic cryptogenic other unusual </li></ul><ul><li>Cerebrovascular diseases disease(20%) embolism(18%) stroke(30%) cause(5%) </li></ul><ul><li>(15%) </li></ul><ul><li>hypoperfusion Atrial fibrillation prothrombic </li></ul><ul><li>atheriogenic emboli valve disease causes </li></ul><ul><li>ventricular thrombi migraine </li></ul><ul><li>vasospasm </li></ul><ul><li>drug abuse </li></ul><ul><li>dissections </li></ul>
  6. 6. ETIOLOGY <ul><li>1) Non modifiable risk factors </li></ul><ul><ul><li>Age </li></ul></ul><ul><ul><li>Gender </li></ul></ul><ul><ul><li>Race </li></ul></ul><ul><ul><li>Family history of stroke </li></ul></ul><ul><ul><li>Low birth weight </li></ul></ul><ul><li>2) Modifiable </li></ul><ul><ul><li>Hypertension </li></ul></ul><ul><ul><li>Atrial fibrillation </li></ul></ul><ul><ul><li>Diabetes </li></ul></ul><ul><ul><li>Cigratte smoking, alcohol </li></ul></ul><ul><ul><li>Sickle cell disease </li></ul></ul><ul><ul><li>Post menopausal hormone therapy </li></ul></ul>
  7. 7. <ul><li>3) Potentially modifiable </li></ul><ul><ul><li>Oral contraceptives </li></ul></ul><ul><ul><li>Migraine </li></ul></ul><ul><ul><li>Drug and alcohol abuse </li></ul></ul><ul><ul><li>Hemostatic and inflammatory factors </li></ul></ul><ul><ul><li>Sleep disorder </li></ul></ul>
  8. 8. P athophysiology Ishemic stroke <ul><li>Carotid atherosclerosis </li></ul><ul><li>Progressive accumulation of lipids and inflammatory cells in the intima of the affected arteries </li></ul><ul><li>Hypertrophy of arterial smooth muscle cells </li></ul><ul><li>Plaque formation </li></ul><ul><li>Stress </li></ul><ul><li>Plaque rupture ,collagen exposure ,platelet aggregation & clot formation </li></ul><ul><li>Clot </li></ul><ul><li>remain in the vessel travel embolism </li></ul>
  9. 9. <ul><li>Local occlusion </li></ul><ul><li>thrombus formation </li></ul><ul><li>arterial occlusion </li></ul><ul><li>decreasing cerebral blood flow </li></ul><ul><li>ishemia </li></ul><ul><li>ishemic cell </li></ul><ul><li>reduction in nutrients </li></ul><ul><li>Depletion of high energy phospahtes (ATP) – maintains membrane integrity </li></ul><ul><li>Extracellular K + Accumulates & Na and H 2 O intracellularly </li></ul><ul><li>Electrolyte imbalance cell swelling & lysis </li></ul>
  10. 10. <ul><li>leads to depolarization of the cell </li></ul><ul><li>influx of Ca ions </li></ul><ul><li>(+) lipases ,proteases, endonucleases ,release of free fatty acids from membrane phospholipids </li></ul><ul><li>accumulation of free fatty acids (arachidonic acids) </li></ul><ul><li>Formation of prostaglandins , leukotrienes, free radicals </li></ul><ul><li>Intracellular acidosis </li></ul><ul><li>occurs in 2-3 hrs </li></ul><ul><li>Cell death </li></ul>
  11. 11. Haemorrhage stroke <ul><li>Presence of blood in the brain parenchyma ,neurotoxicity of the blood </li></ul><ul><li>Damage to the surrounding tissue & hemorrhage volumes >60ml </li></ul><ul><li>mortality at 30 days </li></ul><ul><li>increase in intracranial pressure leads to herniation and death </li></ul>
  12. 12. SIGNS AND SYMPTOMS <ul><ul><li>Sudden numbness or weakness of face ,arm or leg especially affecting only one side of the body </li></ul></ul><ul><ul><li>Confusion trouble in speaking or in understanding others </li></ul></ul><ul><ul><li>Visual disturbances in one or both eyes means blurred or double vision </li></ul></ul><ul><ul><li>Dizziness ,loss of balance and difficulty in walking and coordination </li></ul></ul><ul><ul><li>Severe headache without apparent cause </li></ul></ul><ul><ul><li>Dysarthria. </li></ul></ul>
  13. 13. DIAGNOSIS <ul><li>EEG,ECG( Atrial fibrillation) </li></ul><ul><li>MRI </li></ul><ul><li>CT Scan-hyperintensity (white) –heamorrhage areas </li></ul><ul><li>normal or hypointense (dark)-infarction areas </li></ul><ul><li>Carotid doppler –stenosis in carotid arteries </li></ul><ul><li>Laboratory findings </li></ul><ul><ul><ul><li>1) Complete blood count </li></ul></ul></ul><ul><ul><ul><li>2) Coagulation test- protein c deficiency, anti -phospholipid antibody </li></ul></ul></ul><ul><ul><ul><li>3) Blood lipid test </li></ul></ul></ul><ul><ul><ul><li>4) Measure of cardiac enzymes like troponin, creatinine kinase </li></ul></ul></ul><ul><ul><ul><li>LDH isoenzymes </li></ul></ul></ul>
  14. 14. Management <ul><li>1) Pharmacological </li></ul><ul><li>Acute ischemic stroke </li></ul><ul><ul><li>plasminogen activator (alteplase) with in 3 hrs of onset . Dose -0.9 mg/kg I.V </li></ul></ul><ul><ul><li>aspirin within 48 hrs of onset . Dose -160-325 mg daily started within 48 hrs </li></ul></ul><ul><li>Secondary prevention of ischemic stroke </li></ul><ul><ul><li>antiplatelet therapy </li></ul></ul><ul><ul><ul><li>aspirin 50-325 mg daily </li></ul></ul></ul><ul><ul><ul><li>clopidogrel 75 mg daily </li></ul></ul></ul><ul><ul><ul><li>aspirin 25 mg +dipyridamole 200 mg twice daily </li></ul></ul></ul><ul><ul><li>Anti hypertensive agent </li></ul></ul><ul><ul><li>Statin therapy </li></ul></ul><ul><ul><li>AF , Cardiac source of embolism –warfarin (INR-2.5) </li></ul></ul><ul><ul><li>Heamorrhage stroke </li></ul></ul><ul><ul><ul><li>Nimodipine( Ca channel blockers) </li></ul></ul></ul><ul><ul><ul><li>Carotid stenting </li></ul></ul></ul>
  15. 15. <ul><li>2) Non pharmacological treatment </li></ul><ul><li>Speech therapy </li></ul><ul><li>Psychological therapy </li></ul><ul><li>Stroke rehabilitation </li></ul><ul><ul><li>physical therapy </li></ul></ul><ul><ul><li>occupational therapy </li></ul></ul><ul><ul><li>3) Surgical </li></ul></ul><ul><ul><li>carotid endarterectomy </li></ul></ul><ul><ul><li>EC/IC bypass surgery </li></ul></ul><ul><ul><li>Dipping </li></ul></ul><ul><ul><li>Detachable coil technique </li></ul></ul>
  16. 16. Patient counselling <ul><li>Educate about symptoms that might indicate stroke and other brain disease </li></ul><ul><li>Avoid smoking and use of alcohol </li></ul><ul><li>Regular exercise is advised </li></ul><ul><li>Reduce overweight </li></ul><ul><li>Decrease intake of high cholesterol and fat </li></ul><ul><li>Regular check up of BP, sugar, lipid should be done </li></ul><ul><li>Reduce salt intake </li></ul>

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