2. Contents
⢠Objectives
⢠Definition of Stroke
⢠Risk factors of Stroke
⢠Pathophysiology of Stroke
⢠Classification of stroke
⢠Ischemic stroke
⢠Haemorrhagic stroke
⢠Diagnosis
⢠Summary
⢠References
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3. Objectives
By the end of the presentation the students must be able to
1. Define Stroke
2. List Risk factors of Stroke
3. Explain Pathophysiology of Stroke
4. Classify stroke
5. Discuss Ischemic stroke
6. Discuss Haemorrhagic stroke
7. State Diagnosis
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4. Definition
⢠Stroke or CVA results from ischemia to a part of the brain or
hemorrhage into the brain that results in death of brain cells.
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5. Cerebrovascular Accident
Risk Factors
ďśNonmodifiable:
ďśAge â Occurrence doubles each decade >55 years
ďśGender â Equal for men & women; women die more frequently than men
ďśRace â African Americans, Hispanics, Native Americans, Asian Americans --
higher incidence
ďśHeredity â family history, prior transient ischemic attack, or prior stroke
increases risk
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6. ContdâŚ
Controllable Risks with Medical Treatment & Lifestyle Changes:
High blood pressure Diabetes
Cigarette smoking TIA (Aspirin)
High blood cholesterol Obesity
Heart Disease Atrial fibrillation
Oral contraceptive use Physical inactivity
Sickle cell disease Asymptomatic carotid stenosis
Hypercoagulability
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7. Cerebrovascular Accident
Pathophysiology
ďśAtherosclerosis: major cause of CVA
ď§ Thrombus formation & emboli development
ďAbnormal filtration of lipids in the intimal layer of the arterial wall
ďPlaque develops & locations of increased turbulence of blood -
bifurcations
ďIncreased turbulence of blood or a tortuous area
ďCalcified plaques rupture or fissure
ďPlatelets & fibrin adhere to the plaque
ďNarrowing or blockage of an artery by thrombus or emboli
ďCerebral Infarction: blocked artery with blood supply cut off beyond
the blockage
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8. Transient Ischemic Attack
ďśTemporary focal loss of neurologic function
ďśCaused by ischemia of one of the vascular territories of the brain
ďMicro emboli with temporary blockage of blood flow
ďśLasts less than 24 hrs. â often less than 15 mins
ďśMost resolve within 3 hours
ďśWarning sign of progressive cerebrovascular disease
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11. Ischemic â Thrombotic Stroke
ďśLumen of the blood vessels narrow â then becomes
occluded â infarction
ďśAssociated with HTN and Diabetes Mellitus
ď>60% of strokes
ď50% are preceded by TIA
ďLacunar Stroke: development of cavity in place of infarcted
brain tissue â results in considerable deficits â motor
hemiplegia, contralateral loss of sensation or motor ability
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13. Common sites of Atheroscelorosis
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14. Hemorrhagic Stroke
ďś15% of all strokes
ďśResult from bleeding into the brain tissue
itself
ďIntracerebral
ďSubarachnoid
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17. Hemorrhagic-Subarachnoid
ďśCommonly caused by rupture of cerebral aneurysm
(congenital or acquired)
ďSaccular or berry â few to 20-30 mm in size
ďMajority occur in the Circle of Willis
ďśOther causes: Arteriovenous malformation (AVM),
trauma, illicit drug abuse
ďśIncidence: 6-16/100,000
ďśIncreases with age and more common in women
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18. Clinical manifestations
⢠Motor activity
⢠Elimination
⢠Intellectual function
⢠Spatial-perceptual alterations
⢠Personality
⢠Affect
⢠Sensation
⢠Communication
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20. Characteristic motor deficits (contra-lateral)
â˘Loss of skilled voluntary movement
â˘Impairment of integration of movements
â˘Alterations in muscle tone (flaccid â spastic)
â˘Alterations in reflexes (hypo â hyper)
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21. Communication
⢠Patient may experience aphasia when stroke damages the
dominant hemisphere of the brain
ď§Aphasia: total loss of comprehension and use of language
ď§Dysphasia: difficulty with comprehension and use of
language
⢠Dysarthria
ď§Disturbance in the muscular control of speech
ď§Impairments in pronunciation, articulation, and
phonation; NOT meaning or comprehension
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22. Affect
⢠May have difficulty controlling their emotions
⢠Emotional responses may be exaggerated or unpredictable
⢠Depression , impaired body image and loss of function can
make this worse
⢠May be frustrated by mobility and communication problems
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23. Intellectual function
â˘Memory and judgment may be impaired
â˘Left-brain stroke: more likely to result in memory
problems related to language
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25. Spatial-Perceptual Alterations
⢠Stroke on the right side of the brain is more likely to cause problems
in spatial-perceptual orientation
⢠However, this may occur with left-brain stroke
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26. Spatial-perceptual problems may be divided into four
categories
1. Incorrect perception of self and illness (may deny
illness or body parts)
2. Erroneous perception of self in space (e.g., neglect all
input from affected side; distance judgement)
3. Inability to recognize an object by sight, touch, or
hearing
4. Inability to carry out learned sequential movements
on command
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27. Elimination
⢠Most problems with elimination occur initially and are
temporary
⢠Prognosis for normal bladder function is excellent
when only one hemisphere of brain is affected
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29. Summary
Define stroke
1.List Risk factors of Stroke
1.Explain Pathophysiology of Stroke
Classify stroke
Discuss Ischemic stroke
Discuss Haemorrhagic stroke
State Diagnosis
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30. References
⢠Davidson Principles Of Medicine & Practice Of Medicine .20th Ed.
⢠Harrisonâs PRINCIPLES OF INTERNAL MEDICINE Seventeenth Edition
⢠https://www.cdc.gov/stroke/types_of_stroke.htm
⢠https://www.nhs.uk/conditions/stroke/
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