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Stroke (1)

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Stroke (1)

  1. 1. STROKE
  2. 2.  Introduction  Statistics  Symptoms  Diagnosis  Treatment  Prevention  Conclusion  Case study  References CONTENTS
  3. 3. INTRODUCTION  Stroke – blood flow to brain obstructed - lack of O2 in brain CLASSIFICATION Ischemic stroke Thrombotic stroke Embolic stroke Hemorrhagic stroke Intracerebral hemorrhage Subarachnoid hemorrhage
  4. 4. Figure 1: Thrombotic stroke Figure 2: Embolic stroke Figure 3: Cerebral hemorrhage
  5. 5. STATISTICS  Kills 130 000 Americans each year  759 000 people in US affected every year, 610 000 are first time strokes Stroke – third largest cause of death in Malaysia  Affects 40 000 people  2005 – 17 907 patients admitted  2006 – 52 000 patients admitted
  6. 6. SYMPTOMS Figure 4: Part & function of brain  Patients encounter problem in:  Movement  Communication  Sight  Numbness/paralysis  Headache
  7. 7. (A) Physical Examination Demographic data Vital signs History taking Motor assessment Sensory assessment Cranial assessment DIAGNOSIS
  8. 8. (B) Lab & radiological investigation 1. Blood test 2. Brain imaging test 3. Heart & Blood vessel test 5. Electrocardiogram 4. Leg ultrasound 6. Transcranial Doppler (TCD)
  9. 9. • High cholesterol, sugar level, blood clotting time 1.Blood test • CT Scan - detect bleeding in brain (hemorrhagic stroke) • MRI – detect damaged brain tissue • MRA (Magnetic Resonance Angiography) – visualize narrowing blood vessel 2. Brain Imaging Test • Carotid ultrasonography- clotting in arteries leading to brain • Catheter angiography (arteriography) 3. Heart & Blood Vessel Test
  10. 10. Figure 5: CT Scan result
  11. 11. Figure 6: (a) Carotid Ultrasound (b) Result(normal) (c) Result (narrowing) (a) (b) (c)
  12. 12. • Identify problem with electrical conduction of heart • Regular heart beat rhythmic pattern smooth blood flow • Defect arrhythmia form blood clot stroke 5. Electrocardiogram (ECG) • Detect blood clot in deep vein in legs • Clot movement to brain leads to stroke 4. Leg Ultrasound • Sound waves – measure blood flow blood vessel of hemorrhagic area 6. Transcranial Doppler (TCD)
  13. 13. Figure 7: (a) Leg Ultrasound (b)Result
  14. 14. Figure 8: Result of Electrocardiogram (ECG)
  15. 15. (A) MEDICATION 1. Alteplase (tissue plasminogen activator- TPA) Injected to vein in arm Given 4½ hour after onset of symptoms Dissolve blood clot – restore blood flow 2. Anticoagulant Drugs to thin blood Ex: Aspirin, Heparin, Warfarin 3. Statin Block enzyme in liver Reduce cholesterol in blood TREATMENT
  16. 16. (B) SURGERY 1. Carotid endarterectomy Incision in neck open carotid artery remove fatty acids 2. Craniotomy Small section of skull cut away Remove blood clot / repair burst in blood vessel
  17. 17. Figure 9: Carotid Endarterectomy
  18. 18. Figure 10: Craniotomy
  19. 19. Steps Diet (low fat, high fiber) Quit smoking & alcohol intake Controlling diabetes Maintain healthy weight Exercise Avoiding illicit drugs PREVENTION
  20. 20. COMPLICATIONS 1. Dysphagia Interruption in normal swallowing Small particles enter respiratory tract Prevention: Feeding tube 2. Hydrocephalus Too much CSF in brain cavities Hemorrhagic stroke- stop CSF draining- accumulated Prevention: placing tube into brain 3. Deep Vein Thrombosis (DVT) Slow blood flow in veins – increase BP Blood clot in leg Prevention: 1. anti-clotting medicines 2. Compression stocking
  21. 21. • Stroke - sudden death of brain cells due to lack of oxygen • Caused by blockage of blood flow / rupture of artery to the brain • Symptoms: weakness / paralysis on one side of the body difficulty with balance, speaking, swallowing • Clot-busting drugs like TPA can be used to reverse a stroke • Prevention - minimizing risk factors (controlling high blood pressure, high cholesterol, diabetes) CONCLUSION
  22. 22. CASE STUDY Patient’s detail  54 year old female, indian  Hemorrhagic stroke and suffered from left hemiplegia  No major improvements were noted for almost 3 years
  23. 23. Investigation  MRI of brain showed chronic infarct in the right fronto- parietal and thalamocapsular regions  No acute infarct was seen  The patient had left sided hemiplegia, unable to sit, stand and walk  Neuropsychological assessment showed speed of processing and reaction time was impaired
  24. 24.  Abstraction and fluency impaired  Deficits in working memory, problem solving, sequencing, judgment and set shifting  Her visuoconstructive ability, visual memory and learning were impaired
  25. 25. Treatment  Stem cell therapy - autologous bone marrow and allogeneic cord blood stem cell transplantation
  26. 26. Figure 11: Comparison of brain before and after therapy
  27. 27. • PubMed Health, (2013), Classification of stroke, Viewed on 27th February 2013, http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001740/ • WebMD, (2013), Stroke, Viewed on 27th February 2013, http://www.webmd.com/stroke/guide/default.htm • Mayoclinic, (2012), Symptoms, Viewed on 27th February 2013, http://www.mayoclinic.com/health/stroke/DS00150/DSECTION=sym ptoms • NASAM, (2013), Statistics, Viewed on 27th February 2013, http://www.nasam.org • MSH, (2010), Statistics, Viewed on 27th February 2013, http://www.msh.org.my • Dexter Morris, (2013),Stroke diagnosis, Viewed on 27thth February 2013, http://www.emedicinehealth.com/stroke REFERENCES
  28. 28. • Jose Vega, (2013),Causes of stroke, Viewed on 27thth February 2013, http://stroke.about.com/od/causesofstroke/ • Mayoclinic, (2012),Stroketreatment and drugs, Viewed on 28thth February 2013, http://www.mayoclinic.com/health/stroke/treatments-and-drugs • Stroke center, (2013),Stroke diagnosis and treatment, Viewed on 28thth February 2013, http://www.strokecenter.org/patients/about- stroke/diagnosis-and-treatment/ • NHS, (2012),Stroke condition, Viewed on 28thth February 2013, http://www.nhs.uk/Conditions/Stroke/Pages/treatment • Purandare, C., Belle, V., Shitole, D.G., Joshi, M. (2012), Stem Cell Therapy for Hemorrhagic Stroke: A Single Case Study Report. A Journal of Neuroscience. 2(2): 22-26

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