2. Objectives
• Identify sign and symptoms of anterior and posterior stroke
• Discuss the cause and risk factor of stroke
• Investigate and do primary management of stroke
3. INTRODUCTION
• A stroke is the acute neurologic injury that occurs as a result of
pathologic processes such as ischemia and hemorrhage.
• When blood flow is quickly restored, brain tissue can recover fully and
the patient’s symptoms are transient: this is called a transient
ischemic attack (TIA).
4. CLASSIFICATION
Stroke is classified into two major types:
• Brain ischemia due to thrombosis, embolism, or systemic hypoperfusion
• Brain hemorrhage due to intra-cerebral hemorrhage (ICH) or subarachnoid
hemorrhage (SAH)
5. Clinical Features
• Weakness:
❑Sudden and unilateral weakness which progresses rapidly in a hemiplegic manner
❑Reflexes are initially reduced and later tone and reflexes are increased
❑Upper motor neuron facial weakness
• Speech disturbance: Dysphasia and dysarthria
• Visual deficit: Monocular blindness caused by reduced blood flow in the internal carotid or
ophthalmic arteries whereas ischemia in occipital cortex or optic tracts causes hemianopia
• Visuo-spatial dysfunction: Damage to the non-dominant cortex often results in contralateral
sensory or visual neglect and apraxia
• Ataxia
• Headache
• Seizure and coma
6. On the basis of vascular territories affected:
• Total Anterior Circulation Syndrome(TACS)
• Partial Anterior Circulation Syndrome(PACS)
• Lacunar Syndrome (LACS)
• Posterior Circulation Syndrome(POCS)
7. Diagram of a cerebral hemisphere in coronal section showing
the territories of the major cerebral vessels that branch from
the internal carotid arteries.
8. Anterior Circulation stroke
• unilateral occlusion occurs, it can cause contra lateral sensory and
motor symptoms in the lower extremity, with sparing of the hands
and face.
9. Middle cerebral artery
• most commonly involved in stroke
• typically presents with hemiparesis, facial plegia, and sensory loss
contralateral to the affected cortex.
10. Posterior circulation stroke
• Crossed neurologic deficits (e.g., ipsilateral cranial nerve deficits with
contralateral motor weakness) may indicate a brainstem lesion.
11. RISK FACTORS
Fixed risk factors
• Age
• Gender (male > female except at extremes of age)
• Race (Afro-Caribbean > Asian > European)
• Previous vascular event: Myocardial infarction, Stroke , Peripheral
vascular disease
• Heredity
• Sickle cell disease
• High fibrinogen
13. CAUSES
Brain ischemia
⮚Thrombosis
1. Large vessel disease — Large vessels include both the extracranial (common
and internal carotids, vertebral) and intracranial arterial system (Circle of Willis
and proximal branches)
2. Small vessel disease — Small vessel disease affects the intracerebral arterial
system, specifically penetrating arteries that arise from the distal vertebral
artery, the basilar artery, the middle cerebral artery stem, and the arteries of
the circle of Willis
14. ❑Embolism — Embolic strokes are divided into four categories
1. Those with a known source that is cardiac
2. Those with a possible cardiac or aortic source based upon
transthoracic and/or transesophageal echocardiographic findings
3. Those with an arterial source (artery to artery embolism)
4. Those with a truly unknown source in which tests for embolic sources are
negative
15. • Systemic hypoperfusion
❑The reduced perfusion can be due to cardiac pump failure caused by cardiac
arrest or arrhythmia, or to reduced cardiac output related to acute myocardial
ischemia, pulmonary embolism, pericardial effusion, or bleeding
20. Antithrombolytic therapy
1. Aspirin – 300 mg daily – immediately given unless rt- PA has been
given; reduces the risk of recurrence
2. Heparin – Reduces risk of early ischemic recurrence and venous
thromboembolism
- Increased risk of IC bleeding
22. Investigations
1. Brain imaging – CT/ MRI
• CT – demonstrate intracranial hemorrhage within first few hours ; can
be performed within 24 hours
• MRI – More sensitive than CT ;can distinguish hemorrhagic from
ischemic stoke even after several weeks after onser
23. Indications for immediate CT
• Patient on anticoagulants or with abnormal coagulation
• Consideration for reperfusion (thrombolysis) or immediate
anticoagulants
• Deteriorating conscious level or rapidly progressing deficit
• Suspected cerebellar hematomas to exclude hydrocephalus
