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IMS
Seminar
Stroke
Mohammed sulaiman Alkahmous
Case Scenario
Male , 50 years of age, who presented at the OPD on 20th August ’05 with
tingling/numbness of the upper and lower limbs on the left side. This had begun
10 days earlier and was progressively getting worse. It began with weakness of the
limbs on the left side and he was now unable to move them. An episode of severe
anxiety and fear had precipitated this onset of symptoms. It had progressed further
and now he had slurred speech.
2 months earlier he had developed hypertension. The symptoms at that point were
a similar tingling and numbness on the left upper and lower limbs. This too, was
precipitated by an episode of fear. He was put on antihypertensive medication
which helped and he stopped this on his own after a while.
There were no other CNS symptoms of unconsciousness, projectile vomiting,
convulsions, fever or head injury.
There was no Past History of diabetes, or ischemic heart disease as possible
precipitating factors.
Motor Right Left
Tone: UL Normal Increased ++
Tone : LL Normal Increased ++
Muscle Power: UL Normal
Proximal Muscles: Power 1/5
Distal Muscles: Power 4/5
Muscle Power: LL Normal Complete loss of power: 0/5
Reflexes: UL Normal Hypertonic ++
Reflexes: LL Normal Hypertonic ++
Sensory Normal
Loss of fine touch in Upper and
Lower limbs
Objectives
• What is the differential diagnosis?
• What are the investigation?
• What is the significance of the examination?
• What is the significance of the history?
• What is the treatment?
Rosier Scale For Stroke Assessment
What Is The Differential Diagnosis?
• Acute Hypoglycemia
• Brain Neoplasms
• Encephalitis
• Headache, Migraine
• Hypernatremia in the
Emergency
• Hyperosmolar Hyperglycemic
Nonketotic Coma
• Hypertensive Emergencies
• Hyponatremia
• Labyrinthitis Ossificans
• Meningitis
• Stroke, Ischemic
• Subarachnoid Hemorrhage
• Subdural Hematoma
• Transient Ischemic Attack
What Is The Most Likely Diagnosis?
Overview
STROKE
when the blood supply to part of
your brain is interrupted or
reduced, depriving brain tissue of
oxygen and nutrients. Within
minutes, brain cells begin to die.
Ischemic stroke
(80%)
arteries to your
brain become
narrowed or
blocked, causing
severely reduced
blood flow
(ischemia).
Hemorrhagic
stroke
blood vessel in
your brain leaks
or ruptures.
Thrombotic
stroke. A thrombotic
stroke occurs when
a blood clot
(thrombus) forms in
one of the arteries
that supply blood to
your brain.
Embolic stroke
when a blood clot or
other debris forms
away from your
brain
Watch for these signs and symptoms if you think
you or someone else may be having a stroke!
• Trouble with speaking and understanding. .
• Paralysis or numbness of the face, arm or leg.
• Trouble with seeing in one or both eyes.
• Headache.
• Trouble with walking.
• If you notice any signs or symptoms of a stroke Think "FAST"
FAST
• Face. Ask the person to smile. Does one side of the face
droop?
• Arms. Ask the person to raise both arms. Does one arm
drift downward? Or is one arm unable to rise up?
• Speech. Ask the person to repeat a simple phrase. Is his or
her speech slurred or strange?
• Time. If you observe any of these signs immediately try to
treat
Ischemic Stroke Treatment
• Emergency treatment with medications. Therapy with clot-busting drugs
must start within 4.5 hours if they are given into the vein — and the
sooner, the better. Quick treatment not only improves your chances of
survival but also may reduce complications. You may be given:
• Intravenous injection of tissue plasminogen activator (tPA). (GOLD
STANDARD)
• Emergency endovascular procedures:
1. Medications delivered directly to the brain.
2. Removing the clot with a stent retriever.
3. Carotid endarterectomy.
4. Angioplasty and stents
Hemorrhagic stroke Treatment
Treatment of hemorrhagic stroke focuses on controlling your bleeding and reducing
pressure in your brain. You might also need surgery to help reduce future risk.
• Emergency measures. If you take warfarin (Coumadin, Jantoven) or anti-platelet
drugs such as clopidogrel (Plavix) to prevent blood clots, you may be given drugs
or transfusions of blood products to counteract the blood thinners' effects. You
may also be given drugs to lower pressure in your brain (intracranial pressure),
lower your blood pressure, prevent vasospasm or prevent seizures.
• Surgical blood vessel repair.
1. Surgical clipping.
2. Coiling (endovascular embolization).
3. Surgical AVM removal
4. Stereotactic radiosurgery.
Coiling Clipping
Post Stroke Management
• Most stroke survivors receive treatment in a rehabilitation program. Your
doctor will recommend the most rigorous therapy program you can handle
based on your age, overall health and degree of disability from your stroke.
Your doctor will take into consideration your lifestyle, interests and
priorities, and the availability of family members or other caregivers.
• Every person's stroke recovery is different. Depending on your condition.
• If you've had an ischemic stroke or TIA, your doctor may recommend
medications to help reduce your risk of having another stroke. These
include:
• Anti-platelet drugs.
• Anticoagulants.
Risk Factors
Medical risk factors
• Blood pressure readings higher than
120/80 millimeters of mercury (mm Hg)
• Cigarette smoking or exposure to
secondhand smoke
• High cholesterol
• Diabetes
• Obstructive sleep apnea
• Cardiovascular disease, including heart
failure, heart defects, heart infection or
abnormal heart rhythm
• Personal or family history of stroke, heart
attack or transient ischemic attack.
Lifestyle risk factors
• Being overweight or obese
• Physical inactivity
• Heavy or binge drinking
• Use of illicit drugs such as cocaine and
methamphetamines
THANKS
• Sources:
https://www.mayoclinic.org/diseases-
conditions/stroke/diagnosis-treatment/drc-
20350119
https://www.mayoclinic.org/diseases-
conditions/stroke/symptoms-
http://www.strokecenter.org/patients/strok
e-diagnosis/lab-tests-and-procedures/
http://www.strokecenter.org/patients/strok
e-diagnosis/lab-tests-and-procedures/
Mohammed sulaiman Alkahmous
Alfarabi college of medicine

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Stroke

  • 2. Case Scenario Male , 50 years of age, who presented at the OPD on 20th August ’05 with tingling/numbness of the upper and lower limbs on the left side. This had begun 10 days earlier and was progressively getting worse. It began with weakness of the limbs on the left side and he was now unable to move them. An episode of severe anxiety and fear had precipitated this onset of symptoms. It had progressed further and now he had slurred speech. 2 months earlier he had developed hypertension. The symptoms at that point were a similar tingling and numbness on the left upper and lower limbs. This too, was precipitated by an episode of fear. He was put on antihypertensive medication which helped and he stopped this on his own after a while. There were no other CNS symptoms of unconsciousness, projectile vomiting, convulsions, fever or head injury. There was no Past History of diabetes, or ischemic heart disease as possible precipitating factors.
  • 3. Motor Right Left Tone: UL Normal Increased ++ Tone : LL Normal Increased ++ Muscle Power: UL Normal Proximal Muscles: Power 1/5 Distal Muscles: Power 4/5 Muscle Power: LL Normal Complete loss of power: 0/5 Reflexes: UL Normal Hypertonic ++ Reflexes: LL Normal Hypertonic ++ Sensory Normal Loss of fine touch in Upper and Lower limbs
  • 4. Objectives • What is the differential diagnosis? • What are the investigation? • What is the significance of the examination? • What is the significance of the history? • What is the treatment?
  • 5. Rosier Scale For Stroke Assessment
  • 6. What Is The Differential Diagnosis? • Acute Hypoglycemia • Brain Neoplasms • Encephalitis • Headache, Migraine • Hypernatremia in the Emergency • Hyperosmolar Hyperglycemic Nonketotic Coma • Hypertensive Emergencies • Hyponatremia • Labyrinthitis Ossificans • Meningitis • Stroke, Ischemic • Subarachnoid Hemorrhage • Subdural Hematoma • Transient Ischemic Attack
  • 7. What Is The Most Likely Diagnosis?
  • 8. Overview STROKE when the blood supply to part of your brain is interrupted or reduced, depriving brain tissue of oxygen and nutrients. Within minutes, brain cells begin to die. Ischemic stroke (80%) arteries to your brain become narrowed or blocked, causing severely reduced blood flow (ischemia). Hemorrhagic stroke blood vessel in your brain leaks or ruptures. Thrombotic stroke. A thrombotic stroke occurs when a blood clot (thrombus) forms in one of the arteries that supply blood to your brain. Embolic stroke when a blood clot or other debris forms away from your brain
  • 9. Watch for these signs and symptoms if you think you or someone else may be having a stroke! • Trouble with speaking and understanding. . • Paralysis or numbness of the face, arm or leg. • Trouble with seeing in one or both eyes. • Headache. • Trouble with walking. • If you notice any signs or symptoms of a stroke Think "FAST"
  • 10. FAST • Face. Ask the person to smile. Does one side of the face droop? • Arms. Ask the person to raise both arms. Does one arm drift downward? Or is one arm unable to rise up? • Speech. Ask the person to repeat a simple phrase. Is his or her speech slurred or strange? • Time. If you observe any of these signs immediately try to treat
  • 11. Ischemic Stroke Treatment • Emergency treatment with medications. Therapy with clot-busting drugs must start within 4.5 hours if they are given into the vein — and the sooner, the better. Quick treatment not only improves your chances of survival but also may reduce complications. You may be given: • Intravenous injection of tissue plasminogen activator (tPA). (GOLD STANDARD) • Emergency endovascular procedures: 1. Medications delivered directly to the brain. 2. Removing the clot with a stent retriever. 3. Carotid endarterectomy. 4. Angioplasty and stents
  • 12.
  • 13. Hemorrhagic stroke Treatment Treatment of hemorrhagic stroke focuses on controlling your bleeding and reducing pressure in your brain. You might also need surgery to help reduce future risk. • Emergency measures. If you take warfarin (Coumadin, Jantoven) or anti-platelet drugs such as clopidogrel (Plavix) to prevent blood clots, you may be given drugs or transfusions of blood products to counteract the blood thinners' effects. You may also be given drugs to lower pressure in your brain (intracranial pressure), lower your blood pressure, prevent vasospasm or prevent seizures. • Surgical blood vessel repair. 1. Surgical clipping. 2. Coiling (endovascular embolization). 3. Surgical AVM removal 4. Stereotactic radiosurgery. Coiling Clipping
  • 14. Post Stroke Management • Most stroke survivors receive treatment in a rehabilitation program. Your doctor will recommend the most rigorous therapy program you can handle based on your age, overall health and degree of disability from your stroke. Your doctor will take into consideration your lifestyle, interests and priorities, and the availability of family members or other caregivers. • Every person's stroke recovery is different. Depending on your condition. • If you've had an ischemic stroke or TIA, your doctor may recommend medications to help reduce your risk of having another stroke. These include: • Anti-platelet drugs. • Anticoagulants.
  • 15. Risk Factors Medical risk factors • Blood pressure readings higher than 120/80 millimeters of mercury (mm Hg) • Cigarette smoking or exposure to secondhand smoke • High cholesterol • Diabetes • Obstructive sleep apnea • Cardiovascular disease, including heart failure, heart defects, heart infection or abnormal heart rhythm • Personal or family history of stroke, heart attack or transient ischemic attack. Lifestyle risk factors • Being overweight or obese • Physical inactivity • Heavy or binge drinking • Use of illicit drugs such as cocaine and methamphetamines

Editor's Notes

  1. Mohammed sulaiman Alkahmous
  2. Mohammed sulaiman Alkahmous
  3. Mohammed sulaiman Alkahmous
  4. Mohammed sulaiman Alkahmous
  5. Mohammed sulaiman Alkahmous
  6. Mohammed sulaiman Alkahmous
  7. Mohammed sulaiman Alkahmous
  8. Mohammed sulaiman Alkahmous
  9. Mohammed sulaiman Alkahmous
  10. Mohammed sulaiman Alkahmous
  11. Mohammed sulaiman Alkahmous
  12. Mohammed sulaiman Alkahmous
  13. Mohammed sulaiman Alkahmous
  14. Mohammed sulaiman Alkahmous
  15. Mohammed sulaiman Alkahmous
  16. Mohammed sulaiman Alkahmous