This lecture describes the pathology of stroke, the types of stroke, gross morphology and microscopic changes in stroke, transient ischemic attack, ischemic stroke, hemorrhagic stroke, etiopathogenesis of stroke and infarcts of stroke.

1. BY: MS. SAILI GAUDE
PRINCIPAL
SHIVAM COLLEGE OF NURSING, AMIRGADH

2. DEFINITIONS
• Episodes of focal brain dysfunction due to focal ischemia or infarction
• Common medical emergency

3. CLASSIFICATION
• 1)TIA-Transient Ischemic Attack
• 2) Progressing stroke
• 3) Completed stroke

4. 1)TRANSIENT ISCHEMICATTACK
• Describes patients whose symptoms lasts for few seconds or minutes and resolves
within 24 hours.
• Symptoms are due to transient temporary impairment of blood flow to a specific
part of the brain
• It is an indication that a complete stroke may take place soon

5. 2) PROGRESSING STROKE
• Also called stroke in evolution
• Where the symptoms of stroke worsen from time of stroke
• This may occur as a result of increase in size of infarction or hemorrhage

6. 2) COMPLETED STROKE
• Describes stroke where the focal hypoxic defect persists but does not progress any
further

7. PATHOLOGIC CHANGES
• 1) Hypoxic encephalopathy : diffuse hypoxia is
present. Patient may recover without damage
• 2) Cerebral Infarction : Localised area of tissue
necrosis due to occlusion of blood supply.
• 3) Red infarct – multiple petechial hemorrhage
is seen
• 4) Pale infarct – associated with ischemic injury

8. ETIPATHOGENESIS
• ISCHEMIC STROKE
• Large artery thrombosis
• Small artery thrombosis
• Cardiogenic embolic stroke
• Cryptogenic stroke (no cause)
• Cocaine use
• Coagulopathies

9. ETIPATHOGENESIS
• HEMORRHAGIC STROKE
• Intracerebral hemorrhage
• Subarachnoid hemorrhage
• Cerebral aneurysm
• Arterio venous malformations

10. ISCHAEMIC STROKE
• Disruption of blood flow due to obstruction leads to
complex series of events called the ischemic cascade
• The ischemic cascade starts when the neurons can
no longer withstand O2 deprivation, membrane
pump that maintain electrolyte balance fails and
cells stop functioning

11. HEMMORHAGIC STROKE
• Pathologic changes depends on the type of cerebro vascular disease.
• Here normal brain metabolism is disrupted by the brain getting exposed to
blood due to hemorrhage
• It can occur due to :
• 1. Increased ICP
• 2. Secondary ischemia of the brain due to reduced perfusion pressure
• 3.Vasospasm of the blood vessels

13. GROSS MORPHOLOGY
• Single or multiple small cavity like infarction are seen
• Lake like spaces 1.5 cm wide present in the white mater and grey mater
• Can be clinically silent or cause severe neurologic deficit

14. MICROSCOPIC
• Cavities with loss of tissues are scattered with fat laden macrophages surrounded
by gliosis
• Hemorrhage infarct have extravasation and resorption of blood
• Increased intracerebral hematomas