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Stroke

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Stroke

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Stroke

  1. 1. http://crisbertcualteros.page.tl STROKE
  2. 2. Stroke occurs when the supply of blood to the brain is either interrupted or reduced Brain does not get enough oxygen or nutrients which causes brain cells to die.
  3. 3. Stroke Classification: Ischemic -Ischemic strokes are the most common ( 80%) of stokes -occur when there is an occlusion of a blood vessel impairing the flow of blood to the brain -Ischemic strokes are divided into: a) thrombotic b) embolic c) systemic hypoperfusion. Hemorrhagic
  4. 4. Red Flags Pain in Acute Stroke Patient:  AMI Aortic Dissection Pneumothorax Limb Ischemia
  5. 5. Low BP in Acute Stroke Patient: Silent MI Infective Endocarditis
  6. 6. Mimics of Stroke: Hypoglycemia Neuropathies/plexopathies Structural Brain Lesion(SDH) Focal Epilepsy with Todd’s Paralysis Migraine Aura Transient Global Amnesia Labyrithine D/O Parkinsons Disease Alcohol Intoxication
  7. 7. Golden Hour: within 3.5 hours  thrombolysis Apply ABC HTN: treat only if BP >220/110
  8. 8. Labs: FBC Renal Panel PT/ PTT Fasting Glucose HBA1C CT brain
  9. 9. Emergencies in Stroke Seizure: <2% of patients -Large cortical stroke -Bleeding -CVT Delirium Intracranial Hemorrhage -Inform Neurosurgery ASAP -Target BP: <160/90 -? hemicraniectomy
  10. 10. Emergencies in Stroke Large Cerebellar Stroke -High risk for posterior fossa compression -Hydrocephalus Potentially Malignant MCA Infarcts Sepsis/DVT/PE
  11. 11. Chronic Strokes TACI PACI LACI POCI
  12. 12. Total anterior circulation syndrome Unilateral motor, sensory deficit, or both affecting at least two of face, arm, and leg Higher cerebral dysfunction, e.g. dysphasia, dyspraxia, neglect, dyscalculia Homonymous hemianopia
  13. 13. Partial anterior circulation syndrome Two of the three components of TACS or pure higher cortical dysfunction or pure motor or sensory deficit not as extensive as for lacunar syndromes
  14. 14. Lacunar syndrome (LACS): Pure motor or pure sensory deficit affecting at least two of face, arm, or leg Sensorimotor deficit Ataxic hemiparesis Dysarthria, clumsy hand syndrome Acute onset movement disorder
  15. 15. Posterior circulation syndrome Isolated hemianopia Brain stem signs Cerebellar ataxia
  16. 16. Mechanism of Stroke Atherosclerosis: - AKA “hardening of the arteries,” -calcified lipid or fatty deposits accumulate circumferentially along the innermost intimal layer of the vessel wall -Atherosclerosis and the development of arterial plaques are the product of a host of independent biochemical processes (oxidation of LDL, formation of fatty streaks, and the proliferation of smooth muscle cells) -As the plaques form, the walls become thick, fibrotic, and calcified -lumen narrows, reducing the flow of blood to the tissues the artery supplies
  17. 17. Thrombus A thrombus is a blood clot (aggregation of platelets and fibrin) formed in response to atherosclerotic lesion or to vessel injury In response to vessel or tissue injury, the blood coagulation system is activated, which initiates the following cascade of processes transforming prothrombin and resulting in a fibrin clot: Prothrombin⇒Thrombin⇒Fibrinogen⇒ Fibrin⇒Fibrin Clot Approximately 33% of all stroke cases are attributed to thrombi.
  18. 18. CVD Cardiovascular diseases: atrial fibrillation and myocardial infarction weaken the cardiac wall and introduce abnormalities in the physiological function of the heartbeat result in reduced systemic pressure and conditions of ischemia.
  19. 19. HTN in Stroke (Ischemic) Not to start anti-HTN in 24hours To aim <140/90 in 2weeks post stroke Lacunar Stroke: AIM: <130/90 With IHD: use bets blocker / ACEI With DM: use ACEI Severe Intracranial Disease: allow SBP 130- 150; to drop BP slowly
  20. 20. Statins in Stroke <75 yo: use high intensity statins ( to drop LDL by 50% -Use atorvastatin or rusovastatin -Moderate intensity ( drop LDL by 30-50%) -AIM: LDL <100 or < 2.6
  21. 21. DM in Stroke AIM HBA1C: <7.0
  22. 22. Anticoagulation in AF Target INR: 2-3 NOAC vs Warfarin Pt with contraincation for warfarin: Aspirin + clopidogrel Pt with Intracranial Stenosis: DAPT x 3/12 then back to single antiplate CHANCE TRIAL: Aspirin + Plavix x 3/52 then LIFELONG Aspirin
  23. 23. Sources: Medscape Harrisons Oxford Google

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