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Stroke neurosurgery

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Stroke neurosurgery

  1. 1. Neurosurgery-Stroke Haybusak university 5th year medicine dr. Avet Petrosyan
  2. 2. D E F I N I T I O N • Stroke is defined by the World Health Organization as a clinical syndrome consisting of ‘rapidly developing clinical signs of focal disturbance of cerebral function, lasting more than 24 h or leading to death with no apparent cause other than that of vascular origin’.
  3. 3. C L A S S I F I C A T I O N O F S T R O K E Hemorrhagic (20% of Strokes) Thrombotic 50% Embolic 30% Intracerebral Hemorrhage 15% Subarachnoid Hemorrhage 5% Ischemic (80% of Strokes)
  4. 4. Each year nearly 800,000 people have a new or recurrent stroke A stroke happens every 40 seconds Stroke is the fifth leading cause of death in the U.S Every 4 minutes someone dies from stroke Up to 80 percent of strokes can be prevented Stroke is the leading cause of adult disability in the U.S S T R O K E B Y N U M B E R S
  5. 5. T Y P E S O F S T R O K E 80% Ischemic 20 % hemorrhagic
  6. 6. E V A L U A T I O N O F S T R O K E • 1. symptoms • 2. Localize of lesion • 3. type of stroke • 4. cause • 5. The clinical assessment
  7. 7. T H E M A I N S Y M P T O M S
  8. 8. I N V E S T I G A T I O N S • full blood count, serum electrolytes, renal function tests, cardiac enzymes, and coagulation studies • Blood sugar • An electrocardiogram (ECG) : arrhythmias and myocardial infarction • Echocardiography : valve disease and intra-cardiac clot
  9. 9. N E U R O I M A G I N G • Brain CT scan: sensitive to the intracranial blood • MRI: better at detecting posterior fossa lesions Pons or cerebellum • carotid ultrasound • doppler ultrasound: speed and direction of the blood stream
  10. 10. P O O R P R O G N O S T I C F A C T O R S • Accompanying fever • Hypotension and severe hypertension • Low oxygen saturation • Hyperglycaemia and hypoglycemia • heart failure • severity of hemiparesis
  11. 11. M A N A G E M E N T : A I R W A Y A N D V E N T I L A T I O N • Foreign Bodies, dentures, tongue • Indications for intubation: - hypoxia (pO2 <60 mm Hg or PCO2 >50 mm Hg) - risk of aspiration with or without impairment of arterial oxygenation • elective tracheostomy: after 2 weeks of prolonged coma or pulmonary complications
  12. 12. M A N A G E M E N T : V O L U M E S T A T U S • Hypovolemia has been associated with worse outcome and increased mortality in acute ischemic stroke • Isotonic saline, typically 3 litres per day is given • Do not give hypotonic solution, eg 5% Dextrose in water, as it may worsen cerebral oedema
  13. 13. M A N A G E M E N T : T E M P E R A T U R E • Fever worsens outcome: • 1. increased metabolic demands • 2.enhanced release of neurotransmitters • for every 1°C rise in temp, risk of poor outcome doubles • Greatest effect in the first 24 hours • Treat aggressively with acetaminophen
  14. 14. M A N A G E M E N T : B L O O D P R E S S U R E • lowering of blood pressure by approximately 15 percent during the first 24 hours after stroke onset is suggested 1. Labetalol IV 2. Nicardipine infusion 3. oral agents (captopril, calcium channel blockers) • Systolic blood pressure > 185 and diastolic > 110 is a contraindication for thrombolysis
  15. 15. M A N A G E M E N T : B L O O D P R E S S U R E Reducing formation of brain edema lessening hemorrhagic transformation preventing early recurrent stroke
  16. 16. M A N A G E M E N T : G L Y C A E M I C C O N T R O L Hyperglycemia may augment brain injury by several mechanisms including: • increased tissue acidosis • free radical generation • increased blood brain barrier permeability
  17. 17. M A N A G E M E N T : G L Y C A E M I C C O N T R O L • Hypoglycemia- Hypoglycemia can cause focal neurologic deficits mimicking stroke • Hypoglycemia (blood glucose <60 mg/dL) should be treated in patients with acute ischemic stroke
  18. 18. A N T I C O A G U L A N T S • Heparin 5,000 units 12 hourly(or 8hrly) • unfractionated heparin may be considered for prevention of DVT in patients with intracerebral hemorrhage
  19. 19. A N T I P L A T E L E T A G E N T S • Aspirin prevent risk of recurrent by 13% • Aspirin –within 48hrs – reduce risk of mortality/ disability in ischemic stroke • Anti-platelets contraindicated in hemorrhagic stroke
  20. 20. Tissue Plasminogen Activator TPA < first three hours following the onset of symptoms Contraindicated in hemorrhagic stroke T H R O M B O L Y T I C S
  21. 21. M E D I C A L C O M P L I C A T I O N S O F S T R O K E • 85% of patients with stroke • 50% of mortality after the first week of stroke • the most important causes of mortality in the early period following a stroke are cardiac (arrhythmias, myocardial infarction), infections (pneumonia, urosepsis), and venous thrombo-embolism (pulmonary embolus)
  22. 22. M ED IC AL C O M PL IC AT ION S IN H O SPIT AL IZ ED PAT IEN T S W IT H ST R O KE Complications of Immobility • Deep vein thrombosis/pulmonary embolism • Falls • Pressure sores or ulceration Infections • Chest infection- aspiration pneumonia • Urinary tract infection
  23. 23. MEDICAL COMPLICATIONS IN HOSPITALIZED PATIENTS WITH STROKE Pain • Shoulder pain in the weak limb • Central post-stroke pain Neuropsychiatric Disturbances • Depression, anxiety ,Emotional incontinence • Acute confusional states (delirium) Miscellaneous • Cardiac complications (arrhythmia, myocardial ischemia) • Gastrointestinal complications( bleed, Constipation) • Sleep apnea
  24. 24. S U R G I C A L M A N A G E M E N T • Ischemic stroke: A) endovascular interventions: angioplasty and stenting B) carotid endarterectomy C) bypass surgery
  25. 25. • Hemorrhagic stroke: Surgical evacuation of hematoma S U R G I C A L M A N A G E M E N T
  26. 26. S U R G I C A L M A N A G E M E N T • Subarachnoid hemorrhage: Clipping and coiling of aneurysm
  27. 27. • Cerebral edema Decompressive craniectomy S U R G I C A L M A N A G E M E N T
  28. 28. • Intra ventricular hemorrhage /acute hydrocephalus: Ventricular drainage S U R G I C A L M A N A G E M E N T VENTRICLES ventricles catheter
  29. 29. what type of stroke?
  30. 30. what type of stroke?
  31. 31. thank you…

Editor's Notes

  • Once the brain cells die from a lack of oxygen, the part of the body that part of the brain controls is affected through paralysis, language, motor skills, or vision.

    These symptoms usually persists for stroke survivors making routine daily functions extremely difficult.