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[object Object],[object Object],[object Object],[object Object],[object Object],Stroke Heart attack  Arrhythmias Heart failure  Valvular disease
Everything you ever wanted to know about stroke  (but were afraid to ask) Timothy Lukovits, M.D.
stroke
Objectives ,[object Object],[object Object]
How is a stroke different from a heart attack? ,[object Object],[object Object],[object Object],[object Object],[object Object]
 
Why is heart attack easier to recognize than stroke ? ,[object Object],[object Object],[object Object],[object Object],[object Object]
Copyright restrictions may apply. Pancioli, A. M. et al. JAMA 1998;279:1288-1292. Respondents unable to name  1 warning sign or risk factor for stroke
Which of the following are warning signs of stroke? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],Is heart attack easier to diagnose than stroke?
 
MRI with diffusion weighted imaging Isolated weakness right index finger JS Kim, Neurology, 2002
Where is the stroke?
 
CT scan of arteries of  neck and head
[object Object],[object Object],[object Object],[object Object],Are the causes of heart attack and stroke different?
There are many potential  causes of stroke
Stroke is not just a brain disease and often the brain is just an innocent bystander ,[object Object],[object Object]
How is a Cardiologist different  than a Neurologist ,[object Object],[object Object],[object Object],[object Object]
Case ,[object Object],[object Object],[object Object]
 
 
 
 
[object Object],[object Object],[object Object],[object Object]
How are heart attack and stroke SIMILAR? ,[object Object],[object Object]
Kidwell 2004
You need to call 911 ASAP for both heart attack and stroke! ,[object Object],[object Object],[object Object],[object Object]
 
[object Object],[object Object]
 
 
4:49 PM artery is opened
 
 
[object Object]
 
Improving Stroke Care at DHMC PREPARED INDIVIDUALIZED CARE PROTOCOLS TO DECREASE ERRORS A TEAM APPROACH RAPID EVALUATION
Ways everyone here  can prevent a stroke ,[object Object],[object Object]
 
 
10y risk 88% !
10y risk 13% !
[object Object]
 
 
 
HJM Barnett 1999
Copyright restrictions may apply. Barnett, H. J. M. et al. Arch Neurol 2000;57:40-45. The medical and surgical 5-year Kaplan-Meier curves of freedom from ipsilateral stroke and perioperative stroke and death indicate a 5.9% difference favoring endarterectomy at 5 years in the Asymptomatic Carotid Atherosclerosis Study (ACAS)
Copyright ©2005 American Heart Association Alamowitch, S. et al. Stroke 2005;36:27-31 Kaplan-Meier 5-year risks of ipsilateral ischemic stroke for NASCET patients according to gender and degree of internal carotid artery stenosis in the medical and surgical groups
 
 
18/111 (16%) received  t-PA Average cost for transportation $4,623
2004: 144 pts Rx t-PA 50% had t-PA started at 1 of 47 referring hospitals >50% of these have <60 beds
 
Meyer 2005
MGH  TeleStroke
Effectiveness of Stroke Prevention Absolute risk reduction in a year: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Schaebitz W-R, 2000
 
anticoag RG Hart 2003
Stroke Diagnosis 40 years ago
Stroke Warning Signs ,[object Object],[object Object],[object Object],[object Object],[object Object]
What is a TIA ? ,[object Object],[object Object],[object Object],[object Object]
ABCD 2  Tool   risk of stroke following TIA A Age> or = 60 1 B Blood pressure >140/90 1 C Clinical features unilateral weakness 2 speech impairment  1 D 2 Duration > 60 min 2 10-59 min 1 Diabetes 1
 
 
A B C D E F Systolic BP* 95-105 130-148 130-148 130-148 130-148 130-148 Diabetes No No Yes Yes Yes Yes Cigarettes No No No Yes Yes Yes Prior Atrial Fib. No No No No Yes  Yes Prior CVD No No No No No Yes Estimated 10-year stroke risk in 55-year-old adults according to levels of various risk factors  (FHS).  Source: Wolf et al., Stroke.1991;22:312-318. *BP in millimeters of mercury (mmHg)
Which action would you take if you thought someone was having a heart or stroke? ,[object Object],[object Object],[object Object],[object Object],[object Object]
Which action would you take if you thought someone was having a heart or stroke? ,[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object]
CT scan: ischemic stroke
Intracerebral hemorrhage  at 1 hour and 6 hours
[object Object],[object Object]
High resolution MRI to identify the  unstable  plaque Chu B, Circulation 2005
[object Object]
 
Like with heart disease, the treatment and prevention of stroke needs to be individualized! ,[object Object]
 
11/30/06

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