Understand brain stroke

7. com·pen·di·um
k m pendē m/ə ˈ ə
Noun
a collection of concise but detailed information about
a particular subject, especially in a book or other
publication

9. Four Principles
STROKE is a brain attack.
STROKE is an emergency.

10. Four Principles
STROKE is treatable.
STROKE is preventable.

11. Definitions
Stroke
Clinical syndrome of rapid onset of brain deficits of
lasting more than 24 hours or leading to death

12. Definitions
Transient Ischemic attack (TIA)
Clinical syndrome of rapid onset of brain deficits which
resolves within 24 hours

13. Definitions
Progressive Stroke
A stroke in which the focal neurological deficits worsen
with time
Completed Stroke
A stroke in which the focal neurological deficits persist
and do not worsen with time

15. BRAIN STROKE
Philippines' 2nd
cause of death.
Prevalence of 1%
schemic stroke comprises 70%
hemorrhagic stroke comprises 30%

16. BRAIN STROKE (PH)

17. BRAIN STROKE (PH)
neurologist-to-patient ratio is 1:330,000
67% of neurologists in urban centers

22. Anterior Circulation
Posterior Circulation

23. Types of Stroke

24. Ischemic Stroke
80% of strokes
Arterial occlusion of an intracranial vessel
Two etiological types
Thrombotic
Embolic

25. Etiology of ischemic stroke

26. Etiology of ischemic stroke

27. Etiology of ischemic stroke

28. Thrombotic Stroke
Atherosclerosis is the most common pathology
leading to thrombotic occlusion of blood vessels
Hypercoagulable disorders

29. Etiology of ischemic stroke

30. Blood flow
If zero leads to death of brain tissue within 4-10min
Pathophysiology of Ischemic Stroke

32. Intracerebral Hemorrhage
• Result of chronic hypertension
• Small arteries are damaged due to hypertension
• In advanced stages vessel wall is disrupted and leads
to leakage
• Headache

33. CLINICAL FEATURES

35. History
Onset and progression of neurological symptoms?
History of previous TIAs
History of hypertension & diabetes mellitus
History of heart conditions like arrhythmias, RHD &
prosthetic valves

36. History of seizures & migraine
History of anticoagulant therapy
History of oral contraceptive use
History

37. History of any hypercoagulable disorders like cancer
Substance abuse: cocaine, amphetamines
History

39. General feature
abrupt onset of a focal neurologic deficit
manifestations of stroke are highly variable

40. DIFFERENTIAL DIAGNOSIS

41. Hypoglycemia

42. Space Occupying Lesions

43. SEIZURES AND POST SEIZURE STATES

44. MIGRAINE

45. INVESTIGATION MODALITIES:
BRAIN

48. ISCHEMIC LESION

53. TREATMENT OBJECTIVES
1. MINIMIZE VOLUME OF BRAIN IRREVERSIBLY
DAMAGED
2. PREVENT COMPLICATIONS
3. REHABILITATION
4. REDUCE RISK OF RECCURENCE

55. REHABILITATION
PHYSIOTHERAPY - as early as possible
- prevents contractures, spasticity and
atrophy

56. REHABILITATION
SPEECH THERAPY
IMPROVE QUALITY OF LIFE
WITH MOTOR AIDS

57. PREVENTION
Blood pressure control
Diabetes Management
Lipid Management
Smoking Cessation
Alcohol Moderation

58. PREVENTION
Weight Reduction/Physical Activity
Carotid Artery Interventions

59. PREVENTION
Anti platelet agents /
Anti coagulants
Statins

61. PROGNOSIS
ISCHEMIC STROKE
Mortality rate in first 30 days is 8-12%
First 3 hrs after stroke - GOLDEN PERIOD

62. PROGNOSIS
INTRACEREBRAL HAEMORRHAGE
Mortality rate in first 30 days is almost 50%
Prognosis compared to ischemic type .

64. Four Principles
STROKE is a brain attack.
STROKE is an emergency.
STROKE is treatable.
STROKE is preventable.