Stroke is defined as a sudden loss of brain function caused by an interruption of blood flow to the brain. The document discusses the main types of stroke (ischemic and hemorrhagic), risk factors, clinical features, investigations, management, and rehabilitation. Management involves reperfusion therapy for ischemic strokes, controlling risk factors, preventing recurrence, managing complications, and rehabilitation to improve function.
Is characterized by the sudden loss of blood circulation to an area of the brain, resulting in a corresponding loss of neurologic function. Acute ischemic stroke is caused by thrombotic or embolic occlusion of a cerebral artery and is more common than hemorrhagic stroke.
It can occur
in the carotid
artery of the
neck as well as
other arteries.
When an artery is acutely occluded by thrombus or embolus, the area of the CNS supplied by it will undergo infarction if there is no adequate collateral blood supply.
Surrounding a central necrotic zone, an ‘ischemic penumbra’ remains viable for a time, i.e. it may recover function if blood flow is restored.
CNS ischemia may be accompanied by swelling for two reasons:
● cytotoxic oedema – accumulation of water in damaged glial cells and neurones,
● vasogenic oedema – extracellular fluid accumulation as a result of breakdown of the blood–brain barrier.
In the brain, this swelling may be sufficient to produce clinical deterioration in the days following a major stroke, as a result of a rise in intracranial pressure and compression of adjacent structures.
Is characterized by the sudden loss of blood circulation to an area of the brain, resulting in a corresponding loss of neurologic function. Acute ischemic stroke is caused by thrombotic or embolic occlusion of a cerebral artery and is more common than hemorrhagic stroke.
It can occur
in the carotid
artery of the
neck as well as
other arteries.
When an artery is acutely occluded by thrombus or embolus, the area of the CNS supplied by it will undergo infarction if there is no adequate collateral blood supply.
Surrounding a central necrotic zone, an ‘ischemic penumbra’ remains viable for a time, i.e. it may recover function if blood flow is restored.
CNS ischemia may be accompanied by swelling for two reasons:
● cytotoxic oedema – accumulation of water in damaged glial cells and neurones,
● vasogenic oedema – extracellular fluid accumulation as a result of breakdown of the blood–brain barrier.
In the brain, this swelling may be sufficient to produce clinical deterioration in the days following a major stroke, as a result of a rise in intracranial pressure and compression of adjacent structures.
this is the power point about the stroke and the definition,the different types of stroke and the ways of treatment of stroke because stroke is one of the most important and mainly reasons of deaths nowadays.
CEREBROVASCULAR ACCIDENT/STROKE • Also called “brain attack”, cerebral infarction, cerebral hemorrhage, ischemic stroke or stroke • A stroke is caused by the interruption of the blood supply to the brain, usually because a blood vessel bursts or is blocked by a clot. This cuts off the supply of oxygen and nutrients, causing damage to the brain tissue.
A stroke is a medical condition in which poor blood flow to the brain results in cell death. There are two main types of stroke: ischemic, due to lack of blood flow, and hemorrhagic, due to bleeding.Both result in parts of the brain not functioning properly.
this is the power point about the stroke and the definition,the different types of stroke and the ways of treatment of stroke because stroke is one of the most important and mainly reasons of deaths nowadays.
CEREBROVASCULAR ACCIDENT/STROKE • Also called “brain attack”, cerebral infarction, cerebral hemorrhage, ischemic stroke or stroke • A stroke is caused by the interruption of the blood supply to the brain, usually because a blood vessel bursts or is blocked by a clot. This cuts off the supply of oxygen and nutrients, causing damage to the brain tissue.
A stroke is a medical condition in which poor blood flow to the brain results in cell death. There are two main types of stroke: ischemic, due to lack of blood flow, and hemorrhagic, due to bleeding.Both result in parts of the brain not functioning properly.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
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Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
2. Can be defined as sudden loss of neurological
function caused by an interruption of the blood
flow to the brain.
WHO defines it as “rapidly developing clinical signs
of focal (or global) disturbance of cerebral function,
with symptoms lasting 24 hours or longer or
leading to death, with no apparent cause other
than of vascular origin”
*TIA is defined to last less than 24 hrs
3. 1. Ischaemic-
Most common type
Results when a clot(thrombus) blocks or impairs
blood flow,deprives brain of nutrition and
oxygenation
Thrombotic cerebral infarction results from the
atherosclerotic obstruction of large cervical and
cerebral arteries
Embolic cerebral infarction is due to embolism of
a clot in the cerebral arteries
coming from other parts of the arterial system
4. 2. Haemorrhagic(ICH)-
Occurs when blood vessels rupture ,causing
leakage of blood in and around the brain
Spontaneous intracerebral hemorrhages (as
opposed to traumatic ones) are mainly due
to arteriolar hypertensive disease
3. Subarachnoid haemorrhages(SAH)-
mainly due to the rupture of aneurysms at the
bifurcations of large arteries at the inferior surface
of the brain
5. In 2001 it was estimated that cerebrovascular
diseases (stroke) accounted for 5.5 million deaths
world wide, equivalent to 9.6 % of all deaths.
Two-thirds of these deaths occurred in people
living in developing countries and 40% of the
subjects were aged less than 70 years.
Stroke is more common among men than women.
The prevalence of stroke in men is 1.3 times higher
than that in women.
6. Atherosclerosis and plaque formation leading
narrowing of vessel lumen, progresssing to
interruption of blood flow at certain sites of
predilection
7. Presence of thrombus or emboli may also reduce
blood flow to the brain.
Ischaemia due to atherosclerosis, thrombus or
emboli deprives brain of nutrition and oxygenation
and glucose, leading to cell death. This is k/a
cerebral infarction or tissue death.
Ischaemia may also develop from low perfusion
rates due to cardiac failure or significant blood loss
with resulting systemic hypotension.
8. Haemorrhagic strokes result from abnormal
bleeding in brain due to rupture of cerebral vessels
or as a result of direct trauma.
Intracranial Haemorrhage leads to increased ICP
Other causes are SAH and aneurysms,AVM,etc
9. It describes the relationship between
the contents of the cranium and intracranial
pressure.
As the cranium is made from solid bone, its
structure is fixed and therefore the volume
contained within cannot be changed.
Alongside the brain tissue, the other major
components found within the cranium
are blood and the CSF. The volume of each
of these components is restricted by the
fixed space within the cranium.
In normal cranial physiology, these three
components exist in equilibrium with each
other to satisfy this fixed volume. As such,
if the volume of one component increases,
the volume of another must decrease.
10. Medical factors such as hypertension,heart
disease and diabetes
Inherent biological traits such as age and sex,
physiological characteristics such as high
blood pressure, serum cholesterol,
fibrinogen;
Modifiable behaviors such as smoking, diet,
alcohol consumption, physical inactivity
12. Following ischaemia,the tissues in the brain
can be reviewed by the ‘four tissue
compartments concept”.
The compartments can be distinguished by
the various physiological imaging modalities
during acute ischemic
13. 1) the unaffected tissue;
2) the mildly hypoperfused tissue, but this is not usually at risk (the
oligemic tissue);
3) the tissue at risk (the ischemic penumbra); and
4) the tissue already irreversibly damaged (the ischemic core)
14. Ischaemic strokes lead to cerebral edema which
begins within minutes of the insult and reaches a
maximum with 3-4 days.
This results from tissue necrosis and movement of
water from blood to brain tissue.
If the edema doesnot subside, there is increased
ICP which may lead to contralateral shifting and
brainstem herniation.
15. Most common clinical features include-
1. Motor paresis/paralysis of muscles affecting one
side of the body
2. Alterations in tone (Flaccidity followed by
spasticity)
3. Impaired or abnormal sensations
(numbness,tingling,decreased sensation) and
parasthesia as in thalamic pain
4. Loss or changes in visual acuity such as visual
neglect and homonymous hemianopia
5. Slurring of speech, inability to understand
speech(Wernicke’s aphasia), slow hesistant
speech(Broca’s aphasia)
16.
17. 6. Altered reflexes (initial hyporeflexia with flaccidity,
then hyperreflexia as synergy patterns and spasticity
develop)
7. Positive Babinski sign(extension of great toe with
fanning out of other toes)
8. Problems in swallowing(dysphagia) or drooling from
one corner of mouth
9. Loss of memory
10. Altered or loss of balance and coordination
(cerebellar-ataxia, basal ganglia- bradykinesia or
involuntary movements such as choreoathetosis and
hemiballismus)
*[Chorea- involuntary jerky,dance like movts., Athetosis-slow writhing movt.
Hemiballismus-sudden violent ballistic flinging movts]
18. 12. Apraxia or loss of motor planning
13. Postural disturbances such as asymmetry in wt.
bearing and wt. shifting, increased postural sway,
etc
14. Personality changes and mood affect ( euphoria,
depressed or apathetic.)*
15. Change in perception of self such as unilateral
neglect, Pusher syndrome, etc.
16. Bladder and bowel dysfunction or incontinence
19. Synergy patterns- stereotyped,primitive patterns of
movement that dominate voluntary muscle action
and reflex actions.
Mass movement patterns in response to stimulus
or voluntary effort or both are called abnormal
synergy patterns.
Gross flexor movements flexor synergy
Gross extensor movements extensor synergy
Combination of strongest components produce
mixed synergy
Appear as spasticity develops, isolated movements
cannot be performed
24. A. History taking, clinical evaluation including
grading of severity
B. Physical examination- check for ABC, vitals,
cardiac auscultation and general appearance
Scales used for stroke-
NIH Stroke scale- 1–4 Minor
5–15 Moderate
16–20 Moderate to severe
21–42 Severe
Glasgow outcome scale- The Glasgow Outcome
Scale (GOS) has been widely accepted as a standard means of
describing outcome in head injury patients.The traditional GOS
has five categories, which were extended to eight for the
Glasgow Outcome Scale–Extended (GOSE)
25. B. General investigations-
CXR/ECG
Other laboratory tests such as CBC, blood glucose, CT/BT,
PT, serum lipid/cholesterol profiling
C. CT scan/MRI, carotid ultrasound, cerebral angiogram
CT is much faster and inexpensive than MRI, making it the
study of choice in cases of trauma and other acute neurological
emergencies. However,MRI doesnot use ioning radiations, has a
much greater range of available soft tissue contrast, depicts
anatomy in greater detail, and is more sensitive and specific for
abnormalities within the brain itself.
26.
27. In ischaemic stroke reperfusion therapy with tissue
plasminogen activator (tPA) or endovascular clot
retrieval (ECR) is used. Reperfusion therapy aims to
salvage the ischaemic penumbra and reduce mortality
and disability.
The tPA is given within 4.5 h after the patient was last
known to be well.
If there is no ICH on MRI and pt. is not receiving
reperfusion therapy, dual antiplatelet therapy (DAPT),
consisting of aspirin and clopidogrel, is given within the
first 24 h to reduce risk of stroke recurrence.
In presence of ICH, all anticoagulants are immediately
withheld.
28. Antihypertensives may be necessary. Rapid blood
pressure (BP) control during this acute phase can be
achieved through IV hydralazine and labetalol.
As secondary prevention measure, first-line
antihypertensive therapy can be chosen from the
following classes: angiotensin converting enzyme
inhibitor, angiotensin II receptor antagonists, calcium
channel blockers and thiazide diuretics.
Selection of an agent depends on comorbidities and
tolerability.
Most ischaemic stroke patients should be prescribed a
high-dose statin (e.g atorvastatin) regardless of lipid
levels, to reduce the risk of recurrent stroke. Use of
statin following ICH is not recommended as it can
increase risk of further bleeding.
29. Ischaemic stroke patients may be prescribed long-term
antiplatelet therapy: low-dose aspirin, clopidogrel or
combination of aspirin and dipyridamole.
Ischaemic stroke patients with AF on
electrocardiography or confirmed thrombus on
echocardiogram are started on long-term
anticoagulation therapy(e.g warfarin).
Neuropathic pain may be addressed by gabapentinoids
(GBP), serotonin-noradrenaline reuptake inhibitors
(SNRI) and tricyclic antidepressants (TCA).Second line
treatment may be with use of lignocaine or tramadol.
Nociceptive pain is treated with NSAIDS or paracetamol.
Generalised spasticity is treated with baclofen, while
focal/segmental spasticity require Botulinum toxin A.
30. Surgical procedures include decompressive
surgery(Hemicraniectomy) for cerebellar
haemorrhages, evacuation of supratentorial
haematomas and extraventricular drain
insertions for hydrocephalus.
Editor's Notes
Thrombus-blood clot that forms in ablood vessel
Embolus- unattached material (emboli) such as a blood clot, fat or cholesterol deposit, gas, tissue, or foreign material travels within the bloodstream and occludes flow within a vessel
Aneurysm- An aneurysm is a ballooning at a weak spot in an artery wall.