Classification of cerebrovascular accidents. Transient ischemic attack. Pathogenesis, clinic, treatment, prevention.

1. 37. Classification of cerebrovascular
accidents. Transient ischemic attack.
Pathogenesis, clinic, treatment,
prevention.
By
Berin Mohamed Ashraf
group : 932e

2. cerebrovascular accidents(CVA)
- In other terms : "stroke , brain attack or acute ischemic cerebrovascular
syndrome".
- It Occurs when blood supply to part of the brain is disrupted, causing brain
cells to die. When blood flow to the brain is impaired, oxygen and glucose
cannot be delivered to the brain. Blood flow can be compromised by a
variety of mechanisms.
TYPES OF STROKE
Classification of Stroke based on the underlying pathophysiologic findings,
and classified as :
- ischemic stroke

4. Ischemic stroke
- In an ischemic stroke, blood supply to part of the brain is decreased,
leading to dysfunction and necrosis of the brain tissue in that area.
- There are four reasons why this might happen:
1- thrombosis (obstruction of a blood vessel by a blood clot forming
locally).
2- embolism (idem due to an embolus from elsewhere in the body, see
below).
3- systemic hypoperfusion (general decrease in blood supply, e.g. in
shock) venous thrombosis.
4-Stroke without an obvious explanation is termed "cryptogenic" (of

5. Hemorrhagic stroke
Hemorrhagic stroke is caused by a blood vessel that breaks and bleeds
into the brain.and its divided into
- Intracranial hemorrhage is the accumulation of blood anywhere within
the skull vault. A distinction is made between intra-axial hemorrhage
(blood inside the brain).
- extra-axial hemorrhage (blood inside the skull but outside the brain).
- Intra-axial hemorrhage is due to intraparenchymal hemorrhage or
intraventricular hemorrhage (blood in the ventricular system).

7. Transient ischemic attack(TIA)
- A TIAs is an acute loss of
neurological function caused by
ischaemia with symptoms lasting
minutes to hours (by definition
<24hrs).
- It is called mini-stroke and happen
when the blood supply to the brain
cells is not permanent.
- It is much higher risk of having a

8. Pathogenesis
- A TIA is caused by artery-to-artery emboli (ie ulcerated atheromatous
plaque debris from the proximal neck vessels) or cardiac emboli.
- TIAS are usually the result of microemboli.
- TIAS may be caused by a fall in cerebral perfusion (dysrhythmia,
postural hypotension, decreased flow through vital atheromatous
arteries).
- Rarely, SOL and subdural haematomas cause episodes
indistinguishable from thromboembolic TIAS.
- Increased total red cell volume (polycythaemia) may also be
causative.

9. clinical manifestations
The signs and symptoms of a TIA are the same as a full stroke.
This may include :
- Slurred speech.
- Facial weakness.
- Weakness in an arm and/or leg.
- Headache.
- Dizziness.
- Reduced level of consciousness.

10. treatment
Antiplatelet medicines (Aspirin )
- You'll probably be given aspirin straight after a suspected TIA. It works as an
antiplatelet medicine.
- Antiplatelet medicines work by reducing the ability of platelets( blood cells that
help blood to clot) to stick together and form blood clots.
Anticoagulant medicines (Heparin or Warfarin)
- can help to prevent blood clots by changing the chemical composition of your
blood in a way that stops clots from forming.
- They're usually offered to people who had a TIA that was caused by a blood
clot in their heart. This is often due to a condition called atrial fibrillation, which

11. con….
Surgery
In some cases, an operation called a carotid endarterectomy may be recommended after
having a TIA.
Carotid endarterectomy
- involves removing part of the lining of the carotid arteries – the main blood vessels that
supply the head and neck – plus any blockage inside the carotid arteries.
- When fatty deposits build up inside the carotid arteries, the arteries become hard and
narrow, making it more difficult for blood to flow to your brain.
- This is known as atherosclerosis and can lead to TIAs and strokes if the blood supply to
the brain becomes disrupted.
- By unblocking the carotid arteries when they have become moderately or severely
narrowed, a carotid endarterectomy can significantly reduce the risk of having a stroke or

12. prevention
- Control of hypertension reduces stroke rate by 40%.
- Control of diabetes.
- stopping smoking.
- moderating alcohol intake.
- control of hypercholesterolaemia all reduce atheroma
progression.
- This reduces stroke risk, CAD and MI (the most common
cause of death post stroke)

13. Thanks for your attention