Cerebrovascular disease and ABSITE prep powerpoint
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Hypertension is the most important risk factor for stroke. Ischemic stroke accounts for 85% of strokes and is often caused by embolization from the internal carotid artery or heart. Carotid endarterectomy is indicated for asymptomatic internal carotid artery stenosis over 70% or symptomatic stenosis over 50% and can effectively reduce stroke risk. The procedure involves removing the intima and part of the media from the carotid artery and important technical considerations include ensuring the distal end is clear and using a shunt if back pressure is over 50mmHg or the contralateral carotid is tight or occluded. Complications include perioperative stroke, myocardial infarction, and nerve injuries.
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Posterior circulation ischaemic stroke and tia
Posterior circulation strokes involve the vertebrobasilar arteries and account for about one-fifth of ischemic strokes. They are associated with a high risk of early recurrent stroke. Clinical features can include dizziness, limb weakness, dysarthria, and nausea. Investigations like MRI and MRA are important for diagnosis but may be normal for small brainstem infarcts. There is a higher risk of early recurrent stroke after posterior circulation events compared to carotid events. Secondary prevention focuses on antiplatelet drugs and controlling risk factors like blood pressure, though aggressive lowering is not recommended in some cases of vertebrobasilar stenosis due to risk of recurrent stroke.
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3) Diagnosis is made through imaging like CT, MRI, TTE or TEE which can detect the intimal flap separating the true and false lumens. Management involves controlling blood pressure, heart rate and pain to prevent progression while emergent surgery is needed for Type A dissections involving the ascending aorta.
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Cerebrovascular Accident or stroke is defined as an abrupt onset of neurological deficit caused by a focal vascular issue. Stroke is the second leading cause of death worldwide. The clinical manifestations of stroke can vary widely due to the complex anatomy of the brain and vasculature. Imaging such as CT and MRI are used to determine if the cause is ischemia or hemorrhage. Treatment focuses on rapid evaluation, managing risk factors, IV thrombolysis if appropriate, and rehabilitation to prevent complications and encourage recovery.
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This document provides an overview of cerebrovascular disease and stroke. It discusses the anatomy and physiology of cerebral blood flow, the definition and classifications of stroke, common clinical presentations, investigations including imaging and vascular studies, and management approaches including thrombolysis, aspirin, risk factor modification, and carotid interventions. Stroke is a leading cause of death and disability that requires rapid diagnosis and treatment to minimize brain damage.
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Objectives:
1- Anatomy of the brain blood supply
2-Stroke
- Definition
-type
- Etiology
-Risk Factors
-Clinical presentation
-Diagnosis
-Medical management
3- Role of vascular surgeon in stroke
-Carotid Endarterectomy
-Carotid Angioplasty and Stenting
Stroke syndromes
1. Stroke is defined as a nontraumatic brain injury caused by occlusion or rupture of cerebral blood vessels that results in sudden neurological deficits.
2. The most common types of stroke are ischemic (85%) and hemorrhagic (15%). Ischemic strokes are further classified as thrombotic, embolic, or lacunar.
3. Major risk factors for stroke include hypertension, heart disease, diabetes, smoking, and older age. Location of brain injury determines the specific neurological symptoms, such as deficits on one side of the body for middle cerebral artery strokes.
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Stroke is the third leading cause of death in the US. The main types are ischemic (85%) and hemorrhagic (15%). Ischemic strokes are caused by thrombosis, embolism, or small vessel disease. Common risk factors include hypertension, diabetes, smoking, heart disease, and prior TIA. Strokes cause neurological deficits depending on the affected brain region's blood supply. Accurate diagnosis relies on clinical exam and imaging studies. Prompt treatment aims to restore blood flow and prevent complications.
SUBARACHNOID HEMORRHAGE
Subarachnoid hemorrhage occurs when there is bleeding into the subarachnoid space surrounding the brain. It is usually caused by the rupture of an intracranial aneurysm. Risk factors include age, family history, smoking, and hypertension. Patients often present with a sudden and severe headache described as "the worst headache of my life". Diagnosis is typically made through CT scan or lumbar puncture. Treatment involves securing the aneurysm through clipping or coiling to prevent rebleeding, as well as managing complications such as cerebral vasospasm, seizures, and hydrocephalus.
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1. A stroke is defined as a focal neurological deficit lasting more than 24 hours caused by a disruption of blood flow to the brain. Strokes can be ischemic, due to blockage of a blood vessel, or hemorrhagic, due to bleeding in the brain.
2. The main risk factors for stroke are hypertension, heart disease, diabetes, hyperlipidemia, smoking, excess alcohol, and oral contraceptives. Strokes are classified based on their etiology and can be caused by thrombosis, embolism, or hypoperfusion.
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Posterior circulation ischaemic stroke and tia
Posterior circulation strokes involve the vertebrobasilar arteries and account for about one-fifth of ischemic strokes. They are associated with a high risk of early recurrent stroke. Clinical features can include dizziness, limb weakness, dysarthria, and nausea. Investigations like MRI and MRA are important for diagnosis but may be normal for small brainstem infarcts. There is a higher risk of early recurrent stroke after posterior circulation events compared to carotid events. Secondary prevention focuses on antiplatelet drugs and controlling risk factors like blood pressure, though aggressive lowering is not recommended in some cases of vertebrobasilar stenosis due to risk of recurrent stroke.
Aortic Dissection
1) A 38-year old hypertensive smoker presented with severe central chest pain and was diagnosed with acute aortic dissection.
2) Aortic dissection occurs when a tear in the inner layer of the aorta allows blood to enter and force the layers apart, creating a false lumen. If untreated, mortality is as high as 50% within a week.
3) Diagnosis is made through imaging like CT, MRI, TTE or TEE which can detect the intimal flap separating the true and false lumens. Management involves controlling blood pressure, heart rate and pain to prevent progression while emergent surgery is needed for Type A dissections involving the ascending aorta.
SUBARACHNOID HEMORRHAGE
1. Intracranial aneurysms are abnormal dilations of arteries in the brain that can rupture and cause subarachnoid hemorrhage (SAH).
2. Common types include saccular, fusiform, and dissecting aneurysms, which often form at artery branch points due to hemodynamic stress.
3. Clinical features of SAH include a sudden, severe headache and other signs of meningismus. Diagnosis involves CT, LP, and cerebral angiography.
Myocardial infarction
Acute myocardial infarction, or heart attack, occurs when blood supply to the heart is diminished leading to cell damage and death. It is usually caused by a blockage in the coronary arteries from atherosclerotic plaque or a blood clot. Diagnosis involves EKGs, blood tests of cardiac enzymes, and imaging tests. Treatment depends on the type and severity of MI but may include medications to break up clots, angioplasty and stenting, or coronary bypass surgery. Complications can affect the heart muscles and blood vessels if not properly treated.
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Peripheral vascular disease is a sign of fatty deposits and calcium building up in the walls of the arteries (atherosclerosis). Risk factors include ageing, diabetes and smoking.
Symptoms may include leg pain, particularly when walking.
Tobacco cessation, exercise and a healthy diet are often successful treatments. When these changes aren't enough, medication or surgery can help.
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This document discusses stroke, including its definition, types, symptoms, risk factors, evaluations, management, complications, and surgical treatments. Stroke is defined as a clinical syndrome caused by disrupted blood flow to the brain lasting over 24 hours. There are two main types - ischemic (80%) caused by blockage and hemorrhagic (20%) caused by bleeding. Evaluations include imaging like CT scans and MRIs to determine the specific location and cause of injury. Management focuses on airway/ventilation, blood pressure/volume control, temperature regulation, and glycemic control to prevent further brain damage. Surgical interventions may be needed for certain types of hemorrhagic stroke or complications.
Stroke-and-Spinal-Cord-7-30.ppt
This patient presented with left-sided weakness and slurred speech. CT scan was normal. After tPA infusion, her blood pressure was elevated. The appropriate next step is to administer nicardipine to lower her blood pressure and prevent intracerebral hemorrhage.
This patient is being followed up after an ischemic stroke. Testing shows a left pontine infarct. The appropriate secondary prevention is to substitute clopidogrel for aspirin given his history of peripheral artery disease.
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Cerebrovascular Accident or stroke is defined as an abrupt onset of neurological deficit caused by a focal vascular issue. Stroke is the second leading cause of death worldwide. The clinical manifestations of stroke can vary widely due to the complex anatomy of the brain and vasculature. Imaging such as CT and MRI are used to determine if the cause is ischemia or hemorrhage. Treatment focuses on rapid evaluation, managing risk factors, IV thrombolysis if appropriate, and rehabilitation to prevent complications and encourage recovery.
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This document provides an overview of cerebrovascular disease and stroke. It discusses the anatomy and physiology of cerebral blood flow, the definition and classifications of stroke, common clinical presentations, investigations including imaging and vascular studies, and management approaches including thrombolysis, aspirin, risk factor modification, and carotid interventions. Stroke is a leading cause of death and disability that requires rapid diagnosis and treatment to minimize brain damage.
Type B AORTIC DISSECTION
Type B aortic dissection occurs when blood flows within the aortic wall separating the layers of the media. Computed tomography angiography is useful for establishing the diagnosis by showing two distinct lumens separated by an intimal flap, and for determining the location of the primary intimal tear and extent of dissection. Initial medical management aims to control blood pressure and pain. Intervention may be indicated for complications such as persistent pain, expansion of the dissection, or impaired blood flow to organs. Both open surgical repair and endovascular techniques can be used to treat type B dissection, with endovascular options becoming more common due to lower risks.
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Objectives:
1- Anatomy of the brain blood supply
2-Stroke
- Definition
-type
- Etiology
-Risk Factors
-Clinical presentation
-Diagnosis
-Medical management
3- Role of vascular surgeon in stroke
-Carotid Endarterectomy
-Carotid Angioplasty and Stenting
Stroke syndromes
1. Stroke is defined as a nontraumatic brain injury caused by occlusion or rupture of cerebral blood vessels that results in sudden neurological deficits.
2. The most common types of stroke are ischemic (85%) and hemorrhagic (15%). Ischemic strokes are further classified as thrombotic, embolic, or lacunar.
3. Major risk factors for stroke include hypertension, heart disease, diabetes, smoking, and older age. Location of brain injury determines the specific neurological symptoms, such as deficits on one side of the body for middle cerebral artery strokes.
strokesyndromes-160814143150.pdf
Stroke is the third leading cause of death in the US. The main types are ischemic (85%) and hemorrhagic (15%). Ischemic strokes are caused by thrombosis, embolism, or small vessel disease. Common risk factors include hypertension, diabetes, smoking, heart disease, and prior TIA. Strokes cause neurological deficits depending on the affected brain region's blood supply. Accurate diagnosis relies on clinical exam and imaging studies. Prompt treatment aims to restore blood flow and prevent complications.
SUBARACHNOID HEMORRHAGE
Subarachnoid hemorrhage occurs when there is bleeding into the subarachnoid space surrounding the brain. It is usually caused by the rupture of an intracranial aneurysm. Risk factors include age, family history, smoking, and hypertension. Patients often present with a sudden and severe headache described as "the worst headache of my life". Diagnosis is typically made through CT scan or lumbar puncture. Treatment involves securing the aneurysm through clipping or coiling to prevent rebleeding, as well as managing complications such as cerebral vasospasm, seizures, and hydrocephalus.
cardiac bypass.pptx iulhihuliuFHQIULHFLIhiluhI
Cardiopulmonary bypass (CPB) is used to temporarily stop the heart and lungs during open-heart surgery and replace their function artificially. The heart is accessed via median sternotomy and the great vessels are cannulated before heparinization and connection to the bypass circuit. CPB is used for congenital heart defects, heart transplantation, valve repair, and coronary artery bypass grafting (CABG). CABG involves grafting a blood vessel to bypass a blocked coronary artery and improve blood flow to the heart. It is the standard treatment for multi-vessel coronary artery disease. Risks include bleeding, infection, embolism, neurological and pulmonary complications.
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Stroke is a leading cause of death and disability globally. The presentation summarizes key aspects of stroke management. It describes the epidemiology, pathophysiology, clinical features, diagnosis and management of both ischemic and hemorrhagic strokes. Prevention of initial and recurrent strokes is emphasized through control of risk factors and use of anticoagulants or antiplatelets depending on the patient's risk profile. Early diagnosis and treatment including thrombolysis are important to minimize brain damage from acute strokes.
Stroke presentation by Dr. Alemayew 4.ppt
Cerebrovascular diseases like stroke are a major cause of death and disability in the US. There are two main types of stroke - ischemic caused by blockage of an artery and hemorrhagic caused by bleeding. Risk factors include age, hypertension, diabetes, smoking, prior stroke or TIA. Diagnosis involves brain imaging like CT or MRI. Treatment depends on type and severity but may include thrombolysis, anticoagulation, antiplatelet drugs, managing risk factors, and rehabilitation. Preventing stroke requires risk factor modification and treatments like antiplatelet drugs.
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cerebralvascularaccidentformedicalstudents-160513113916.pptx
1. A stroke is defined as a focal neurological deficit lasting more than 24 hours caused by a disruption of blood flow to the brain. Strokes can be ischemic, due to blockage of a blood vessel, or hemorrhagic, due to bleeding in the brain.
2. The main risk factors for stroke are hypertension, heart disease, diabetes, hyperlipidemia, smoking, excess alcohol, and oral contraceptives. Strokes are classified based on their etiology and can be caused by thrombosis, embolism, or hypoperfusion.
3. The clinical features of a stroke depend on its location and type. A thorough history and neurological examination are important for diagnosis. Stro
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- 2. STROKE - STATS • 3rd leading cause of death in the United States • Leading cause of serious disability in the United States • HTN most important risk factor • MCA is most commonly diseased
- 3. STROKE - GENERAL •Hemorrhagic stroke • 15% of all strokes • Involve intraparenchymal bleeding typically from hypertension •Ischemic stroke • 85% of all strokes • Ischemic Stroke/TIA is most commonly caused by embolization of the ICA, 2nd source is the heart
- 4. High yield anatomy ECA - Triphasic- antegrade, retrograde, anterograde ICA Continuous forward flow
- 6. Internal carotid artery stenosis As the blood circulates through the carotid bifurcation, there is separation of flow into the low- resistance internal carotid artery and the high- resistance external carotid artery. The carotid atherosclerotic plaque typically forms in the outer wall opposite to the flow divider due in part to the effect of the low shear stress region, which also creates a transient reversal of flow during the cardiac cycle.
- 7. Internal carotid artery stenosis • Diagnosis • Duplex ultrasound • CTA/MRA • Indications for repair • Asymptomatic >70% stenosis • Symptomatic >50% stenosis • Emergent repair with changing neuro sx or crescendo TIAs
- 8. Internal carotid artery stenosis • Diagnosis • Duplex ultrasound • CTA/MRA • Indications for repair • Asymptomatic >70% stenosis • Symptomatic >50% stenosis • Emergent repair with changing neuro sx or crescendo TIAs
- 10. Carotid endarderectomy • Indications for repair • Asymptomatic >70% stenosis • Symptomatic >50% stenosis • Emergent repair with changing neuro sx or crescendo TIAs • Rules for repair • Tightest side first • Dominant side first • Never intervene on an occluded artery
- 11. Carotid endarderectomy • Technical concerns • Remove intima and part of media • Distal end point is most important factor • When to use a shunt • Back pressure > 50mmhg OR contralateral side is tight or occluded. • poor correlation with EEG and ischemia
- 12. High lesions • Nasotracheal intubation • Division of the posterior belly of the digastric • Hypoglossal nerve, spinal accessory, and the glossopharyngeal nerve • Resect the styloid process • Anterior subluxation of the mandible
- 13. Carotid endarterectomy • Complications • Perioperative stroke- immediately after explore • MI (most common cause of non-stroke M&M following CEA • Hypertension (20%) • Pseudoaneurysm - pulsatile mass, drape and prep prior to intubation • Vagus is the most common n. injury, vascular clamp (hoarseness) • Mandibular br. Facial N retractor at jaw angle (smile) • Hypoglossal N: tongue deviation towards (speech mastication issues) • Glossopharyngeal N: difficulty swallowing • Restenosis- 15%
- 14. Carotid body tumors • Paraganglioma, chemodectoma, glomus tumor • Very rare, only known tumor of the carotid body • Sporadic, familial, and hyperplastic • Periadventia of the posterior surface of the carotid bifurcations • Composed of neural crest • Most are benign, malignant transformation reported • Rarely functional, may secrete catacholamines
- 16. Treatment • Surgery • Palliative radiation