This document discusses various neurological emergencies including acute ischemic stroke, intracranial hemorrhage, status epilepticus, Guillain-Barre syndrome, acute myelopathy, and myasthenic crisis. It provides details on the presentation, diagnosis, and treatment of acute ischemic stroke and intracranial hemorrhage, the two most common neurological emergencies. Key factors in evaluation and management are discussed such as use of CT, MRI, and thrombolytic therapy for ischemic stroke and controlling hypertension, treating coagulopathy, and managing intracranial pressure for intracranial hemorrhage.
Stroke is the third leading cause of death and can be caused by thrombosis, embolism, or hemorrhage. The main types of cerebral vascular diseases that cause stroke are thromboembolic infarction, intracerebral hemorrhage, and subarachnoid hemorrhage. Risk factors for stroke include age, gender, hypertension, cardiac diseases, diabetes, smoking, and high alcohol intake. Transient ischemic attacks are focal neurological symptoms lasting less than 24 hours and often precede a major stroke.
The document discusses cerebrovascular accidents (strokes) including definitions, blood supply to the brain, conditions caused by occlusion of different arteries, classification of strokes, diagnostic studies, and management of strokes. It covers topics such as transient ischemic attacks, the circle of Willis, effects of reduced cerebral blood flow, intravenous thrombolysis with tPA, complications of strokes, and risk factors. Rehabilitation goals and emerging therapies are also mentioned.
Ishcemic and hemorrhagic stroke, a light on integrated approachJayagovinda Ukkinadka
Management of stroke in Ayurveda gives very good results. In severe cases with the help of some emergency management from modern medicine gives tremendous result with Ayurveda management. We have treated more than 2500 patients as in patients with nearly half of them being acute strokes. Other than that we have also treated many stroke patients on out patient basis. This slide show is for all Ayurveda practitioners to which may help them in the management of stroke with better understanding. Now days many modern physicians criticize Ayurveda for treating stroke stating that Ayurveda people don't know the pathology involved in it, they treat with massage, how come a massage can help stroke patient and so on. I wonder why can't the modern physicians appreciate the tremendous result which we get in stroke patients with Ayurveda. Here I have tried my best to explain the mode of action of these Ayurveda measures both from Ayurveda point of view and also as per the contemporary medical science. Also welcome comments from Ayurveda scholars.
This document provides biographical information about Dr. Ronald Sanchez-Magbitang, including his educational background and medical training. It lists that he received his B.S. in Biology from the University of Santo Tomas and his Doctor of Medicine degree from Saint Louis University. It also notes his current position as Chief of Hospital at Gov. Eduardo L. Joson Memorial Hospital in Cabanatuan City.
A stroke occurs when blood flow to the brain is disrupted, depriving brain tissue of oxygen and nutrients. It is a leading cause of death and disability. Risk factors include hypertension, diabetes, heart disease, smoking, and older age. Symptoms depend on the affected brain region but may include weakness, numbness, vision/speech problems, and impaired coordination. Treatment focuses on restoring blood flow and minimizing brain damage through medications, surgery, rehabilitation, and lifestyle changes to reduce long-term effects and risk of recurrence.
This document discusses cerebrovascular accidents (strokes). It defines strokes as occurring when blood flow to the brain is interrupted, and describes the two main types: ischemic (caused by blockage) and hemorrhagic (caused by ruptured blood vessel). Risk factors include conditions like high blood pressure, smoking, obesity, and older age. Symptoms appear suddenly and may include weakness, trouble speaking, or vision issues. Diagnosis involves tests like CT/MRI scans and angiograms. Treatment depends on stroke type but aims to restore blood flow or control bleeding. Prevention focuses on controlling risk factors like blood pressure and diabetes.
Stroke or Cerebrovascular incident, is defined as an abrupt onset of a neurological deficit that is attributable to a focal vascular cause.
The clinical manifestations of stroke are highly variable because of the complex anatomy of the brain
The document provides information about protocols for treating patients exhibiting signs of an acute stroke or CVA. It outlines assessments and tests to determine if a patient is having a stroke, including the Cincinnati Pre-hospital Stroke Scale (CPSS) and Rapid Arterial Occlusion Evaluation (RACE). If CPSS is positive, RACE is used to determine stroke severity. Patients scoring 4 or higher on RACE should be transported to a Comprehensive Stroke Center if possible. Treatment protocols are also provided, focusing on airway management, vital sign monitoring, glucose testing, and seizure management. Transport is usually to the nearest Primary or Comprehensive Stroke Center.
Stroke is the third leading cause of death and can be caused by thrombosis, embolism, or hemorrhage. The main types of cerebral vascular diseases that cause stroke are thromboembolic infarction, intracerebral hemorrhage, and subarachnoid hemorrhage. Risk factors for stroke include age, gender, hypertension, cardiac diseases, diabetes, smoking, and high alcohol intake. Transient ischemic attacks are focal neurological symptoms lasting less than 24 hours and often precede a major stroke.
The document discusses cerebrovascular accidents (strokes) including definitions, blood supply to the brain, conditions caused by occlusion of different arteries, classification of strokes, diagnostic studies, and management of strokes. It covers topics such as transient ischemic attacks, the circle of Willis, effects of reduced cerebral blood flow, intravenous thrombolysis with tPA, complications of strokes, and risk factors. Rehabilitation goals and emerging therapies are also mentioned.
Ishcemic and hemorrhagic stroke, a light on integrated approachJayagovinda Ukkinadka
Management of stroke in Ayurveda gives very good results. In severe cases with the help of some emergency management from modern medicine gives tremendous result with Ayurveda management. We have treated more than 2500 patients as in patients with nearly half of them being acute strokes. Other than that we have also treated many stroke patients on out patient basis. This slide show is for all Ayurveda practitioners to which may help them in the management of stroke with better understanding. Now days many modern physicians criticize Ayurveda for treating stroke stating that Ayurveda people don't know the pathology involved in it, they treat with massage, how come a massage can help stroke patient and so on. I wonder why can't the modern physicians appreciate the tremendous result which we get in stroke patients with Ayurveda. Here I have tried my best to explain the mode of action of these Ayurveda measures both from Ayurveda point of view and also as per the contemporary medical science. Also welcome comments from Ayurveda scholars.
This document provides biographical information about Dr. Ronald Sanchez-Magbitang, including his educational background and medical training. It lists that he received his B.S. in Biology from the University of Santo Tomas and his Doctor of Medicine degree from Saint Louis University. It also notes his current position as Chief of Hospital at Gov. Eduardo L. Joson Memorial Hospital in Cabanatuan City.
A stroke occurs when blood flow to the brain is disrupted, depriving brain tissue of oxygen and nutrients. It is a leading cause of death and disability. Risk factors include hypertension, diabetes, heart disease, smoking, and older age. Symptoms depend on the affected brain region but may include weakness, numbness, vision/speech problems, and impaired coordination. Treatment focuses on restoring blood flow and minimizing brain damage through medications, surgery, rehabilitation, and lifestyle changes to reduce long-term effects and risk of recurrence.
This document discusses cerebrovascular accidents (strokes). It defines strokes as occurring when blood flow to the brain is interrupted, and describes the two main types: ischemic (caused by blockage) and hemorrhagic (caused by ruptured blood vessel). Risk factors include conditions like high blood pressure, smoking, obesity, and older age. Symptoms appear suddenly and may include weakness, trouble speaking, or vision issues. Diagnosis involves tests like CT/MRI scans and angiograms. Treatment depends on stroke type but aims to restore blood flow or control bleeding. Prevention focuses on controlling risk factors like blood pressure and diabetes.
Stroke or Cerebrovascular incident, is defined as an abrupt onset of a neurological deficit that is attributable to a focal vascular cause.
The clinical manifestations of stroke are highly variable because of the complex anatomy of the brain
The document provides information about protocols for treating patients exhibiting signs of an acute stroke or CVA. It outlines assessments and tests to determine if a patient is having a stroke, including the Cincinnati Pre-hospital Stroke Scale (CPSS) and Rapid Arterial Occlusion Evaluation (RACE). If CPSS is positive, RACE is used to determine stroke severity. Patients scoring 4 or higher on RACE should be transported to a Comprehensive Stroke Center if possible. Treatment protocols are also provided, focusing on airway management, vital sign monitoring, glucose testing, and seizure management. Transport is usually to the nearest Primary or Comprehensive Stroke Center.
Dr. Syed Muhammad Ali Shah provides an overview of ischemic stroke. Key points include:
- Stroke is defined as rapid onset of neurological deficit lasting over 24 hours caused by a vascular issue.
- Risk factors include atrial fibrillation, hypertension, smoking, obesity, and high cholesterol.
- Diagnosis involves investigations like CT scans and MRI. Treatment depends on the cause but may include thrombolysis within 4.5 hours, aspirin, rehabilitation, and preventing future strokes through controlling risk factors.
- Future advances include endovascular therapies to remove clots and research on neuroprotection strategies. Prevention through lifestyle changes and medications can reduce stroke risk.
[Int. med] cerebrovascular accident from SIMS LahoreMuhammad Ahmad
This document discusses stroke, including definitions, types, risk factors, symptoms, assessments, and treatments. It defines stroke as a reduction in blood flow to the brain caused by a blockage or rupture of a blood vessel. The main types are ischemic (blockage) and hemorrhagic (rupture). Risk factors include age, hypertension, diabetes, heart disease, smoking, and family history. Symptoms depend on the affected brain region but may include weakness, confusion, visual issues, and severe headache. Assessments involve neurological exams, CT scans, and lab tests. Treatments focus on restoring blood flow, controlling blood pressure, preventing complications, and rehabilitation.
Stroke is the third leading cause of death in Malaysia. The document defines stroke, classifies its types, and outlines its diagnosis and management. Key points include that stroke is caused by blocked blood flow to the brain, and risk factors include age, gender, family history, hypertension, diabetes, atrial fibrillation, smoking, and high cholesterol. Diagnostic tests include CT/MRI scans and angiograms to determine the cause. Treatment focuses on rehabilitation, managing risk factors, and preventing future strokes.
This document summarizes information about hemiplegia, including its causes, risk factors, clinical presentation, investigations, management, complications, and prognosis. Hemiplegia is caused by stroke and results in complete or partial paralysis of one side of the body. Stroke is commonly due to thrombosis, embolism, or hemorrhage. Risk factors include age, gender, medical conditions like hypertension, and behaviors like smoking. Clinical features depend on the location of damage in the brain. Management involves supportive care, prevention of complications, treatment of underlying causes, and rehabilitation. Outcomes vary, but many patients regain functional independence.
This document discusses strokes, including definitions, types, risk factors, pathophysiology, clinical manifestations, diagnosis, and treatment. A stroke is defined as a neurological deficit lasting over 24 hours caused by a focal vascular issue. There are two main types: ischemic (caused by clot or embolism) and hemorrhagic (caused by bleeding). Risk factors include hypertension, atrial fibrillation, diabetes, and smoking. Treatment focuses on supporting vital functions, reversing damage with thrombolysis if given early, and rehabilitation.
This document provides information on managing patients with stroke. It discusses the objectives of reviewing stroke etiology, identifying stroke type based on exam, and acute management of ischemic and hemorrhagic strokes. It then covers the three main types of strokes - ischemic, intracerebral hemorrhage, and subarachnoid hemorrhage. Key aspects of acute stroke management are outlined, including the ABCs, use of the NIH Stroke Scale to determine severity, thrombolysis guidelines, complications to watch for, and supportive therapies. The importance of blood pressure control, glucose management, and avoiding fever are emphasized for optimizing patient outcomes.
This document provides information about stroke, including intracerebral hemorrhage (ICH). It defines stroke and notes that ischemic stroke accounts for 80% of cases. Globally, 15 million people suffer strokes annually, making it a leading cause of death and disability. The document discusses risk factors, pathophysiology, clinical presentation, investigations, management, and rehabilitation for stroke. It provides details on diagnosing and treating ICH, including protocols for stabilizing patients, controlling blood pressure and coagulopathy, and indications for surgery.
CVA (cerebrovascular accident), also known as stroke, and TIA (transient ischemic attack) are disruptions in blood flow to the brain. A CVA is caused by ischemia or hemorrhage in the brain and results in cell death, while a TIA's disruption is temporary without cell death. Risk factors include atherosclerosis, hypertension, cardiac issues, and diabetes. Symptoms depend on the location and size of the affected area but may include paralysis, impaired speech/vision, and sensory changes. Treatment focuses on prevention by controlling risk factors and potentially using blood thinners. Nursing care revolves around monitoring for complications and maximizing recovery of functions.
The document provides information about protocols for treating patients exhibiting signs of an acute stroke or CVA. It outlines assessments and tests to determine if a patient is having a stroke, including the Cincinnati Pre-hospital Stroke Scale (CPSS) and Rapid Arterial Occlusion Evaluation (RACE). It describes treating potential underlying causes of stroke symptoms like hypoglycemia. It also notes the differences between primary and comprehensive stroke centers in terms of capabilities for treating patients.
Stroke results from a disruption in blood flow to the brain. It is a leading cause of death and disability. Risk factors include hypertension, smoking, heart disease, diabetes, and older age. There are two main types - ischemic caused by blockage and hemorrhagic caused by bleeding. Treatment depends on the type but may include blood thinners, clot busters, or surgery. Physical therapy focuses on regaining mobility and function through exercises, gait training, and positioning. Prevention emphasizes controlling risk factors like blood pressure, cholesterol, diabetes, and lifestyle changes like quitting smoking.
Acute management of patients with stroke is to stabilize the patient and to complete initial evaluation and assessment, including imaging and laboratory studies, within 60 minutes of patient arrival.
Critical decisions focus on the need for intubation, blood pressure control, and determination of risk/benefit for thrombolytic intervention.
This document provides an overview of radiological imaging in the management of stroke. It discusses:
1) Various imaging modalities used including unenhanced CT, CT angiography, MRI, and their benefits. Diffusion weighted MRI can detect acute ischemia within 30 minutes.
2) Examples of imaging findings for different stroke types like ischemic and hemorrhagic strokes. Ischemic strokes appear as bright lesions on DWI MRI.
3) Surgical interventions for acute stroke management include decompressive hemicraniectomy to reduce intracranial pressure for large hemispheric infarcts, and external ventricular drainage for intraventricular hemorrhage and hydrocephalus.
Management of stroke three to twenty four hourswebzforu
This document provides information on the management of stroke from 3 hours to 24 hours. It discusses the definition of stroke, types and mechanisms of stroke including ischemic and hemorrhagic strokes. It covers the clinical evaluation, investigations, and treatment approaches for ischemic and hemorrhagic strokes. Specific topics covered include thrombolysis, anticoagulation, management of hypertension, glucose levels, and pyrexia in the acute ischemic stroke period. Rehabilitation and new developments in interventions and neuroprotectives are also mentioned.
This document provides an overview of ischaemic stroke, including its definition, risk factors, pathophysiology, clinical presentation, diagnosis and management. Key points include:
- Ischaemic stroke accounts for 80% of strokes and results from focal brain infarction due to obstruction of cerebral blood flow.
- Major risk factors include hypertension, atrial fibrillation, diabetes, hyperlipidemia and previous stroke or TIA.
- Clinical syndromes depend on the location of brain infarction and can include motor/sensory deficits, aphasia and visual field cuts.
- Diagnosis involves neuroimaging such as CT, MRI and vascular imaging to identify the cause.
- Acute
A cerebrovascular accident, or stroke, is caused by a lack of oxygenated blood flow to the brain. It can be ischemic, due to a blockage, or hemorrhagic, due to a ruptured blood vessel. Symptoms depend on the affected brain area and can include weakness, sensory changes, speech problems, and visual issues. Stroke severity is classified as mild, moderate, or severe based on symptoms and exam findings. Risk factors include hypertension, atrial fibrillation, diabetes, and lifestyle factors like smoking and diet. Prevention focuses on controlling modifiable risks while treatment involves supportive care, thrombolysis if administered early, and long-term secondary prevention with antiplatelets or anticoagul
1. A 70-year-old woman collapsed at home and was found confused by her daughter. EMS determined she may have had a stroke and transported her to the hospital within 30 minutes of the collapse.
2. At the hospital, she was found to have high blood pressure, left-sided weakness, and a CT scan showed a blood clot in her carotid artery causing a right hemisphere stroke.
3. Her risk factors included a history of untreated hypertension and a previous transient ischemic attack. She was diagnosed with an ischemic stroke likely due to atherosclerosis.
This document summarizes information about yoga for cerebrovascular disease or stroke. It begins by defining stroke and its causes, then discusses the signs, symptoms, and modern medical treatments. It notes that yoga can help with stroke rehabilitation by improving flexibility, strength, and reducing stress. Specific yoga poses and practices are recommended for recovery from and prevention of stroke.
This document discusses increased intracranial pressure. It can result from an increase in brain tissue, blood, or cerebrospinal fluid within the skull. Common causes include head injuries, brain tumors, strokes, and hydrocephalus. Symptoms include restlessness, changes in consciousness, changes in vital signs, headaches, nausea, vomiting, pupil changes, and decreased motor function. Treatment involves managing symptoms, monitoring intracranial pressure, administering medications to reduce pressure such as mannitol and diuretics, and surgical intervention if needed.
This document discusses increased intracranial pressure. It can result from an increase in brain tissue, blood, or cerebrospinal fluid within the skull. Common causes include head injuries, brain tumors, strokes, and hydrocephalus. Symptoms include restlessness, changes in consciousness, changes in vital signs, headaches, nausea, vomiting, pupil changes, and decreased motor function. Treatment involves managing symptoms, monitoring intracranial pressure, administering medications to reduce pressure such as mannitol and diuretics, and surgical intervention if needed.
Dr. Syed Muhammad Ali Shah provides an overview of ischemic stroke. Key points include:
- Stroke is defined as rapid onset of neurological deficit lasting over 24 hours caused by a vascular issue.
- Risk factors include atrial fibrillation, hypertension, smoking, obesity, and high cholesterol.
- Diagnosis involves investigations like CT scans and MRI. Treatment depends on the cause but may include thrombolysis within 4.5 hours, aspirin, rehabilitation, and preventing future strokes through controlling risk factors.
- Future advances include endovascular therapies to remove clots and research on neuroprotection strategies. Prevention through lifestyle changes and medications can reduce stroke risk.
[Int. med] cerebrovascular accident from SIMS LahoreMuhammad Ahmad
This document discusses stroke, including definitions, types, risk factors, symptoms, assessments, and treatments. It defines stroke as a reduction in blood flow to the brain caused by a blockage or rupture of a blood vessel. The main types are ischemic (blockage) and hemorrhagic (rupture). Risk factors include age, hypertension, diabetes, heart disease, smoking, and family history. Symptoms depend on the affected brain region but may include weakness, confusion, visual issues, and severe headache. Assessments involve neurological exams, CT scans, and lab tests. Treatments focus on restoring blood flow, controlling blood pressure, preventing complications, and rehabilitation.
Stroke is the third leading cause of death in Malaysia. The document defines stroke, classifies its types, and outlines its diagnosis and management. Key points include that stroke is caused by blocked blood flow to the brain, and risk factors include age, gender, family history, hypertension, diabetes, atrial fibrillation, smoking, and high cholesterol. Diagnostic tests include CT/MRI scans and angiograms to determine the cause. Treatment focuses on rehabilitation, managing risk factors, and preventing future strokes.
This document summarizes information about hemiplegia, including its causes, risk factors, clinical presentation, investigations, management, complications, and prognosis. Hemiplegia is caused by stroke and results in complete or partial paralysis of one side of the body. Stroke is commonly due to thrombosis, embolism, or hemorrhage. Risk factors include age, gender, medical conditions like hypertension, and behaviors like smoking. Clinical features depend on the location of damage in the brain. Management involves supportive care, prevention of complications, treatment of underlying causes, and rehabilitation. Outcomes vary, but many patients regain functional independence.
This document discusses strokes, including definitions, types, risk factors, pathophysiology, clinical manifestations, diagnosis, and treatment. A stroke is defined as a neurological deficit lasting over 24 hours caused by a focal vascular issue. There are two main types: ischemic (caused by clot or embolism) and hemorrhagic (caused by bleeding). Risk factors include hypertension, atrial fibrillation, diabetes, and smoking. Treatment focuses on supporting vital functions, reversing damage with thrombolysis if given early, and rehabilitation.
This document provides information on managing patients with stroke. It discusses the objectives of reviewing stroke etiology, identifying stroke type based on exam, and acute management of ischemic and hemorrhagic strokes. It then covers the three main types of strokes - ischemic, intracerebral hemorrhage, and subarachnoid hemorrhage. Key aspects of acute stroke management are outlined, including the ABCs, use of the NIH Stroke Scale to determine severity, thrombolysis guidelines, complications to watch for, and supportive therapies. The importance of blood pressure control, glucose management, and avoiding fever are emphasized for optimizing patient outcomes.
This document provides information about stroke, including intracerebral hemorrhage (ICH). It defines stroke and notes that ischemic stroke accounts for 80% of cases. Globally, 15 million people suffer strokes annually, making it a leading cause of death and disability. The document discusses risk factors, pathophysiology, clinical presentation, investigations, management, and rehabilitation for stroke. It provides details on diagnosing and treating ICH, including protocols for stabilizing patients, controlling blood pressure and coagulopathy, and indications for surgery.
CVA (cerebrovascular accident), also known as stroke, and TIA (transient ischemic attack) are disruptions in blood flow to the brain. A CVA is caused by ischemia or hemorrhage in the brain and results in cell death, while a TIA's disruption is temporary without cell death. Risk factors include atherosclerosis, hypertension, cardiac issues, and diabetes. Symptoms depend on the location and size of the affected area but may include paralysis, impaired speech/vision, and sensory changes. Treatment focuses on prevention by controlling risk factors and potentially using blood thinners. Nursing care revolves around monitoring for complications and maximizing recovery of functions.
The document provides information about protocols for treating patients exhibiting signs of an acute stroke or CVA. It outlines assessments and tests to determine if a patient is having a stroke, including the Cincinnati Pre-hospital Stroke Scale (CPSS) and Rapid Arterial Occlusion Evaluation (RACE). It describes treating potential underlying causes of stroke symptoms like hypoglycemia. It also notes the differences between primary and comprehensive stroke centers in terms of capabilities for treating patients.
Stroke results from a disruption in blood flow to the brain. It is a leading cause of death and disability. Risk factors include hypertension, smoking, heart disease, diabetes, and older age. There are two main types - ischemic caused by blockage and hemorrhagic caused by bleeding. Treatment depends on the type but may include blood thinners, clot busters, or surgery. Physical therapy focuses on regaining mobility and function through exercises, gait training, and positioning. Prevention emphasizes controlling risk factors like blood pressure, cholesterol, diabetes, and lifestyle changes like quitting smoking.
Acute management of patients with stroke is to stabilize the patient and to complete initial evaluation and assessment, including imaging and laboratory studies, within 60 minutes of patient arrival.
Critical decisions focus on the need for intubation, blood pressure control, and determination of risk/benefit for thrombolytic intervention.
This document provides an overview of radiological imaging in the management of stroke. It discusses:
1) Various imaging modalities used including unenhanced CT, CT angiography, MRI, and their benefits. Diffusion weighted MRI can detect acute ischemia within 30 minutes.
2) Examples of imaging findings for different stroke types like ischemic and hemorrhagic strokes. Ischemic strokes appear as bright lesions on DWI MRI.
3) Surgical interventions for acute stroke management include decompressive hemicraniectomy to reduce intracranial pressure for large hemispheric infarcts, and external ventricular drainage for intraventricular hemorrhage and hydrocephalus.
Management of stroke three to twenty four hourswebzforu
This document provides information on the management of stroke from 3 hours to 24 hours. It discusses the definition of stroke, types and mechanisms of stroke including ischemic and hemorrhagic strokes. It covers the clinical evaluation, investigations, and treatment approaches for ischemic and hemorrhagic strokes. Specific topics covered include thrombolysis, anticoagulation, management of hypertension, glucose levels, and pyrexia in the acute ischemic stroke period. Rehabilitation and new developments in interventions and neuroprotectives are also mentioned.
This document provides an overview of ischaemic stroke, including its definition, risk factors, pathophysiology, clinical presentation, diagnosis and management. Key points include:
- Ischaemic stroke accounts for 80% of strokes and results from focal brain infarction due to obstruction of cerebral blood flow.
- Major risk factors include hypertension, atrial fibrillation, diabetes, hyperlipidemia and previous stroke or TIA.
- Clinical syndromes depend on the location of brain infarction and can include motor/sensory deficits, aphasia and visual field cuts.
- Diagnosis involves neuroimaging such as CT, MRI and vascular imaging to identify the cause.
- Acute
A cerebrovascular accident, or stroke, is caused by a lack of oxygenated blood flow to the brain. It can be ischemic, due to a blockage, or hemorrhagic, due to a ruptured blood vessel. Symptoms depend on the affected brain area and can include weakness, sensory changes, speech problems, and visual issues. Stroke severity is classified as mild, moderate, or severe based on symptoms and exam findings. Risk factors include hypertension, atrial fibrillation, diabetes, and lifestyle factors like smoking and diet. Prevention focuses on controlling modifiable risks while treatment involves supportive care, thrombolysis if administered early, and long-term secondary prevention with antiplatelets or anticoagul
1. A 70-year-old woman collapsed at home and was found confused by her daughter. EMS determined she may have had a stroke and transported her to the hospital within 30 minutes of the collapse.
2. At the hospital, she was found to have high blood pressure, left-sided weakness, and a CT scan showed a blood clot in her carotid artery causing a right hemisphere stroke.
3. Her risk factors included a history of untreated hypertension and a previous transient ischemic attack. She was diagnosed with an ischemic stroke likely due to atherosclerosis.
This document summarizes information about yoga for cerebrovascular disease or stroke. It begins by defining stroke and its causes, then discusses the signs, symptoms, and modern medical treatments. It notes that yoga can help with stroke rehabilitation by improving flexibility, strength, and reducing stress. Specific yoga poses and practices are recommended for recovery from and prevention of stroke.
This document discusses increased intracranial pressure. It can result from an increase in brain tissue, blood, or cerebrospinal fluid within the skull. Common causes include head injuries, brain tumors, strokes, and hydrocephalus. Symptoms include restlessness, changes in consciousness, changes in vital signs, headaches, nausea, vomiting, pupil changes, and decreased motor function. Treatment involves managing symptoms, monitoring intracranial pressure, administering medications to reduce pressure such as mannitol and diuretics, and surgical intervention if needed.
This document discusses increased intracranial pressure. It can result from an increase in brain tissue, blood, or cerebrospinal fluid within the skull. Common causes include head injuries, brain tumors, strokes, and hydrocephalus. Symptoms include restlessness, changes in consciousness, changes in vital signs, headaches, nausea, vomiting, pupil changes, and decreased motor function. Treatment involves managing symptoms, monitoring intracranial pressure, administering medications to reduce pressure such as mannitol and diuretics, and surgical intervention if needed.
This document provides an overview of the management of acute stroke. It defines stroke and transient ischemic attack, and discusses the epidemiology, classification, risk factors, pathophysiology, clinical presentation, diagnosis, management, complications and prognosis of stroke. The management involves resuscitation, reperfusion therapies like thrombolysis and thrombectomy, treating complications, secondary prevention including blood pressure and diabetes control, and rehabilitation. The document emphasizes the importance of specialized stroke units and timely management to improve outcomes for patients with acute stroke.
This document provides information about strokes, including:
- Strokes occur when the blood supply to the brain is interrupted, causing neurological deficits. The two main types are ischemic (85%) and hemorrhagic (15%).
- Risk factors include hypertension, diabetes, high cholesterol, smoking, obesity, and prior cardiovascular disease.
- Diagnosis involves history, physical exam, blood tests, CT/MRI scans. CT scans are used to distinguish between ischemic and hemorrhagic strokes.
- Treatment depends on the type of stroke. Ischemic strokes may be treated with fibrinolytic drugs like rtPA within 3 hours to break up clots. Hemorrhagic strokes focus on controlling
Cerebro Vascular Accident - A case presentationAkhil Sai
This document presents a case of cerebrovascular accident (CVA) in a 65-year-old male patient. The patient presented with headache, blurred vision, vertigo, slurred speech, and imbalance. He has a history of hypertension and diabetes. Diagnostic tests revealed lacunar infarcts. He was assessed as having a CVA due to hypertension. His treatment included amlodipine, atorvastatin, meclizine, glycerin, pantoprazole, B complex, and aspirin.
1. Hyperacute management of stroke focuses on reperfusion through thrombolysis or mechanical disruption of clots, reducing infarct size, and treating complications like raised intracranial pressure.
2. For intracerebral hemorrhage, the goals are to stop or slow the initial bleeding, control blood pressure, and reduce edema through hematoma evacuation, osmotherapy, or neuroprotective measures.
3. Specific treatments discussed include thrombolysis within 4.5 hours, aspirin, anticoagulants, blood pressure control, osmotherapy with mannitol or hypertonic saline, hematoma evacuation, seizure control with antiepileptics only for clinical seizures, and avoiding
Guidelines for management of acute strokesankalpgmc8
This document provides an overview of stroke types, pathophysiology, investigations, and management guidelines. It discusses the three main types of stroke: ischemic, intracerebral hemorrhage, and subarachnoid hemorrhage. For ischemic stroke, it describes the ischemic core and penumbra. It outlines the emergency evaluation of acute ischemic stroke including vital signs, blood tests, imaging, and scales like the NIH Stroke Scale. Management strategies discussed include thrombolysis, antiplatelet/anticoagulation drugs, neuroprotective agents, and surgical interventions. Complications like cerebral edema and their management are also summarized.
Stroke emergency treatment for 26th march 00PS Deb
The document discusses emergency treatment of stroke. It covers normal brain physiology, types of strokes including ischemic and hemorrhagic, evaluating patients in the emergency department, imaging tests, thrombolysis and endovascular treatment within 3 hours, managing complications, and treating subarachnoid hemorrhage and primary intracerebral hemorrhage. Surgical intervention may be considered for certain stroke types or if a patient is deteriorating.
Stroke presentation final Dr. Tarek (1).pptxAhmedalmahdi16
This document summarizes key information about stroke including types, symptoms, diagnosis, and treatment. It discusses that ischemic stroke is the most common type, resulting from artery occlusion. Transient ischemic attacks (TIAs) are defined as temporary neurological deficits without infarction. Computed tomography (CT) and magnetic resonance imaging (MRI) are important diagnostic tools. Treatment depends on the type of stroke, but may include thrombolysis for ischemic strokes within 4.5 hours if hemorrhage is excluded, and controlling blood pressure for hemorrhagic strokes.
This document provides an overview of cerebrovascular accident (CVA), also known as stroke. It begins with definitions of CVA and discusses the anatomy of blood supply to the brain. It then covers the epidemiology, causes, risk factors, types, pathophysiology, clinical features, diagnosis, management, complications, prognosis, and rehabilitation of CVA. CVA is caused by interrupted blood flow to the brain, depriving it of oxygen and nutrients. The main causes are ischemia (blockage of an artery) and hemorrhage (bleeding). Risk factors include hypertension, diabetes, smoking, and high cholesterol. Treatment involves restoring blood flow, preventing further complications, and long-term rehabilitation. Prognosis depends on
This document provides information about myocardial infarction (MI) or heart attack. It defines MI as reduced blood flow in a coronary artery due to atherosclerosis or blockage. MI is a leading cause of death. Risk factors include age, family history, smoking, hypertension, high cholesterol, diabetes and stress. Signs and symptoms include chest pain and shortness of breath. Diagnosis involves ECG, cardiac enzymes and angiography. Treatment includes aspirin, nitrates, beta blockers, statins, clot-busting drugs, angioplasty and bypass surgery. Complications can include arrhythmias, heart failure and heart rupture.
This document provides information about myocardial infarction (MI) or heart attack. It defines MI as reduced blood flow in a coronary artery due to atherosclerosis or blockage. MI is a leading cause of death. Risk factors include age, family history, smoking, hypertension, high cholesterol, diabetes and stress. Signs and symptoms include chest pain and shortness of breath. Diagnosis involves ECG, cardiac enzymes and angiography. Treatment includes aspirin, nitrates, beta blockers, statins, clot-busting drugs, angioplasty and bypass surgery. Complications can include arrhythmias, heart failure and heart rupture.
Traumatic brain injury can result from blunt or penetrating trauma to the head. Common causes include motor vehicle accidents, falls, and sports-related injuries. The primary injury causes damage directly to the brain tissue, while secondary injuries such as swelling and bleeding can exacerbate the initial trauma. Treatment aims to prevent secondary injuries through supportive care, intracranial pressure monitoring and management, and surgery if necessary to evacuate hematomas. Patients require close monitoring for complications and long-term rehabilitation to address neurological and functional deficits.
Subarachnoid hemorrhage is caused most commonly by the rupture of a saccular aneurysm. The rupture causes blood to fill the subarachnoid space, which can lead to neurological deficits or death. Treatment involves securing the aneurysm through surgical clipping or endovascular coiling to prevent rebleeding, as well as managing complications like vasospasm, hydrocephalus, and seizures. Outcomes depend on the grade and location of the initial bleed and development of delayed cerebral ischemia.
1. Stroke can be caused by blockage of blood flow (ischemic) or bleeding in the brain (hemorrhagic). Treatment depends on the type and location of stroke.
2. Risk factors for stroke can be modifiable like hypertension, diabetes, smoking or non-modifiable like age, sex, family history. Managing modifiable risk factors is important for prevention.
3. Acute treatment of ischemic stroke may involve clot-busting drugs intravenously or surgery to remove clots, while hemorrhagic stroke management focuses on controlling blood pressure, reducing swelling in the brain.
Hypertension remains a major risk factor for cardiovascular and renal disease. Hypertensive crises are classified as emergencies, with severe elevation of blood pressure and acute target organ damage, or urgencies, with severe elevation but no organ damage. Untreated emergencies have a 1-year mortality of over 79%. Causes include non-adherence to treatment, renal disease, pregnancy disorders, withdrawal of medications, pheochromocytoma, and illicit drug use. Target organ damage includes brain, heart, kidneys, eyes, and aorta. Treatment focuses on rapidly lowering blood pressure with intravenous drugs like sodium nitroprusside, labetalol, or nitroglycerine to prevent further injury. Management depends
The document provides information about myocardial infarction (MI), also known as a heart attack. It defines MI as the death of heart muscle caused by a blockage of blood flow through the coronary arteries. It discusses the causes, symptoms, diagnosis, and treatment of MI. The main symptoms of MI are chest pain and shortness of breath. Diagnosis involves electrocardiograms, cardiac enzyme levels, and other cardiac tests. Treatment focuses on restoring blood flow, reducing myocardial workload, and preventing complications through medications, procedures like angioplasty, and lifestyle changes.
This document discusses the challenges in nursing care for patients experiencing a cerebrovascular accident (CVA) or stroke. It begins by defining a CVA as a sudden loss of brain function caused by disrupted blood flow to the brain. The document then covers the types, risk factors, clinical manifestations, investigations, and management of strokes. It emphasizes the nursing priorities of initial treatment to prevent further deterioration, ongoing risk assessment, and interventions to address impaired mobility, vital signs, nutrition, and more. The overall goal of nursing management is to control symptoms, prevent complications, and optimize recovery through a coordinated, multidisciplinary approach.
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There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
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NVBDCP.pptx Nation vector borne disease control programSapna Thakur
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Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
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Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
4. Acute Ischemic Stroke
AIS is caused by the sudden loss of blood circulation to an
area of the brain resulting in ischemia and corresponding
loss of neurological function.
Within seconds to minutes of loss of perfusion, an
ischemic cascade is unleashed resulting in a central area
of irreversible infarction surrounded by an area of
potentially reversible ischemic penumbra.
Goal of treatment : To preserve the area of oligemia in the
ischemic penumbra. This is done by limiting the severity
of injury (neuronal protection) and by restoring blood flow
to the penumbra.
5. Presentation
No clinical feature reliably distinguishes AIS from
hemorrhagic stroke, though headache, N/V, and
altered mental status make hemorrhagic stroke more
likely.
Common symptoms of AIS include the abrupt onset
of hemiparesis, monocular visual loss, ataxia, vertigo,
aphasia, or sudden depressed level of
consciousness.
Establishing the onset of symptoms is essential when
considering possible thrombolytic therapy.
6. Transient Ischemic Attack
TIA’s are defined as a transient ischemic neurological
deficit that resolves within 24 hours
80% resolve within 60 minutes
TIA’s precede 30% of AIS
Left untreated, 30% of TIA’s progress to AIS (20%
within the first month and 50% within the first year)
7. Physical Exam.
Goal of PE is to look for extra cranial causes of AIS and
to distinguish AIS from stroke mimics (seizures, tumors,
toxic-metabolic disturbances, positional vertigo, etc).
HEENT: Look for trauma signs and nuchal rigidity, listen
for cranial or cervical bruits, evaluate pulse strength.
Fundoscopy to look for emboli, hemorrhage,
papilledema.
C/V: Signs of CHF, Atrial fibrillation, arrhythmias.
Ext: Signs of venous thrombosis and arterial emboli.
17. Neurologic exam: AIS
Goal is to establish baseline for monitoring response to
therapy and to determine size and location of AIS
MS, CN, Motor, Coordination, Sensory and Gait need to be
covered, however speed is of the essence!
MCA: Contralateral : Hemiparesis, Hemianopsia and
Sensory loss
Ipsilateral: Gaze preference.
Dominant Hemisphere: Aphasia
Non-Dominant Hemisphere: Hemi-neglect and
cortical sensory deficits
18. Neurologic exam: AIS
ACA: Disinhibition, primitive reflexes, contralateral
hemiparesis (legs>arms), urinary incontinence.
PCA: Contralateral hemianopsia, cortical blindness,
altered mental status, impaired memory.
Vertebrobasilar: Vertigo, nystagmus, ataxia.
Crossed findings (ipsilateral cranial nerve deficits
along with contralateral long track signs).
Lacunar Infarcts: Pure motor, pure sensory,
ataxia/hemiparesis.
19. Work up: AIS
Labs: CBC with platelets, CMP, PT, PTT, cardiac
biomarkers, EKG.
Imaging: Emergent non-contrast CT
Distinguishes hemorrhagic from ischemic stroke
Defines age and anatomic distribution of stroke
Large hypodense area seen within 3 hours brings into
question of timing of AIS and may predict poor outcome
Hyperdense MCA sign
24. Other imaging studies: AIS
CT Angiography
MRI:
Diffusion-Perfusion mismatch (correlates to the core area of
infarction and surrounding area of the ischemic penumbra)
More sensitive than CT to early ischemic changes
MR Angiography
Conventional Cerebral Angiography
Echocardiography: (CHF, akinetic wall, vegetation/clots,
septal defects, PFO)
Carotid Doppler Ultrasound: Carotid stenosis evaluation
25. Treatment
ABCD’s
Airway: Intubation for GCS < 8 or lack of airway
protective reflexes
Breathing: O2 if hypoxic. Keep PCO2 32-36 mmHg
Circulation: Maintain adequate CPP (MAP-ICP).
Do not treat HTN unless > 200/120
D = Dextrose. Maintain normoglycemia (even if insulin is
needed) as hyperglycemia worsens neurological
outcome
26. Coma cocktail - DONT
Dextrose
Oxygen
Naloxone
Thiamine
Flumazanil?
27. Treatment : AIS
Fever: Hyperthermia worsens ischemic injury
Cerebral edema: Peaks 72-96 hours. Hyperventilation
can decrease CPP.
Mannitol may leak across compromised BBB. No
evidence of benefit for steroids.
Decompressive craniectomy and resection of necrotic
tissue may be indicated, especially in the setting of
hemorrhagic transformation.
Seizure control: Prophylactic AED is not indicated unless
malignant elevated ICP is present
28. Acute Thrombolysis:AIS
Balance restoration of blood flow and hemorrhage risk
No evidence of hemorrhage on CT
Hypodensity on CT < 1/3 of hemisphere
Onset of symptoms within 3 hours of rTPA use
SBP < 185 DBP < 110
INR < 1.7, Platelets > 100,000, No ASA or
anticoagulation, No trauma or recent surgery
rTPA: 0.9 mg/kg IV over 60 minutes with 10% of
dose given over the 1st minute
31. Intraventricular Hemorrhage
Accounts for 3% of all non-traumatic ICH
Hypertension is the most common etiology
Often results from an intraparenchymal hemorrhage
that extends into the ventricular system
S/S: Headache, N/V, Progressive deterioration of
consciousness, raised ICP, Nuchal rigidity
Survivors may develop post-hemorrhagic
hydrocephalus
32. Intraparenchymal Hemorrhage
Basal Ganglia Hemorrhage
Contralateral hemiparesis, hemichorea, hemisensory loss, and
hemi-neglect are common neurological deficits
34. Intraparenchymal Hemorrhage
Pontine Hemorrhage
Abrupt onset of coma, pinpoint pupils, autonomic
instability, horizontal gaze paralysis, and
quadriparesis
The miotic pupils and depressed LOC may mimic
opiate overdose
36. Intracranial Hemorrhage
Cerebellar Hemorrhage
Sudden onset of vertigo, severe N/V, and ataxia
altered mental status and coma over a few hours
Obstructive hydrocephalus can contribute to brainstem
herniation
Urgent posterior fossa decompression is essential for survival
39. Etiology: Intraparenchymal Hemorrhage
Hypertension is the #1 cause in adults
Anticoagulation and Anti-Platelet Meds
Systemic anticoagulated states (eg. DIC)
Aneurysms, AVM’s, Cavernous Angiomas
40. Treatment: ICH
ABCD’s
Intubation??
Treat Hypertension to keep SBP < 160 mmHg
Fluid and Electrolyte Management
Use Normal Saline, avoid Dextrose
Watch for SIADH and Cerebral Salt Wasting
Prevent Hyperthermia
Seizure Prophylaxis
Correct Underlying Coagulopathy
FFP, platelet Infusions, Vitamin K
41. Treatment :ICH
Recombinant Factor VII
Dosing ranges between 40 and 160 micrograms
Beneficial if given within 4 hours of onset
Risk of myocardial infarction and AIS
Management of ICP
Hyperventilate to keep PaCO2 around 30 mmHg
Avoid Mannitol (can leak into hematoma)
External Ventricular Drain (if hydrocep0halus present)
Surgical Evacuation of Hematoma (controversial)
42. Subarachnoid Hemorrhage
Aneurysmal rupture accounts for 80% of cases
Risk Factors
Advancing age, Smoking, HTN, Cocaine use, Hypertension,
Heavy Alcohol use, Connective Tissue Disorders, Sickle Cell
Disease, First Degree Relatives with Aneurysms
Fatality rate is 50% within 2 weeks
30% of survivors require lifelong care
15% of patients will have > 1 aneurysm
Outcome largely dependent on clinical presentation
and CT findings
43. Subarachnoid Hemorrhage
• Sudden-Onset “Thunderclap
Headache”
• “Worst Headache of my life”
• CN III palsy (p. comm aneurysm)
• CN VI palsy (raised ICP)
• Retinal Hemorrhages
• Altered Mental Status
• Nuchal Rigidity
Clinical
presenting
signs
44. Diagnostic Work Up
CT Imaging
Will pick up > 90% SAH (get thin cuts through skull
base)
Sensitivity drops to < 50% after 2 weeks
Carefully evaluate basilar cisterns for hemorrhage
45.
46. Diagnostic Work Up
Lumbar Puncture
Perform if high index of suspicion and negative CT
Elevated Opening Pressure
Increased RBC count that does not “clear” between tubes one and tube four
Xanthochromia (rule of 2’s)
Starts at 2 hours, Peaks at 2 days, Clears by 2 weeks
47. Diagnostic Work Up
Angiography
Digital Subtraction Angiography is gold standard
CT Angiography
MR Angiography
Look for Multiple Aneurysms
52. Status Epilepticus
Definitions
A single seizure or back-to-back seizures
without return of consciousness lasting
> 45 minutes (primate studies)
>30 minutes (WHO definition)
>10 minutes (working definition)
53. Etiologies
Idiopathic (24%) No precipitating event, pt is
neurologically and developmentally normal
Febrile (24%) Includes “febrile seizures” and
seizures in the setting of a febrile illness
Prior neurological insult or developmental
brain malformation
54. Etiologies
Vascular
Stroke (Hemorrhagic > Ischemic)
Subarachnoid Hemorrhage
Hypoxic Ischemic Encephalopathy
Toxic
Cocaine and other sympathomimetics
Alcohol withdrawal
Various Medications (Isoniazid, TCA’s, various
chemotherapy agents)
AED non-compliance or withdrawal
56. Status Epilepticus
History
Fever, pre-existing epilepsy, trauma, baseline AED’s and their dosing
Physical Exam
Signs of trauma, nuchal rigidity, end organ injury
Subtle signs of seizures (tachycardia, pupil dilation and hippus, nystagmus,
irregular respirations)
Work Up
Lytes, glucose, AED levels, CPK, LFT’s, ABG, ammonia
CT of brain
LP (when stable) if indicated. Empiric antibiotics.
57. Treatment
ABCD’s
Airway: Risk of aspiration,
suction to bedside
Breathing: Give
supplemental O2
C/V: Initial tachycardia
giving way to hypotension
(especially when
Benzos or Barbiturates
are given)
Dextrose: Symptomatic
hypoglycemia is causing
irreversible brain
injury until corrected
60. Long-Acting Anticonvulsant Therapy
Phenytoin
20 mg/kg over 20 minutes (regardless of weight)
C/R monitor during load
No dextrose in line
Extravasation injuries are severe
61. Long-Acting Anticonvulsant Therapy
Phenobarbital
20 mg/kg over 20 minutes
Watch for respiratory suppression (especially if the patient has received
Benzodiazepines)
Watch for hypotension
Good for Febrile Status Epilepticus
62. Refractory Status
Secure airway
Transfer to ICU
Extra lines for hypotension treatment
EEG Monitoring (electrical-clinical dissociation)
Medications
Pentobarbital
Other agents (Midazolam drip, Propofol, Lidocaine,
inhalation anesthetics, other AED’s)
63. Guillan-Barre´Syndrome
Progressive ascending weakness along with
various cranial neuropathies
Areflexia
Minimal sensory deficits (though radicular pain is
common)
Progression over days to 4 weeks
Preceding infection or Immunization: 1 to 4
weeks prior to onset of weakness (C. jejuni,
CMV, Mycoplasma, dT, OPV, VZV)
64. Physical Exam
Bulbar and Respiratory Compromise
Relatively Symmetric Ascending Weakness
Diminished/Absent DTR’s
No Sensory Level
Radicular Pain/Paresthesias
Autonomic Dysfunction: Increased or Decreased SNS or
PNS Function (tachy-brady arrhythmias,
hyper/hypotension, urinary retention,
decreased GI mobility)
65. Laboratory workup
CSF: Albuminocytological Dissociation
Elevated Protein without Pleocytosis
Nerve Conduction:
66. Treatment
ABC’s
Airway/Breathing: (Serial Examinations)
Forced Vital Capacity: (want > 15 ml/kg)
Negative Inspiratory Force (want > - 40 mmHg)
ABG’s : Look for rising Pa CO2
Clinical Exam (accessory muscles, SOB, diminished exhalation strength)
Elective Intubation if Respiratory Insufficiency or significant Bulbar Weakness
67. ABC’s
Cardiovascular
BP Monitoring
Careful when treating hypo or hypertension
Excessive Vagal Response with GI pain, Intubation, Tracheal
Suctioning and other Procedures
ICU Monitoring Until Patient Reaches Nadir of Weakness
68. IVIG
5 day infusion of 0.4 g/kg per day
Plasmapharesis
5 exchanges (40-50 ml/kg) given on alternate days using saline and
albumin as replacement fluid
No Role for Steroids
69. Outcome-GBS
10% to 20% require mechanical ventilation
Mortality 2% to 5%
After nadir, plateau phase lasts 2-4 weeks
70% complete recovery within 1 yr, 82% by 2 yrs
3% will go on to have relapse (CIDP)
71. Definition
Syncope is a symptom, the defining clinical
characteristics of which are:
• transient
• self-limited loss of consciousness
• leads to falling
• onset is relatively rapid
• recovery is spontaneous, complete, and
usually prompt
The underlying mechanism is a transient global
cerebral hypoperfusion
72. Classification of Syncope
Syncope must be differentiated from other
“non-syncopal” conditions which also lead
to transient loss of consciousness.
Pathophysiological classification is based on
the principal causes of the transient loss of
consciousness.
73. Real or apparent transient loss of consciousness
Syncope Non-syncopal attacks
• With partial or complete
loss of consciousness
• Without any impairment of
consciousness
75. Loss of consciousness: II - Non-syncopal
Partial or complete loss of consciousness
Metabolic Hypoxia,hyperventilation,
hypoglycemia
Epilepsy
Intoxication
Vertebro-basilar TIA
Any impairment of consciousness
Falls
Cataplexy
Drop attacks
Psychogenic ‘pseudo-syncope’ Fictitious disorders, malingering
and conversion
Carotid TIA
77. Management strategy
• Initial evaluation
(history, physical exam, ECG & BP supine/upright)
• Laboratory investigations guided by the
initial evaluation
• Treatment
The diagnostic strategy based on the initial
evaluation
79. Initial evaluation
Question 1
• Syncope or non-syncopal attack ?
Question 2
• Is heart disease present or absent ?
Question 3
• Which history of syncope ?
3 key questions:
80. Initial evaluation
Important historical features
1 - Questions about circumstances just prior to attack
• Position (supine, sitting or standing)
• Activity (supine, during or after exercise)
• Situation (urination, defecation, cough or swallowing)
• Predisposing factors (e.g., crowded or warm places, prolonged
standing, post-prandial period)
• Precipitating events (e.g., fear, intense pain, neck movements)
2 - Questions about onset of attack
• Nausea, vomiting, feeling of cold, sweating, aura, pain in neck
or shoulders
3 - Questions about attack (eyewitness)
• Skin colour (pallor, cyanotic)
• Duration of loss of consciousness
• Movements (tonic-clonic, etc)
• Tongue biting
81. Initial evaluation
Important historical features
5 - Questions about end of attack
Nausea, vomiting, diaphoresis, feeling of cold, confusion,
muscle aches, skin colour, wounds
6 - Questions about background
• Number and duration of syncopes
• Family history of arrhythmogenic disease
• Presence of cardiac disease
• Neurological history (Parkinsonism, epilepsy, narcolepsy)
• Internal history (diabetes, etc.)
• Medication (hypotensive and antidepressant agents)
82. Initial evaluation
Diagnostic criteria
• Vasovagal syncope is diagnosed if precipitating
events such as fear, severe pain, emotional
distress, instrumentation and prolonged standing
are associated with typical prodromal symptoms.
• Situational syncope is diagnosed if syncope
occurs during or immediately after urination,
defaecation, cough or swallowing.
• Orthostatic syncope is diagnosed when there is
documentation of orthostatic hypotension
associated with syncope or presyncope.
83. Initial evaluation
ECG diagnostic criteria
Syncope due to cardiac arrhythmia is diagnosed
in case of:
• Symptomatic sinus bradycardia <40 beats/min
or repetitive sino-atrial blocks or
sinus pauses >3 s.
• Mobitz II 2nd or 3rd degree atrioventricular block.
• Alternating left and right bundle branch block.
• Rapid paroxysmal supraventricular tachycardia
or ventricular tachycardia.
• Pacemaker malfunction with cardiac pauses.
84. Initial evaluation
ECG diagnostic criteria
Syncope due to cardiac ischemia
is diagnosed when symptoms are present with
ECG evidence of acute myocardial ischaemia
with or without myocardial infarction,
independently of its mechanism (*).
85. Clinical and ECG features that suggest a cardiac syncope
Presence of severe structural heart disease
Syncope during exertion or supine
Palpitations at the time of syncope
Suspected VT (e.g. heart failure or NSVT)
BBB
Mobitz 1 second degree AVB
Sinus bradycardia <50 bpm
WPW
Long QT
ARVD or Brugada Syndrome
86. Clinical and ECG features that suggest a neurally-mediated
syncope
Absence of cardiac disease.
Long history of syncope.
After sudden unexpected unpleasant sight, sound,
or smell.
Prolonged standing or crowded, warm places.
Nausea, vomiting associated with syncope.
During or in the absorptive state after a meal.
After exertion.
With head rotation, pressure on carotid sinus.
88. Certain or suspected heart disease
yes no
Cardiac evaluation
-Echocardiogram
-ECG monitoring
-Exercise test
-EP study
-ILR
NM evaluation
-Carotid sinus massage
-Tilt testing
-ATP test
-ILR
90. Treatment of Syncope:
General Principles
Principal goals of treatment:
Prevent recurrences
Reduce risk of mortality
Additional goals:
Prevent injuries associated with recurrences
Improve quality of life
91. Neurally-mediated syndromes: therapy
Initial treatment:
Education and reassurance
Sufficient for most
No treatment Single syncope and no high
risk settings
Additional treatment High risk or high frequency
settings
Recommendations
92. Treatment of Orthostatic
Hypotension
CAUSE TREATMENT
Drug-induced
autonomic
failure
Eliminate the offending
agent
Primary &
secondary
autonomic
failure
Modify physical factors
that influence systemic
blood pressure*
93. Treatment of Cardiac Arrhythmias
as Primary Cause
Treatment Goals:
Prevention of symptom recurrence
Improvement of quality of life
Reduction of mortality risk
94. Treatment of Cardiac Arrhythmias
Cardiac pacemaker therapy is indicated
Elimination of drugs that may increase susceptibility to
bradycardia should be considered
Catheter ablation for control of atrial arrhythmias
Sinus node dysfunction
(including bradycardia/tachycardia syndrome)
95. Metabolic Disturbances:
Hyperventilation
Hyperventilation resulting in hypocapnia and
transient alkalosis may be responsible for
confusional states or behavioral disturbances.
Clearcut distinction between such symptoms and
syncope may be difficult .
Frequently associated with anxiety episodes
and/or ‘panic’ attacks.
Recurrent faints associated with hyperventilation
should justify a psychiatric consultation.