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Neurological disorder(stroke). presentation
- 1. Disorders of Neurological function Mr.AMJAD ALI. BSN from KHYBER MEDICAL UNIVERSITY Peshawar MSN (SiP) from UNIVERSITY OF LAHORE ,Lahore Unit No : 03.B Pathophysiology II BSN
- 2. • Stroke (CVA) •Transient Ischemic Attacks (TIAS).
- 3. Objectives At the completionof this unit learners will be able to: 1. Review the major vessels in the cerebral circulation. 2. Review the, blood brain, & brain cerebrospinal fluid barrier. 3. Explain the degeneration of the nervous tissue that cause alteration in cerebral blood flow (stroke). • Risk factors and types of stroke • Transient Ischemic Attacks (TIAS).
- 4. Stroke Occurs when ablood vessel that carries oxygen and nutrients to the brain is either blocked by a clot or ruptures. Physical, cognitive, emotional, & financial impact
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- 7. MENINGES OF THEBRAIN
- 8. Anatomy of CerebralCirculation
- 9. The blood-brain barrieris the barrier between the cerebral capillary blood and the interstitial fluid of the brain. It is made up of capillary endothelial cells and basement membrane, neuroglial membrane, and glial podocytes,
- 10. Cerebrovascular Accident Anatomy ofCerebral Circulation Blood Supply Anterior: Carotid Arteries – middle & anterior cerebral arteries frontal, parietal, temporal lobes; basal ganglion; part of the diencephalon (thalamus & hypothalamus) Posterior: Vertebral Arteries – basilar artery Mid and lower temporary & occipital lobes, cerebellum, brainstem, & part of the diencephalon Circle of Willis – connects the anterior & posterior cerebral circulation
- 11. Cerebrovascular Accident Anatomy ofCerebral Circulation Blood Supply 20% of cardiac output—750-1000ml/min >30 second interruption– neurologic metabolism is altered; metabolism stops in 2 minutes; brain cell death < 5 mins.
- 14. Type of stroke Basedon underlying pathophysiologic findings
- 15. Stroke Type Ischemic Stroke Thrombotic Embolic HemorrhagicStroke Intracerebral Hemorrhage Subarachnoid Hemorrhage Aneurysm Berry or Saccular
- 16. Cerebrovascular Accident Classifications IschemicStroke—inadequate blood flow to the brain from partial or complete occlusions of an artery--85% of all strokes – Extent of a stroke depends on: • Rapidity of onset • Size of the lesion • Presence of collateral circulation – Symptoms may progress in the first 72 hours as infarction & cerebral edema increase Types of Ischemic Stroke: Thrombotic Stroke Embolic Stroke
- 17. Cerebrovascular Accident Ischemic –Thrombotic Stroke Lumen of the blood vessels narrow – then becomes occluded – infarction Associated with HTN and Diabetes Mellitus >60% of strokes Lacunar Stroke: development of cavity in place of infarcted brain tissue – results in considerable deficits – motor hemiplegia, contralateral loss of sensation or motor ability
- 18. Cerebrovascular Accident Ischemic –Embolic Stroke Embolus lodges in and occludes a cerebral artery Results in infarction & cerebral edema of the area supplied by the vessel Second most common cause of stroke – 24% Emboli originate in endocardial layer of the heart – atrial fibrillation, MI, infective endocarditis, rheumatic heart disease, valvular prostheses Rapid occurrence with severe symptoms – body does not have time to develop collateral circulation Any age group Recurrence common if underlying cause not treated
- 19. Cerebrovascular Accident Hemorrhagic Stroke HemorrhagicStroke 15% of all strokes Result from bleeding into the brain tissue itself Intracerebral Subarachnoid
- 20. Cerebrovascular Accident Hemorrhage Stroke IntracerebralHemorrhage Rupture of a vessel Hypertension – most important cause Others: vascular malformations, coagulation disorders, anticoagulation, trauma, brain tumor, ruptured aneurysms Sudden onset of symptoms with progression Neurological deficits, headache, nausea, vomiting, decreased LOC, and hypertension Prognosis: poor – 50% die within weeks 20% functionally independent at 6 months
- 22. Cerebrovascular Accident Hemorrhagic-Subarachnoid Hemorrhagic Stroke–SubarachnoidHemorrhage Intracranial bleeding into the cerebrospinal fluid-filled space between the arachnoid and pia mater membranes on the surface of the brain
- 24. Cerebrovascular Accident Hemorrhagic-Subarachnoid Commonly causedby rupture of cerebral aneurysm (congenital or acquired) Saccular or berry – few to 20-30 mm in size Majority occur in the Circle of Willis Other causes: Arteriovenous malformation (AVM), trauma, illicit drug abuse Incidence: 6-16/100,000 Increases with age and more common in women
- 25. Cerebrovascular Accident Hemorrhagic-Subarachnoid Cerebral Aneurysm WarningSymptoms: sudden onset of a severe headache – “worst headache of one’s life” Change of LOC, Neurological deficits, nausea, vomiting, seizures, stiff neck Despite improvements in surgical techniques, many patients die or left with significant cognitive difficulties
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- 27. Stroke or Cerebrovascular Accident Clinical Manifestations RightBrain – Left Brain Damage
- 31. Cerebrovascular Accident Treatment Goals Prevention– Health Maintenance Focus: Healthy diet Weight control Regular exercise No smoking Limit alcohol consumption Route health assessment Control of risk factors
- 32. Cerebrovascular Accident Treatment Goals Prevention DrugTherapy Surgical Therapy Rehabilitation
- 34. Transient ischemic attack(TIA) • A transient ischemic attack (TIA) is a temporary period of symptoms similar to those of a stroke. A TIA usually lasts only a few minutes and doesn't cause permanent damage. • Often called a ministroke, a TIA may be a warning. About 1 in 3 people who has a TIA will eventually have a stroke, with about half occurring within a year after the TIA.
- 36. References 1. Carol, P.M. (2000). Pathophysiology concept of altered health states. Philadelphia:J. B. Lippincott 2. Author D. Fluid & electrolyte made incredibly easy. (2002). 2 nd ed). Pennsylvania springhouse. 3. Sue, Huether E. (2000). Understanding pathophysiology New York: Mosby. 4.Tortora, G. J., & Anagnostakos, N. P. (2000). Principles of anatomy and physiology New York:Harper & Row. 5. Wilson, S. A. P & LM. (1997). Clinical concepts of disease processes (5th ed). Mosby
- 42. • 1. Whatis another name for a stroke? • A. Heart attack • B. Brain attack • C. Myocardial infarction • D. None of the above • Correct B
- 43. • Which ofthese is a symptom of stroke? • A. Sudden confusion • B. Sudden weakness in an arm or leg • C. Sudden severe headache with no cause • D. Sudden trouble seeing • E. All of the above • Correct E
- 44. • If aperson has an ischemic stroke, how quickly should the person be treated to minimize long-term problems? • A. Within 30 minutes • B. Within 1 hour • C. Within 2 hours • D. Within 3 hours • Correct A
Editor's Notes
- #29 جذباتی spatial Within the visual domain these include locating points in space, determining the orientation of lines and objects, assessing location in depth, appreciating geometric relations between objects, and processing motion, including motion in depth.
- #30 neurological disorder characterized by loss of the ability to execute or carry out skilled movements and gestures, despite having the desire and the physical ability to perform them
- #35 Oral Birth Control, weakness or the inability to move on one side of the body, making it hard to perform everyday activities like eating or dressing. a neurological disorder characterized by loss of the ability to execute or carry out skilled movements and gestures, despite having the desire and the physical ability to perform them. Homonymous hemianopia is a visual field defect involving either the two right or the two left halves of the visual fields of both eyes.