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Presented by : Gunpreet
Singh
Roll no. 19064
Old Final Year
Approach to Stroke
Definition and Types
Stroke is defined as sudden global or focal neurological deficit
resulting from spontaneous hemorrhage or infarction of central
nervous system with objective evidence of infarction/
haemorrhage irrespective of duration of clinical symptoms
Types of stroke :
1. ISCHEMIC STROKE - a) Thrombotic stroje
b) Embolic stroke
2. HAEMORRHAGIC STROKE- a) Intra cerebral haemorrhage
b) Sub Arachnoid haemorrhage
Risk Factors for Stroke
Modifiable :
Hypertension
Heart Disease (atrial
fibrillation)
Endocarditis
Diabetes Mellitus
Hyperlipidemia
Smoking
Excessive alcohol
Oral contraceptives
Non Modifiable :
Age
Gender (M>F)
Heredity
Previous vascular
event like MI,
peripheral embolism
High fibrinogen
Ischemic - Thrombotic Stroke
Etiologies : Lacunar Stroke
Large vessel thrombosis
Hypercoagulable disorders
Atherosclerosis is the most common pathology leading to
thrombotic occlusion of blood vessels
Hypercoagulable disorders are among uncommon cause
- antiphospholipid syndrome
- sickle cell anaemia
- polycythemia vera
_ homocysteinemia
Vasculitis : PAN, Wegner’s Granulomatosis
Ischemic- Embolic stroke
Cardioembolic stroke:
embolus from the heart gets lodged into intracranial vessels
Middle cerebral artery is thw most commonly affected
Atrial fibrillation is the most common cause
Artery to artery embolism:
Thrombus formed on atherosclerotic plaques gets embolized to
intracranial vessels
Carotid bifurcation atherosclerosis is the most common source of
emboli
Ischemia leads to formation of ischemic core and later on ischemic
penumbra and finally leading to the deatn of the brain tissue
Haemorrhagic- Intracerebral
Result of chronic hypertension
Small arteries are damaged due to hypertension
In advanced stages vessel wall is disrupted and leads to leakage
Other causes are amyloid angiopathy, anticoagulant therapy,
cavernous hemangioma, cocaine and amphetamines
Haemorrhagic- Subarachnoid
Most common cause is rupture of saccular or Berry aneurysms
Other causes are arteriovenous malformations, angiomas,
mycotic aneurysmal rupture
Associated with extremely severe headache
Pathophysio of hemorrhagic stroke
. Explosive entry of blood into the brain parenchyma structurally
disrupts neurons
. White matter fibre tracts are split
. Immediate cessation of neuronal function
. Expanding hemorrhage can act as a mass lesion and cause
further progression of neurological deficits
. Large hemorrhages can cause transtentorial coning and rapid
death
Clinical features and History taking
Ask for onset and progression of symptoms- completed stroke or
stroke in evolution
History of previous TIA’s and amaurosis fugax
History of chronic hypertension and diabetes mellitus
History of heart conditions like arrhythmias, RHD, and prosthetic
valves
History of seizures and migraine
History of any anticoagulant therapy
History of any hypercoagulable dis. Like sickle cell anaemia
Substance abuse like cocaine or amphetamines
Signs and symptoms of MCA stroke
Paralysis of contra lateral face, arm, amd leg along with sensory
impairment of the same area
Motor aphasia
Central aphasia
Conduction aphasia
Homonymous hemianopia
Paralysis of conjugate gaze to the opposite side
If stroke occurs prior to the anterior communicating artery it is
usually well tolerated secondary to collateral circulation
Paralysis of contralateral foot and leg
Sensory loss in contralateral foot and leg
Left sided strokes may develop transcortical motor aphasia
Gait apraxia
Urinary incontinence which usually occurs with bilateral damage
in acute phase
Signs and symptoms of ACA stroke
THANK YOU !!!

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Presentation.pptx

  • 1. Presented by : Gunpreet Singh Roll no. 19064 Old Final Year Approach to Stroke
  • 2. Definition and Types Stroke is defined as sudden global or focal neurological deficit resulting from spontaneous hemorrhage or infarction of central nervous system with objective evidence of infarction/ haemorrhage irrespective of duration of clinical symptoms Types of stroke : 1. ISCHEMIC STROKE - a) Thrombotic stroje b) Embolic stroke 2. HAEMORRHAGIC STROKE- a) Intra cerebral haemorrhage b) Sub Arachnoid haemorrhage
  • 3. Risk Factors for Stroke Modifiable : Hypertension Heart Disease (atrial fibrillation) Endocarditis Diabetes Mellitus Hyperlipidemia Smoking Excessive alcohol Oral contraceptives Non Modifiable : Age Gender (M>F) Heredity Previous vascular event like MI, peripheral embolism High fibrinogen
  • 4. Ischemic - Thrombotic Stroke Etiologies : Lacunar Stroke Large vessel thrombosis Hypercoagulable disorders Atherosclerosis is the most common pathology leading to thrombotic occlusion of blood vessels Hypercoagulable disorders are among uncommon cause - antiphospholipid syndrome - sickle cell anaemia - polycythemia vera _ homocysteinemia Vasculitis : PAN, Wegner’s Granulomatosis
  • 5. Ischemic- Embolic stroke Cardioembolic stroke: embolus from the heart gets lodged into intracranial vessels Middle cerebral artery is thw most commonly affected Atrial fibrillation is the most common cause Artery to artery embolism: Thrombus formed on atherosclerotic plaques gets embolized to intracranial vessels Carotid bifurcation atherosclerosis is the most common source of emboli Ischemia leads to formation of ischemic core and later on ischemic penumbra and finally leading to the deatn of the brain tissue
  • 6. Haemorrhagic- Intracerebral Result of chronic hypertension Small arteries are damaged due to hypertension In advanced stages vessel wall is disrupted and leads to leakage Other causes are amyloid angiopathy, anticoagulant therapy, cavernous hemangioma, cocaine and amphetamines Haemorrhagic- Subarachnoid Most common cause is rupture of saccular or Berry aneurysms Other causes are arteriovenous malformations, angiomas, mycotic aneurysmal rupture Associated with extremely severe headache
  • 7. Pathophysio of hemorrhagic stroke . Explosive entry of blood into the brain parenchyma structurally disrupts neurons . White matter fibre tracts are split . Immediate cessation of neuronal function . Expanding hemorrhage can act as a mass lesion and cause further progression of neurological deficits . Large hemorrhages can cause transtentorial coning and rapid death
  • 8. Clinical features and History taking Ask for onset and progression of symptoms- completed stroke or stroke in evolution History of previous TIA’s and amaurosis fugax History of chronic hypertension and diabetes mellitus History of heart conditions like arrhythmias, RHD, and prosthetic valves History of seizures and migraine History of any anticoagulant therapy History of any hypercoagulable dis. Like sickle cell anaemia Substance abuse like cocaine or amphetamines
  • 9. Signs and symptoms of MCA stroke Paralysis of contra lateral face, arm, amd leg along with sensory impairment of the same area Motor aphasia Central aphasia Conduction aphasia Homonymous hemianopia Paralysis of conjugate gaze to the opposite side
  • 10. If stroke occurs prior to the anterior communicating artery it is usually well tolerated secondary to collateral circulation Paralysis of contralateral foot and leg Sensory loss in contralateral foot and leg Left sided strokes may develop transcortical motor aphasia Gait apraxia Urinary incontinence which usually occurs with bilateral damage in acute phase Signs and symptoms of ACA stroke