Stroke is defined as abrupt neurological deficit caused by reduced blood flow to the brain. It is the second leading cause of death worldwide, affecting over 70 million people annually. The main types are ischemic (88%) and hemorrhagic (12%) strokes. Major risk factors include age, hypertension, atrial fibrillation, diabetes, and smoking. Pathophysiology involves thrombosis, embolism, or bleeding that reduces blood flow and causes brain cell death from oxygen deprivation. Signs and symptoms include numbness, weakness, confusion, and headaches. Diagnosis involves imaging tests and lab work. Treatment focuses on revascularization, medication to reduce risk of future strokes, and rehabilitation.

1. STROKE

2. DEFINITION Stroke is defined as abrupt onset of a neurologic deficit that is attributable to a focal vascular cause.

3. INTRODUCTION Stroke is second leading killer worldwide Stroke is a neurological damage caused by reduction of blood flow to the brain .The part of the brain damaged from loss of oxygen is called infarct It is also called brain attack

4. EPIDEMIOLOGY It is occurs in more than 70,00000 individuals per year and results in 1,50000 deaths. 75% of stroke occurs in elderly patients of age more than 65 years

5. Classification Stroke Hemorrhage (12%) intraparenchymal subarachnoidal Ishemic stroke(88%) Atherosclerotic penetrating artery cardiogenic cryptogenic other unusual Cerebrovascular diseases disease(20%) embolism(18%) stroke(30%) cause(5%) (15%) hypoperfusion Atrial fibrillation prothrombic atheriogenic emboli valve disease causes ventricular thrombi migraine vasospasm drug abuse dissections

6. ETIOLOGY 1) Non modifiable risk factors Age Gender Race Family history of stroke Low birth weight 2) Modifiable Hypertension Atrial fibrillation Diabetes Cigratte smoking, alcohol Sickle cell disease Post menopausal hormone therapy

7. 3) Potentially modifiable Oral contraceptives Migraine Drug and alcohol abuse Hemostatic and inflammatory factors Sleep disorder

8. P athophysiology Ishemic stroke Carotid atherosclerosis Progressive accumulation of lipids and inflammatory cells in the intima of the affected arteries Hypertrophy of arterial smooth muscle cells Plaque formation Stress Plaque rupture ,collagen exposure ,platelet aggregation & clot formation Clot remain in the vessel travel embolism

9. Local occlusion thrombus formation arterial occlusion decreasing cerebral blood flow ishemia ishemic cell reduction in nutrients Depletion of high energy phospahtes (ATP) – maintains membrane integrity Extracellular K + Accumulates & Na and H 2 O intracellularly Electrolyte imbalance cell swelling & lysis

10. leads to depolarization of the cell influx of Ca ions (+) lipases ,proteases, endonucleases ,release of free fatty acids from membrane phospholipids accumulation of free fatty acids (arachidonic acids) Formation of prostaglandins , leukotrienes, free radicals Intracellular acidosis occurs in 2-3 hrs Cell death

11. Haemorrhage stroke Presence of blood in the brain parenchyma ,neurotoxicity of the blood Damage to the surrounding tissue & hemorrhage volumes >60ml mortality at 30 days increase in intracranial pressure leads to herniation and death

12. SIGNS AND SYMPTOMS Sudden numbness or weakness of face ,arm or leg especially affecting only one side of the body Confusion trouble in speaking or in understanding others Visual disturbances in one or both eyes means blurred or double vision Dizziness ,loss of balance and difficulty in walking and coordination Severe headache without apparent cause Dysarthria.

13. DIAGNOSIS EEG,ECG( Atrial fibrillation) MRI CT Scan-hyperintensity (white) –heamorrhage areas normal or hypointense (dark)-infarction areas Carotid doppler –stenosis in carotid arteries Laboratory findings 1) Complete blood count 2) Coagulation test- protein c deficiency, anti -phospholipid antibody 3) Blood lipid test 4) Measure of cardiac enzymes like troponin, creatinine kinase LDH isoenzymes

14. Management 1) Pharmacological Acute ischemic stroke plasminogen activator (alteplase) with in 3 hrs of onset . Dose -0.9 mg/kg I.V aspirin within 48 hrs of onset . Dose -160-325 mg daily started within 48 hrs Secondary prevention of ischemic stroke antiplatelet therapy aspirin 50-325 mg daily clopidogrel 75 mg daily aspirin 25 mg +dipyridamole 200 mg twice daily Anti hypertensive agent Statin therapy AF , Cardiac source of embolism –warfarin (INR-2.5) Heamorrhage stroke Nimodipine( Ca channel blockers) Carotid stenting

15. 2) Non pharmacological treatment Speech therapy Psychological therapy Stroke rehabilitation physical therapy occupational therapy 3) Surgical carotid endarterectomy EC/IC bypass surgery Dipping Detachable coil technique

16. Patient counselling Educate about symptoms that might indicate stroke and other brain disease Avoid smoking and use of alcohol Regular exercise is advised Reduce overweight Decrease intake of high cholesterol and fat Regular check up of BP, sugar, lipid should be done Reduce salt intake