Downloaded 16 times
Uploaded bySabah Salim
Stroke
This document provides information about strokes, including: - The anatomy of the brain and its blood supply from arteries. - The definition of a stroke as a neurological dysfunction lasting over 24 hours due to cerebrovascular disease. - The types, causes, risk factors, signs and symptoms, and management of ischemic and hemorrhagic strokes. - Myths and facts about strokes, including that up to 80% are preventable but they can affect anyone at any time. It then discusses the case of a 77-year-old woman who suffered paralysis on her right side and an inability to speak after a stroke, indicating a left middle cerebral artery blockage.
More Related Content
![Neurocognitive Disorders [2020]](https://cdn.slidesharecdn.com/ss_thumbnails/ncd2020v2-200526001756-thumbnail.jpg?width=640&height=640&fit=bounds)
Stroke
- 1. STROKE Prepared By :MS. Nechirvan M Arif MS. Sabah Salim Majeed
- 2. • Anatomy ,BloodSupply ,Function Areas • Introducion ,Definiton ,infos • Pathophysiology ,Risk Factors ,Causes • Types ,Syndromes ,S&S ,Differentation • Managment ,DDx ,Prognosis • Facts and Myths • Case Discussion (Problem Solving)
- 3. A 77-year-old womanwas cooking in the kitchen when she collapsed onto the floor. Her daughter called an ambulance and the woman was taken to the emergency room. She had suffered a stroke, and slowly regained consciousness over the next two days. However, when she woke up, she had the following signs and symptoms: - paralysis of the right face and arm - loss of sensation to touch on the skin of the right face and arm - inability to answer questions but ability to understand what was said to her - ability to write down her thoughts more easily than to speak them Disscussion would be on the LAST SLIDES
- 4. Anatomy of brainand it’s blood supply • The brain receives its arterial supply from two pairs of vessels, the vertebral and internal carotid arteries which are interconnected in the cranial cavity to produce an arterial circle (of Willis). • Vertebral Artery Branch of first part of subclavian A Passes – foramen transvesarium C6 – C1 Enters through foramen magnum – perforates dura & arachnoid mater – enters subarachnoid space Turns upward, forward, medially – medulla oblongata Lower border of pons – joins opposite side to form BASILAR artery. • The two internal carotid arteries enter the cranial cavity through the carotid canals on either side.
- 9. Functional areas ofbrain
- 10.
- 11. What’s Stroke ? •an episode of neurological dysfunction due to a cerebrovasculare diseases which last for more than 24hr. & reach it's peak of defecit in less than 6hr
- 12. Top 10 causesof death worldwide • Of the 56.4 million deaths worldwide in 2015, more than half (54%) were due to the top 10 causes. Ischaemic heart disease and stroke are the world’s biggest killers, accounting for a combined 15 million deaths in 2015. These diseases have remained the leading causes of death globally in the last 15 years
- 13. Stroke By TheNumbers •Each year nearly 800,000 people experience a new or recurrent stroke. •A stroke happens every 40 seconds. •Stroke is the fifth leading cause of death in the U.S. •Every 4 minutes someone dies from stroke. •Up to 80 percent of strokes can be prevented. •Stroke is the leading cause of adult disability in the U.
- 14. Types of stroke •Ischemic stroke It accounts for 80% of all stroke cases. • Hemorrhagic stroke : aneurysms and arteriovenous malformations(AVMs). But uncontrolled hypertension (high blood pressure). • TIA (transient ischemic attack) : “mini stroke”symptoms resolve within 24 hours due to a temporary clot
- 16. Types of Stroke 80%ischemic 20% hemorrhagic 50% Thromboti c 30% embolic 13% Intracerebral 7% SAH Mortality 40% Mortality 80%
- 17. Causes of stroke AtherosclerosisHypertension Embolization Intravascular coagulation Vasculitis
- 18. Pathophysiology of ischemicstroke • Insufficiency of blood supply • causes cell hypoxia • 6-8 minutes ---> Infarction • neurons & other cells die. • Ischemic Penumbra : area of stunned parenchyma surrounding the ischemic core. • Has the potential for recovery ONLY if reperfusion is rapidly established.
- 19.
- 20. (A) Non modifiable: –age –Race/ethnicity –Gender: Male>Female –Family history Risk factors
- 21. Risk factors (B) Modifiable: •Hypertension • DM • Heart disease (AF) • Hyperlipidemia • Cigarette Smoking • Excessive alcohol consumption • Estrogen –containing drugs e.g OCP • Sickle cell diseases ,polycythemia • Malignancy
- 22. 1- Hemorrhagic &Ischemic. 2- Anterior & Posterior cerebral circulation. How To Diffrentiate ??? (clinical) Stroke syndromes
- 23. ***About 80 outof 100 strokes are ischemic strokes.
- 24. Ischemic Stroke • Suddennumbness or weakness of the face, arm or leg, especially involving one side of the body • Sudden confusion, trouble speaking or understanding • Loss of vision in one or both eyes • Trouble walking, dizziness, loss of balance or coordination
- 25. Hemorrhagic Stroke (A) Intracerebralhemorrhage (B) Subarachnoid hemorrhage
- 26. (A) Intracerebral hemorrhage— Symptoms almost always occur when the person is awake. it appeara without warning, and develop gradually. Symptoms worsen over a period of 30 to 90 minutes include: – Sudden weakness – Paralysis or numbness in any part of the body – Inability to speak – Inability to control eye movements correctly – Vomiting – Difficulty walking – Irregular breathing – Stupor – Coma
- 27. (B) Subarachnoid hemorrhage— When caused by a ruptured aneurysm, symptoms can include: – A very severe headache that starts suddenly (Some people describe it like a "thunderclap.") – Loss of consciousness – Nausea and vomiting – Inability to look at bright light – Stiff neck – Dizziness – Confusion – Seizure – Loss of consciousness
- 29. Posterior Patients usually havecrossed findings (cranial nerve findings ipsilateral, with motor and sensory findings contralateral) and include some of the 5 Ds (dizziness, diplopia, dysarthria, dysphagia, and dystaxia)
- 31.
- 32. Investigation • CT scan(Computerised Tomography) : to rule out a possible bleed in the brain. • Blood tests : TF, cholesterol levels and glucose levels. • Carotid Duplex (atherosclerosis). • ECG • MRI scan
- 33. Management Of IschemicStroke • ABC: Airway - secure? Breathing - O2 Sat, CHF? Circulation - BP too high or too low ? • BP,BS,Hydration,Infection • Thrombolysis : Less than three hr. rTPA (recombinant tissue plasminogen activator ) • Antiplatelete : Aspirin Clopidogril • Anticoagulant : Warfarin • Statin
- 34. Saving penumbra area •KeepBP high •Good oxygenation •hypothermia •Euglycemia •Keeping the brain dry
- 35. Management Of Hemorrhagic •O2 • Manitol • Head elevation 30 degree • Hyperventilation • High-dose 20% mannitol (1.4 g/kg) results in better ICP control and outcome than lower doses • –STANDARD: No Steroids! • BP Reduction • Prophylactic phenytoin for 7 days for patients at risk for increased ICP • Surgical Management
- 36. Differential diagnosis Functional Hypoglycemia Todd's paresis Conversionaldisorders Encephalitis Demyelination Migraine with aura Structural Primary brain tumor Metastatic brain tumor SDH Cerebral abscess
- 37. ***ICH – WorseOutcomes Than Ischemic Stroke ***Stroke Effect depends on Site , Duration and amount of dead brain tissue Prognosis
- 38. MYTH FACT MYTH: Strokecannot be prevented. FACT: Up to 80 percent of strokes are preventable. MYTH: There is no treatment for stroke. FACT: At any sign of stroke call 9-1-1- immediately. Treatment may be available. MYTH: Stroke only affects the elderly. FACT: Stroke can happen to anyone at any time. MYTH: Stroke happens in the heart. FACT: Stroke is a "brain attack". MYTH: Stroke recovery only happens for the first few months after a stroke. FACT: Stroke recovery is a lifelong process. MYTH: Strokes are rare. FACT: There are nearly 7 million stroke survivors in the U.S. Stroke is the 5th leading cause of death in the U.S. MYTH: Strokes are not hereditary. FACT: Family history of stroke increases your chance for stroke. MYTH: If stroke symptoms go away, you don’t have to see a doctor. FACT: Temporary stroke symptoms are called transient ischemic attacks (TIA). They are warning signs prior to actual stroke and need to be taken seriously.
- 39. A 77-year-old womanwas cooking in the kitchen when she collapsed onto the floor. Her daughter called an ambulance and the woman was taken to the emergency room. She had suffered a stroke, and slowly regained consciousness over the next two days. However, when she woke up, she had the following signs and symptoms: - paralysis of the right face and arm - loss of sensation to touch on the skin of the right face and arm - inability to answer questions but ability to understand what was said to her - ability to write down her thoughts more easily than to speak them
- 40. Questions: 1. Based uponthe patient's symptoms, which cerebral artery was blocked? (Be Specific) 2. Why was she paralyzed in the right face and arm? 3. What is the name of her language disorder, and what caused it? 4. Was this woman's dominant or nondominant hemisphere damaged?
- 41.