Hypertension is the leading modifiable risk factor for stroke globally. Stroke is a major cause of death and disability worldwide, with low and middle income countries like those in Africa having the highest burden. While prevention through control of risk factors like hypertension is critical, many resource-limited areas lack adequate acute stroke care and rehabilitation services.
Neurosyphilis occurs when the syphilis bacterium spreads to the central nervous system. The diagnosis of neurosyphilis is challenging due to a lack of gold standard tests and many controversies. Treatment involves intravenous penicillin, though alternatives exist. The prevalence of neurosyphilis is difficult to determine and management of patients who do not respond fully to treatment remains controversial.
Evolution of National Family Planning Programme (NFPP) and National Populatio...Dr Kumaravel
This presentation discuss the evolution of India's National Family Planning Program and National Population Policy 2000, significant impact of 1994 Cairo conference on country's Reproductive health approach.
Epidemiology prevention control of hypertensionAbhi Manu
This document discusses hypertension (high blood pressure), including its epidemiology, prevention, and control. It begins with learning objectives and defines hypertension. An estimated 1.13 billion people worldwide have hypertension. Prevalence is increasing and it is a major cause of death. Prevention efforts include population-wide strategies like reducing sodium intake and increasing physical activity, as well as high-risk strategies like monitoring blood pressure from childhood. Treatment involves lifestyle changes and medication to control blood pressure. New initiatives in India are screening for hypertension at all levels of the healthcare system.
The document defines social determinants as the economic and social conditions that shape health, such as income, education, employment, housing, and gender. It provides examples of social determinants like income level, employment conditions, and access to healthcare services. It also notes that addressing social determinants takes a holistic approach to healthcare and challenges paradigms that perpetuate HIV stigma. Several state organizations plan to collaborate to identify how social determinants impact clients and address root causes of HIV risk through programming.
Health policy refers to plans and actions undertaken by governments and institutions to achieve specific health care goals for a society. National health policies in Pakistan aim to improve access to health care, ensure equitable access, and increase investments in health. However, policies have achieved limited success due to issues like lack of coordination, poor resource allocation, and inadequate capacity. Effective policy formulation requires situational analysis, increased funding, community involvement, and monitoring and evaluation.
This presentation contains in brief about various Non-communicable diseases (NCDs) and International interventions to combat NCDs. It also contains recent updates on current problem statement of common NCDs and updates on National Programme for Prevention and Control of non-Communicable Diseases (NP-NCDs).
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.
Neuromuscular disorders in children (2)shivani1305
The document discusses neuromuscular diseases. It defines the motor unit and its components. Some key neuromuscular diseases discussed include muscular dystrophies, congenital and metabolic myopathies, anterior horn cell disorders, and neuromuscular junction diseases. Common symptoms of neuromuscular diseases are then outlined. Diagnostic tests and treatment approaches are also summarized for several specific conditions like spinal muscular atrophy, Guillain-Barré syndrome, and myasthenia gravis.
Neurosyphilis occurs when the syphilis bacterium spreads to the central nervous system. The diagnosis of neurosyphilis is challenging due to a lack of gold standard tests and many controversies. Treatment involves intravenous penicillin, though alternatives exist. The prevalence of neurosyphilis is difficult to determine and management of patients who do not respond fully to treatment remains controversial.
Evolution of National Family Planning Programme (NFPP) and National Populatio...Dr Kumaravel
This presentation discuss the evolution of India's National Family Planning Program and National Population Policy 2000, significant impact of 1994 Cairo conference on country's Reproductive health approach.
Epidemiology prevention control of hypertensionAbhi Manu
This document discusses hypertension (high blood pressure), including its epidemiology, prevention, and control. It begins with learning objectives and defines hypertension. An estimated 1.13 billion people worldwide have hypertension. Prevalence is increasing and it is a major cause of death. Prevention efforts include population-wide strategies like reducing sodium intake and increasing physical activity, as well as high-risk strategies like monitoring blood pressure from childhood. Treatment involves lifestyle changes and medication to control blood pressure. New initiatives in India are screening for hypertension at all levels of the healthcare system.
The document defines social determinants as the economic and social conditions that shape health, such as income, education, employment, housing, and gender. It provides examples of social determinants like income level, employment conditions, and access to healthcare services. It also notes that addressing social determinants takes a holistic approach to healthcare and challenges paradigms that perpetuate HIV stigma. Several state organizations plan to collaborate to identify how social determinants impact clients and address root causes of HIV risk through programming.
Health policy refers to plans and actions undertaken by governments and institutions to achieve specific health care goals for a society. National health policies in Pakistan aim to improve access to health care, ensure equitable access, and increase investments in health. However, policies have achieved limited success due to issues like lack of coordination, poor resource allocation, and inadequate capacity. Effective policy formulation requires situational analysis, increased funding, community involvement, and monitoring and evaluation.
This presentation contains in brief about various Non-communicable diseases (NCDs) and International interventions to combat NCDs. It also contains recent updates on current problem statement of common NCDs and updates on National Programme for Prevention and Control of non-Communicable Diseases (NP-NCDs).
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.
Neuromuscular disorders in children (2)shivani1305
The document discusses neuromuscular diseases. It defines the motor unit and its components. Some key neuromuscular diseases discussed include muscular dystrophies, congenital and metabolic myopathies, anterior horn cell disorders, and neuromuscular junction diseases. Common symptoms of neuromuscular diseases are then outlined. Diagnostic tests and treatment approaches are also summarized for several specific conditions like spinal muscular atrophy, Guillain-Barré syndrome, and myasthenia gravis.
This document discusses cerebrovascular diseases and provides details on various types:
1. It describes cerebrovascular disease as any abnormality of the brain caused by blood vessels, including thrombosis, embolism, and hemorrhage.
2. Stroke is defined as a sudden neurological deficit due to a vascular impairment, which is a common cause of death in the US.
3. Details are given on global cerebral ischemia from reduced blood flow and focal ischemia from localized vessel obstruction.
Primary health care is the first level of contact between individuals and the health care system. It aims to provide equitable, accessible, and affordable basic health services to communities through primary health centers, sub-centers, and dispensaries. Secondary health care handles more complex cases referred from primary care, while tertiary care provides specialized services and training at regional and central hospitals. The principles of primary health care emphasize community participation, multisectoral collaboration, and using appropriate technologies delivered by community health workers.
this presentation will contains problem of old age, how can they affect the life of geriatric peoples, prevention and control of geriatric problems, national program for better health of old peoples, initiations done by private trusts to improve their health
Ataxic cerebral palsy is a rare form of cerebral palsy affecting around 5% to 10% of all people diagnosed. It gets its name from the word ataxia, which means lack of coordination and without order.
This document discusses initiatives for the prevention and control of non-communicable diseases (NCDs) globally and in India. It outlines gaps in understanding NCDs, global initiatives like the WHO Global Action Plan 2013-2020, and national programs in India such as the National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS). The Action Plan aims to reduce NCD mortality by 25% by 2025 through multisectoral actions targeting NCD risks and strengthening health systems. NPCDCS screens for and manages common NCDs through India's public health system.
At the end of this session, the student shall be able to
What is gerontology and it’s branches?
Describe the growing burden of geriatric age group.
Classify and Enumerate the Health problems of the aged.
What are the lifestyle factors which helps the aged?
Describe the health status of the aged in India.
Describe the Schemes & Policy for Older Person in India
Explain the Implication of the ageing population in India
How are these diseases prevented in the elderly?
The document provides details about the Intensified Pulse Polio Immunization program that will take place from January 17-19, 2016 in Ananthapuramu District, Andhra Pradesh, India. It includes the district profile, roles of different government officials, and information about why repeated polio vaccination is important and eligibility for the program. The main goals of the program are to provide oral polio drops to all children under 5 years old in the district to work towards global polio eradication.
Paraplegia is a spinal cord injury that paralyzes the lower limbs, caused by damage to the spinal cord and nervous system. It affects movement in the trunk, legs, and pelvic region. Causes include spinal fractures, tumors, infections, and trauma. Paraplegia is categorized as complete or incomplete based on the extent of movement loss. Complications include pressure sores, urinary issues, muscle tightness, osteoporosis, and respiratory problems. Physiotherapy focuses on prevention of complications, strengthening, stretching, mobility training, and achieving independence through exercise and assistive devices.
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.
The National Health Programme aims to control communicable diseases like malaria, leprosy, tuberculosis, and AIDS through various disease-specific programmes. The National Vector Borne Disease Control Programme and National Malaria Control Programme work to reduce malaria morbidity and mortality in India. A three-pronged strategy of early diagnosis, prompt treatment, and vector control is used. Urban areas also have malaria control schemes focused on source reduction and larval control.
Guillain-Barre syndrome is a rare disorder where the immune system attacks the peripheral nervous system, damaging nerves and causing muscle weakness and paralysis. It has several forms but commonly results in ascending paralysis beginning in the lower extremities. It is often triggered by a bacterial or viral infection and works by demyelinating peripheral nerves. Diagnosis involves spinal fluid analysis and nerve conduction tests. Treatment focuses on supportive care like ventilation and plasma exchange or IV immunoglobulin to stop antibody damage. Nursing care monitors for complications and manages symptoms like respiratory issues, mobility, nutrition, and autonomic dysfunction.
This document provides an overview of community medicine. It defines community medicine, public health, and preventive medicine. The goals of community medicine are to promote health, prevent disease, and control disease spread through organized community efforts. Community medicine aims to provide perfect health for all people by addressing both individual and environmental determinants of health. It covers key topics like epidemiology, biostatistics, environmental health, nutrition, mental health, and health management and systems. The role of community medicine is to apply public health functions like assessment, policy development, and assurance to influence health determinants and reach the vision of optimal health for communities.
This document presents Nepal's National Adolescent Health and Development Strategy. It notes that adolescents aged 10-19 make up over 20% of Nepal's population and face many health risks like early pregnancy, STIs, and substance abuse. Currently, half of adolescent girls and one-fifth of boys are married, a quarter are already mothers, and contraceptive use is low. Nutritional deficiencies and poor access to education, especially for girls, also negatively impact adolescent health. The strategy aims to improve adolescent health through increasing access to information, counseling services, and an enabling and supportive environment. It outlines roles for various stakeholders and priorities for the program.
The shake test is used to detect freeze damage in certain vaccines like DTP, DT, Td, TT, typhoid, and hepatitis B. These vaccines cannot be frozen as it reduces their effectiveness. When frozen, the alum content separates out and sediments faster than non-frozen vaccines when shaken. To perform the shake test, a vaccine vial is frozen as a control and another vial suspected of freezing is selected. Both vials are shaken and observed over time - if the suspected vial sediments slower than the frozen control vial, it has not been damaged and can be used.
Cerebral palsy can be classified in several ways:
(1) By the region of the body affected, such as hemiplegia which affects one side of the body, diplegia which primarily affects both legs, and quadriplegia which affects all four limbs.
(2) By the type of motor impairment, with spastic cerebral palsy being the most common type and affecting muscle tone, and other types including athetoid, choreiform, ataxic, and rigid.
(3) Temporally based on when the brain injury occurred such as prenatal, perinatal, or postnatal causes. Cerebral palsy results from a non-progressive
A process aimed at encouraging people to want to be healthy, to know how to stay healthy, to do what they can individually and collectively to maintain health and to seek help when needed.
Role of community medicine in control of genetic diseasesPreetika Maurya
Genetic disorders are an important cause of disease and community medicine plays a role in their prevention and control. Screening programs can help detect genetic disorders during pregnancy or in newborns to allow for early treatment or intervention. Genetic counseling educates families about the risks and options for conditions with a genetic basis. Prevention strategies include screening, counseling, and public health efforts like vaccination or nutrition programs. Community medicine aims to understand and reduce the impact of genetic diseases through population-level interventions.
This document discusses spinal muscular atrophy (SMA), including its causes, types, signs and symptoms, diagnosis, and treatment. SMA is caused by a mutation in the SMN1 gene that results in a lack of survival motor neuron protein and the degeneration of alpha motor neurons in the spinal cord. It is classified into five types based on age of onset and severity. There is currently no cure for SMA, but treatment focuses on managing symptoms through rehabilitation, assistive devices, ventilation support, and gene therapy research shows promise for slowing disease progression.
The document discusses the "iceberg concept" or "iceberg phenomenon" of disease occurrence in a population. It represents the burden of disease, with the visible tip representing clinically apparent cases but most of the iceberg submerged and representing latent, subclinical, undiagnosed, and carrier states in the population. Factors like the agent, host, and environment determine the size and shape of the iceberg. The iceberg concept is useful for detecting subclinical cases, understanding disease pathogenesis and spread, and designing control programs targeting the larger hidden reservoir of disease.
This document discusses the epidemiology of coronary heart disease. It begins by providing an overview of cardiovascular diseases and the proportions of deaths caused by coronary heart disease, cerebrovascular disease, and other cardiovascular diseases in males and females globally. It then discusses the descriptive epidemiology of coronary artery disease, including trends in India, deaths by age and gender in India, and worldwide trends and international comparisons. It also covers the distribution patterns of coronary heart disease by age, gender, ethnicity, and analytical epidemiology on modifiable and non-modifiable risk factors.
Dr. Sumita Sharma presents an outline on stroke that includes an introduction, the burden of stroke globally and in India, types and risk factors, pathophysiology, signs and symptoms, prevention, ongoing trials, and programs related to stroke. Stroke is the 2nd leading cause of death and 3rd leading cause of disability globally. In India, it is estimated to have a prevalence of 1.54 per 1000 population. Stroke can be ischemic due to blockage or hemorrhagic due to bleeding in the brain. Risk factors include hypertension, atrial fibrillation, diabetes, high cholesterol, smoking, alcohol, obesity, and coronary artery disease. Prevention involves controlling risk factors through lifestyle changes and medication.
This document discusses cerebrovascular diseases and provides details on various types:
1. It describes cerebrovascular disease as any abnormality of the brain caused by blood vessels, including thrombosis, embolism, and hemorrhage.
2. Stroke is defined as a sudden neurological deficit due to a vascular impairment, which is a common cause of death in the US.
3. Details are given on global cerebral ischemia from reduced blood flow and focal ischemia from localized vessel obstruction.
Primary health care is the first level of contact between individuals and the health care system. It aims to provide equitable, accessible, and affordable basic health services to communities through primary health centers, sub-centers, and dispensaries. Secondary health care handles more complex cases referred from primary care, while tertiary care provides specialized services and training at regional and central hospitals. The principles of primary health care emphasize community participation, multisectoral collaboration, and using appropriate technologies delivered by community health workers.
this presentation will contains problem of old age, how can they affect the life of geriatric peoples, prevention and control of geriatric problems, national program for better health of old peoples, initiations done by private trusts to improve their health
Ataxic cerebral palsy is a rare form of cerebral palsy affecting around 5% to 10% of all people diagnosed. It gets its name from the word ataxia, which means lack of coordination and without order.
This document discusses initiatives for the prevention and control of non-communicable diseases (NCDs) globally and in India. It outlines gaps in understanding NCDs, global initiatives like the WHO Global Action Plan 2013-2020, and national programs in India such as the National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS). The Action Plan aims to reduce NCD mortality by 25% by 2025 through multisectoral actions targeting NCD risks and strengthening health systems. NPCDCS screens for and manages common NCDs through India's public health system.
At the end of this session, the student shall be able to
What is gerontology and it’s branches?
Describe the growing burden of geriatric age group.
Classify and Enumerate the Health problems of the aged.
What are the lifestyle factors which helps the aged?
Describe the health status of the aged in India.
Describe the Schemes & Policy for Older Person in India
Explain the Implication of the ageing population in India
How are these diseases prevented in the elderly?
The document provides details about the Intensified Pulse Polio Immunization program that will take place from January 17-19, 2016 in Ananthapuramu District, Andhra Pradesh, India. It includes the district profile, roles of different government officials, and information about why repeated polio vaccination is important and eligibility for the program. The main goals of the program are to provide oral polio drops to all children under 5 years old in the district to work towards global polio eradication.
Paraplegia is a spinal cord injury that paralyzes the lower limbs, caused by damage to the spinal cord and nervous system. It affects movement in the trunk, legs, and pelvic region. Causes include spinal fractures, tumors, infections, and trauma. Paraplegia is categorized as complete or incomplete based on the extent of movement loss. Complications include pressure sores, urinary issues, muscle tightness, osteoporosis, and respiratory problems. Physiotherapy focuses on prevention of complications, strengthening, stretching, mobility training, and achieving independence through exercise and assistive devices.
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.
The National Health Programme aims to control communicable diseases like malaria, leprosy, tuberculosis, and AIDS through various disease-specific programmes. The National Vector Borne Disease Control Programme and National Malaria Control Programme work to reduce malaria morbidity and mortality in India. A three-pronged strategy of early diagnosis, prompt treatment, and vector control is used. Urban areas also have malaria control schemes focused on source reduction and larval control.
Guillain-Barre syndrome is a rare disorder where the immune system attacks the peripheral nervous system, damaging nerves and causing muscle weakness and paralysis. It has several forms but commonly results in ascending paralysis beginning in the lower extremities. It is often triggered by a bacterial or viral infection and works by demyelinating peripheral nerves. Diagnosis involves spinal fluid analysis and nerve conduction tests. Treatment focuses on supportive care like ventilation and plasma exchange or IV immunoglobulin to stop antibody damage. Nursing care monitors for complications and manages symptoms like respiratory issues, mobility, nutrition, and autonomic dysfunction.
This document provides an overview of community medicine. It defines community medicine, public health, and preventive medicine. The goals of community medicine are to promote health, prevent disease, and control disease spread through organized community efforts. Community medicine aims to provide perfect health for all people by addressing both individual and environmental determinants of health. It covers key topics like epidemiology, biostatistics, environmental health, nutrition, mental health, and health management and systems. The role of community medicine is to apply public health functions like assessment, policy development, and assurance to influence health determinants and reach the vision of optimal health for communities.
This document presents Nepal's National Adolescent Health and Development Strategy. It notes that adolescents aged 10-19 make up over 20% of Nepal's population and face many health risks like early pregnancy, STIs, and substance abuse. Currently, half of adolescent girls and one-fifth of boys are married, a quarter are already mothers, and contraceptive use is low. Nutritional deficiencies and poor access to education, especially for girls, also negatively impact adolescent health. The strategy aims to improve adolescent health through increasing access to information, counseling services, and an enabling and supportive environment. It outlines roles for various stakeholders and priorities for the program.
The shake test is used to detect freeze damage in certain vaccines like DTP, DT, Td, TT, typhoid, and hepatitis B. These vaccines cannot be frozen as it reduces their effectiveness. When frozen, the alum content separates out and sediments faster than non-frozen vaccines when shaken. To perform the shake test, a vaccine vial is frozen as a control and another vial suspected of freezing is selected. Both vials are shaken and observed over time - if the suspected vial sediments slower than the frozen control vial, it has not been damaged and can be used.
Cerebral palsy can be classified in several ways:
(1) By the region of the body affected, such as hemiplegia which affects one side of the body, diplegia which primarily affects both legs, and quadriplegia which affects all four limbs.
(2) By the type of motor impairment, with spastic cerebral palsy being the most common type and affecting muscle tone, and other types including athetoid, choreiform, ataxic, and rigid.
(3) Temporally based on when the brain injury occurred such as prenatal, perinatal, or postnatal causes. Cerebral palsy results from a non-progressive
A process aimed at encouraging people to want to be healthy, to know how to stay healthy, to do what they can individually and collectively to maintain health and to seek help when needed.
Role of community medicine in control of genetic diseasesPreetika Maurya
Genetic disorders are an important cause of disease and community medicine plays a role in their prevention and control. Screening programs can help detect genetic disorders during pregnancy or in newborns to allow for early treatment or intervention. Genetic counseling educates families about the risks and options for conditions with a genetic basis. Prevention strategies include screening, counseling, and public health efforts like vaccination or nutrition programs. Community medicine aims to understand and reduce the impact of genetic diseases through population-level interventions.
This document discusses spinal muscular atrophy (SMA), including its causes, types, signs and symptoms, diagnosis, and treatment. SMA is caused by a mutation in the SMN1 gene that results in a lack of survival motor neuron protein and the degeneration of alpha motor neurons in the spinal cord. It is classified into five types based on age of onset and severity. There is currently no cure for SMA, but treatment focuses on managing symptoms through rehabilitation, assistive devices, ventilation support, and gene therapy research shows promise for slowing disease progression.
The document discusses the "iceberg concept" or "iceberg phenomenon" of disease occurrence in a population. It represents the burden of disease, with the visible tip representing clinically apparent cases but most of the iceberg submerged and representing latent, subclinical, undiagnosed, and carrier states in the population. Factors like the agent, host, and environment determine the size and shape of the iceberg. The iceberg concept is useful for detecting subclinical cases, understanding disease pathogenesis and spread, and designing control programs targeting the larger hidden reservoir of disease.
This document discusses the epidemiology of coronary heart disease. It begins by providing an overview of cardiovascular diseases and the proportions of deaths caused by coronary heart disease, cerebrovascular disease, and other cardiovascular diseases in males and females globally. It then discusses the descriptive epidemiology of coronary artery disease, including trends in India, deaths by age and gender in India, and worldwide trends and international comparisons. It also covers the distribution patterns of coronary heart disease by age, gender, ethnicity, and analytical epidemiology on modifiable and non-modifiable risk factors.
Dr. Sumita Sharma presents an outline on stroke that includes an introduction, the burden of stroke globally and in India, types and risk factors, pathophysiology, signs and symptoms, prevention, ongoing trials, and programs related to stroke. Stroke is the 2nd leading cause of death and 3rd leading cause of disability globally. In India, it is estimated to have a prevalence of 1.54 per 1000 population. Stroke can be ischemic due to blockage or hemorrhagic due to bleeding in the brain. Risk factors include hypertension, atrial fibrillation, diabetes, high cholesterol, smoking, alcohol, obesity, and coronary artery disease. Prevention involves controlling risk factors through lifestyle changes and medication.
World Stroke Day is observed annually on October 29th to raise awareness about stroke prevention and treatment. This year's theme is "support for life after stroke" to highlight the needs of stroke survivors and caregivers. Stroke is a leading cause of death and disability worldwide. Risk factors include high blood pressure, heart disease, diabetes, unhealthy diet, smoking, and excessive alcohol. Symptoms can include numbness, confusion, vision problems, trouble walking, and severe headache. Treatment focuses on early diagnosis and management to limit disability. Prevention strategies emphasize lifestyle changes like quitting smoking, healthy diet, exercise and controlling blood pressure and cholesterol.
The document discusses stroke, including its definition, epidemiology, and management. Some key points:
- Stroke is a clinical syndrome caused by disrupted blood flow to the brain.
- It is a leading cause of death and disability worldwide. Rates are increasing in developing countries.
- Risk factors include hypertension, atrial fibrillation, diabetes, and smoking.
- Early management involves rapid evaluation and treatment to restore blood flow if possible.
Rheumatic heart disease is a serious complication that can develop after acute rheumatic fever, which is caused by a prior streptococcal throat infection. It leads to damage of heart valves, most commonly the mitral and aortic valves, causing stenosis, regurgitation, or a combination of the two. While rheumatic heart disease was once a major health problem worldwide, its incidence has declined in Sudan in recent decades according to national surveys. The disease is diagnosed using the Modified Jones Criteria which looks for specific major and minor clinical features in combination with evidence of a previous streptococcal infection. Long term complications involve progressively worsening valve damage over time.
This document provides an overview of cardiovascular disease (CVD) risk assessment. It discusses the burden of non-communicable diseases like CVD in Ethiopia. It defines primary and secondary CVD prevention strategies and risk factor modification. The document outlines tools for assessing individual CVD risk, like the WHO/ISH risk charts, and recommendations for lifestyle modifications and medical treatment based on assessed risk level, such as the use of statins or aspirin. The goal is to identify those at high risk and prevent future cardiovascular events through optimization of modifiable risk factors.
This document discusses coronary heart disease in young adults. It finds that while most coronary disease occurs in older populations, 2-6% of acute coronary events occur in younger "premature" patients under 55 years old. Major risk factors for young adults include smoking, family history of early heart disease, male gender, and hyperlipidemia. Diagnostic tests may include electrocardiograms, stress tests, echocardiograms, CT angiograms, and calcium scoring. Aggressive risk factor modification including smoking cessation and statin therapy is important for prognosis. While short term outcomes of revascularization are good, long term mortality is still elevated compared to the general population.
http://www.thinkred.co.za/get-involved/events | Thousands of people around the globe are affected by at least one type of Cardiovascular Disease (CVD) every day. This only emphasises the importance of heart health in this day and age. Learn what CVD is about the impact that it has had on people over the years. With simple diet and lifestyle changes many diagnosed individuals can overcome this threat.
1) The lecture discussed cardiovascular disease (CVD) risk assessment for nursing students. CVD is a major cause of death worldwide and in Ethiopia.
2) It reviewed various CVD risk factors and scoring systems to assess individual risk, such as the WHO/ISH charts. Risk factors include age, smoking status, blood pressure, cholesterol levels, and diabetes.
3) Prevention strategies were outlined for both primary prevention of high-risk individuals and secondary prevention for those with existing CVD. Lifestyle changes and medications aim to reduce modifiable risk factors and prevent further events.
Diet, nutrition and the prevention of cancer,pptRajeeeeeeeeeeev
The document discusses chronic diseases and their risk factors. It summarizes that chronic diseases, such as heart disease, stroke, cancer, diabetes and respiratory diseases, cause 63% of all deaths worldwide. Risk factors like tobacco use, unhealthy diet, obesity, physical inactivity and alcohol consumption contribute to many chronic diseases and cancers. The document provides details on specific chronic diseases like diabetes, cardiovascular diseases, cancer and overweight/obesity. It discusses the types, symptoms, worldwide prevalence and prevention strategies for these conditions.
This document discusses risk factors of cardiovascular diseases. It begins by defining cardiovascular diseases and coronary heart disease. It then discusses the global burden of cardiovascular diseases, providing statistics on deaths and prevalence rates in various parts of the world. The major risk factors discussed include smoking, high blood pressure, diabetes, obesity, physical inactivity, and stress. Strategies for prevention and intervention at the population level, high-risk level, and secondary prevention level are described. Clinical trials investigating risk factor modification are also summarized.
This document discusses strategies for preventing stroke through lifestyle modifications. It recommends maintaining a healthy diet low in salt and sugar and high in fruits and vegetables. It also stresses the importance of regular physical activity, maintaining a healthy weight, not smoking, and managing risk factors like blood pressure, cholesterol and blood sugar. Following these lifestyle guidelines can significantly reduce one's risk of having a stroke.
The Future of Cardiology (2018 – 2030): Advanced Treatments to Combat the Global Advance of Cardiovascular Diseases. I presented this at Conference Series Cardiology Conference 2017 in Philadelphia, Pennsylvania on 09/01/2017. I first look the the number of people globally affected by cardiovascular diseases. Then I look at the cumulative "lost productivity" globally as a result of people suffering from cardiovascular diseases. Following that, I look at the total costs of treating cardiovascular diseases globally. Then I present the reasons why cardiovascular diseases are rising so rapidly throughout the world - lifestyle/clinical. Then I look at the rates of smoking throughout the world; one of the main culprits of cardiovascular diseases (CVDs). The next slides look at the "Gold Standard" of care for coronary artery diseases (CAD), congestive heart failure (CHF), and aortic valve disease. I also present what is driving industry consolidation and associated major transactions. I then provide some perspective on the future of interventional cardiology. And finally, I provide some insight into "evolving technologies" for cardiovascular care and interventional cardiovascular care. It was a lengthy presentation, but I feel, all critical. This is a very complex field. It takes at least 12 continuous years of education and training to become an interventional or non-interventional cardiologist (4 years pre-med, 3 years medical school, 3 years medical residency, 2 years fellowship (where a cardiologist selects and trains on their cardiovascular specialties)). Some authorities are even calling for post-fellowship training for procedures like transcatheter aortic valve implantation (TAVI) and pacemaker/ICD implantation.
The document discusses the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) in India. It summarizes that NPCDCS aims to prevent and control four major non-communicable diseases through strengthening infrastructure, human resource development, health promotion, early diagnosis, and management/referral. It also briefly outlines the burden and risk factors of cardiovascular diseases, highlighting they are a leading cause of death in India and globally.
The document discusses stroke, which occurs when blood flow to the brain is blocked or reduced, preventing brain tissue from getting oxygen and nutrients. Stroke is a leading cause of death and disability worldwide. There are two main types of stroke - ischemic (caused by blockage) and hemorrhagic (caused by bleeding). Some key risk factors for stroke include hypertension, heart disease, smoking, diabetes, and high cholesterol. Transient ischemic attacks (TIAs) or "mini-strokes" involve temporary blockages and are important to address because they can lead to full strokes if not treated. Recognizing stroke symptoms and responding quickly by calling emergency services can help reduce long-term effects.
This document discusses cardiovascular disease risk factors. It begins by introducing the topic and outlines the sections. The introduction notes that CVD is a leading cause of death worldwide. The epidemiology section describes the prevalence of CVD globally and in certain regions. The pathophysiology section explains the development of atherosclerosis. The traditional risk factors section lists established risks like hypertension, diabetes, and smoking. The document focuses on emerging risk factors, describing biomarkers like lipoprotein(a), apolipoprotein B, and homocysteine that can help identify risk beyond traditional factors. It discusses the evidence supporting these novel factors and their clinical implications.
A 60-year-old right handed man presents with inability to move the right upper and lower limbs of 1 hour duration. The document discusses the definitions, pathophysiology, risk factors, presentation, diagnosis and management of ischemic and hemorrhagic stroke. For acute ischemic stroke, management includes brain imaging to rule out hemorrhage followed by thrombolysis with rt-PA if indicated. For hemorrhagic stroke, management is largely supportive and focuses on controlling blood pressure to reduce hematoma expansion and improve outcomes. Long term prevention emphasizes control of modifiable risk factors like hypertension, diabetes and lifestyle changes.
The document discusses public health issues related to cardiovascular disease, including the major types of CVD, risk factors, epidemiology, and trends. CVD is a leading cause of death globally and is influenced by factors like age, gender, ethnicity, geography, and lifestyle behaviors. The document examines descriptive and analytic epidemiology approaches to understanding CVD occurrence, distribution, and relationships to risk factors.
This document discusses risk factors for ischemic stroke. It identifies non-modifiable risk factors such as age, sex, race and heredity. The major modifiable risk factors are hypertension, atrial fibrillation, diabetes, hyperlipidemia, cigarette smoking, and physical inactivity. Approximately 90% of strokes can be explained by 10 risk factors, including these medical conditions and behavioral risks. The document provides details on how each of these factors increases the risk of ischemic stroke. It also discusses additional potential risk factors that are still under investigation.
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1. Epidemiology and Aetiology of Stroke
Dr Michael B. Fawale
Medicine Department, OAU, Ile-Ife
bimbofawale@live.com
2. • Stroke remains a leading cause of death and
long-term disability worldwide
• Global estimates suggest sub-Saharan Africa
has the highest incidence, prevalence & case
fatality
• Low-income and middle-income countries in
Africa have scant resources for acute stroke
care and rehabilitation
Background
3. Background
• Stroke is associated with greater loss of
productivity and wage-earning years in the
younger age group
• While health systems strengthening is critical,
prevention remains the most plausible
strategy
5. • Cerebrovascular Disease (CVD)
– Designates any abnormality of the brain resulting
from a pathologic process of the blood vessels
– Includes CVA (Stroke); TIA ; cerebral angioma ;
Subdural hematoma, Aneurysms; Vascular
malformations; Small vessel disease
(arteriosclerosis); Cerebral Amyloid angiopathy;
Cerebral Angitis; Fibromuscular dysplasia;
Moyamoya disease
Concepts & Definitions
6. • Stroke (Lay definition): Sudden loss of brain
function due to sudden sustained interruption
of blood flow and oxygen supply.
• This interruption may be due to an occlusion
(Ischemic stroke) or rupture (Hemorrhagic
stroke) of a vessel.
Concepts & Definitions
7. Acute reduction or cessation
of cerebral blood flow
Temporary Sustained
TIA CI
Concepts & Definitions
TIA Transient ischaemic attack, CI Cerebral infarct
8. • The definitions of stroke and TIA are evolving
• Old Concepts:
– TIA: Any focal cerebral ischemic event with
symptoms lasting < 24 hours
– Stroke: A rapidly developed focal/global cerebral
dysfunction of vascular origin lasting >24 hrs or
leading to death - (WHO 1988)
• Included in this definition are CI, ICH, SAH.
Concepts & Definitions
9. • Old Concepts:
– Misclassifies up to 1/3 of patients
– Most (90%) TIAs last 10 mins; resolve in 30 mins.
– If symptoms last > I hr, chances of resolution:15%
– Can impede administration of acute stroke
therapies
• Does not suggest medical emergency
• Does not take into cognizance the use of thrombolytics
within 270 mins (4 ½ hrs) in CI or Recombinant
activated factor VII within 4 hours in ICH
Concepts & Definitions
10. New Concepts:
• TIA:
– focal brain or retinal ischemia, with clinical
symptoms typically lasting < 1 hour, and without
evidence of acute infarction
• Stroke
– Time-based - > 1 hr
– Tissue based – sudden global or focal neurological
dysfunction resulting from spontaneous
haemorrhage or infarction of the CNS, irrespective
of the duration of the symptoms
Concepts & Definitions
16. • The most common cause of adult disability.
• 2nd most common cause of dementia.
• 2nd leading cause of death in LIC, MIC, HIC .
• If no urgent action, deaths from stroke will
increase over the next decade by:
– 12% globally
– 20% in resource-limited countries.
• Stroke impairs QOL, constitutes huge economic
cost and burden to caregivers, family and
society.
The global burden of stroke
17. • Incidence:
– 100-300/100,000 in most countries
– 15 million cases annually (2/3 in developing world)
• 5.5 million deaths yearly, 5 million disabled, 5 million
recover
• Stroke incidence over the past 4 decades
– 42% ↓ in High Income Countries and 100%↑ in
Low/Middle Income Countries.
• Stroke the leading cause of neurological
admission in most centers in Nigeria
• Prevalence: Nigeria: 58-114 (West: 400-
700)/100,000
The global burden of stroke
18. • USA:
– 30 day stroke mortality - 28%
• CI - 19%, ICH-30-50%, SAH-45%
– 1-year survival (Ischemic Stroke) - 77%
• Nigeria:
– 30 day stroke mortality – 36.1–60.4%
(*1 in 6 people will have a stroke in their lifetime
*6 million deaths yearly
*Every 6 seconds, someone somewhere dies from stroke)
Profile of Stroke Mortality
21. “We cannot afford to say, ’we must
tackle other diseases first -HIV/AIDS,
malaria, TB- then we will deal with
chronic diseases later -Stroke, heart
disease and cancers ’. If we wait even
ten years, we will find that the problem
is even larger and more expensive to
address.”
-President Olusegun Obasanjo
(foreword to a 2005 WHO publication on Preventing CHRONIC DISEASES: a
vital investment)
21
22. Exercise
• Answer T or F
A. Ischaemic stroke is more common than
haemorrhagic stroke
B. Thrombotic and embolic strokes are sugtypes of
haemorrhagic stroke
C. Stroke is the leading cause of adult disability globally
D. Deaths due to stroke are more than deaths due to
malaria, HIV and TB combined
E. Stroke incidence is declining in high-income
countries and rising in resource-limited countries
24. Stroke Risk Factors
• Risk factors = attributes or exposures associated
with increased probability of disease but are not
necessarily causal
– They directly increase disease probability and if
absent or removed reduce disease probability
• Stroke risk factors
– Non-modifiable
– Modifiable
• Well-documented
• Less well-documented
25. Non-modifiable risk factors
• Age:
– The risk of stroke increases with age
– Stroke risk increased by 9%/y in men and 10%/y in
women (Data from 8 European countries)
– The risk of ischemic stroke and ICH doubles for
each successive decade after age 55
26. Non-modifiable risk factors
• Age
– The mean age at stroke occurrence is decreasing
– In the SIREN study, 39% of ICH and 16% of CI were
> 65 yrs
– Although the younger age groups are at lower
stroke risk, the public health burden is higher -
relatively greater loss of productivity and wage-
earning years
27. Non-modifiable risk factors
• Sex: generally, M>F
• Race: Blacks 38% > whites
• Family history of stroke increases risk by ~ 30%
• Father x 2.4, mother x 1.4
• Low birth weight
– The odds of stroke in 2500 g > 2 x that of 4000 g
28. Modifiable risk factors
• Hypertension
– Remains the most important well-documented,
modifiable risk factor for stroke
– The relationship between BP and stroke risk is strong,
continuous, graded, consistent, independent,
predictive, and etiologically significant
– Even within normal limits, higher BP confers higher
stroke risk
• The risk of stroke begins at 115/75mmHg & doubles with
each increment of 20/10mmHg
29. Modifiable risk factors
• Hypertension
• Stroke Investigative Research and Education
Network (SIREN) Study
– Prevalence of hypertension in stroke:
• Indigenous Africans – 92.8%
• African Americans – 82.4%
• European Americans – 62.0%
– Stroke had an OR & PAR of 19·36 and 90·8% for
hypertension
34. Hypertension and Cardiovascular Risk
• The overall global prevalence of hypertension
(HT) in adults is ~ 30 - 45%
• HT becomes progressively more common with
advancing age, with a prevalence of >60% in
people aged >60 years
• As populations age, adopt more sedentary
lifestyles, and increase their body weight, the
prevalence of HT will continue to rise.
35. Hypertension and Cardiovascular Risk
• It is estimated that the number of people with HT
will increase by 15–20% by 2025, reaching close
to 1.5 billion
• SBP ≥140 mmHg accounts for most of the
mortality and disability burden (70%) globally
• The largest number of SBP-related deaths/year
are due to ischaemic heart disease, haemorrhagic
stroke and ischaemic stroke
• HT has continuous and independent association
with myocardial infarction, stroke, sudden death,
heart failure, peripheral artery disease & end-
stage renal disease.
36. Modifiable risk factors
• Smoking
– Has a strong graded linear association
with all strokes
• RR – 1.9 for CI, 2.9 for SAH
– Smoking + OCP use (RR=7.2)
– Stroke risks:
• 18% current smokers
• 6% former smokers
• 12% environmental tobacco smoke exposure
-Bonita,1999; Kurth, 2003
– Contributes to 12% to 14% of all stroke deaths
37. Modifiable risk factors
• Diabetes
– Independently increases the risk of ischemic
stroke (RR = 1.8-6)
– Prevalence of self-reported stroke - 9% among
persons with diabetes ≥ 35 years
• Dyslipidemia
– 25% increase in ischemic stroke rates for every 1
mmol/L (38.7 mg/dL) increase in total cholesterol
– High total (RR- 1.5, low HDL-2.0)
– Inverse relationship with hemorrhagic stroke
39. Modifiable risk factors
• Diet/nutrition
Salt
– High dietary sodium and low
potassium increase the risk of stroke
– Na intake > 2300 mg, K intake < 4700 mg
Vegetables, Fruits & Fish
– An inverse dose-relationship between intake of
fruits, vegetables & boiled or baked fish and
stroke occurrence
40. Modifiable risk factors
• Physical Inactivity
– Poor exercise and sedentary lifestyle increase the
risk of ischemic stroke - (Kurth et al., 2005).
– Physically active men and women generally
have a 25% to 30% lower stroke or death risk
41. Modifiable risk factors
• Obesity and Body Fat Distribution
• Increased adiposity is associated
with increased risk of stroke.
• There is a progressive, direct,
dose-response relationship
above 25 kg/m2 between BMI
and stroke mortality
– The risk of stroke increases by 1.04
per unit increase in BMI
42. Measures of Adiposity
BMI (kg/m2) Risk of Disease
<18.5 Underweight
18.5–24.9 Healthy weight
25.0–29.9 Overweight Increased
30.0–34.9 Obesity High
35.0–39.9 Obesity Very high
≥ 40 Extreme Obesity Extremely high
Sex Waist Circumference
Men >94 cm (37 in)
Women >80 cm (31.5 in)
43. Modifiable risk factors
• Sickle cell disease (RR = 200–400)
– Prevalence of stroke by age 20 is at least 11%
– Majority occur in homozygous SCD
– A substantial number have “silent” strokes on brain
MRI
– The highest stroke rates occur in early childhood
(1%/year)
– Patients with Transcranial Doppler (TCD) evidence
of high cerebral blood flow velocities (time-
averaged mean velocity 200 cm/s) have a stroke
rate of 10% per year
44. Modifiable risk factors
• Past history of stroke/TIA
• Atrial fibrillation is associated with a 4-5-fold
increased risk of ischemic stroke
– due to embolism of stasis-induced thrombi
forming in the left atrial appendage
• Asymptomatic carotid stenosis (RR = 2.0)
• Oral Contraceptive use: (RR = 2.3)
• Postmenopausal hormone therapy (RR = 1.4)
45. • Data obtained from Nigerian and Ghana
indicate that 98.2% (95% CI 97.2–99.0) of
adjusted PAR of stroke was associated with 11
potentially modifiable risk factors
The Lancet Global Health. 6(4): e436-e446.
46. Risk Factor Odds Ratio
(OR)
Population Attributable
Ratio (PAR)
Hypertension 19·36 90·8%
Dyslipidaemia 1・85 35・8%
Regular meat consumption 1・59 31・1%
Elevated waist-to-hip ratio 1・48 26・5%
Diabetes 2・58 22・1%
Low green leafy vegetable consumption 2・43 18・2%
Stress (psychosocial) 1・89 11・6%
Added salt at the table 2・14 5・3%
Cardiac disease 1・65 4・3%
Physical inactivity 2・13 2・4%
Current cigarette smoking 4・42 2・3%
The Lancet Global Health. 6(4): e436-e446.
51. Risk Factors for Aneurysmal Rupture
• Hypertension
• Cigarette smoking
• Excessive alcohol consumption
• SAH in a first degree relative.
• Past history
52. Exercise
• The following are modifiable risk factors for
stroke except
A. Hypertension
B. Sickle cell disease
C. Asymptomatic carotid disease
D. Atrial fibrillation
E. Low birth weight
53. Exercise
• Answer T or F
• > 90% of stroke risk is modifiable
• Hypertension is the most important
modifiable risk factor for stroke
• Up to 1/3 of the world’s adult population has
hypertension
• As populations age, adopt more sedentary
lifestyles, and increase their body weight, the
prevalence of HT will continue to rise
57. The neurologic deficits of stroke reflect
the area of the brain typically involved
Frontal Lobe
Reasoning,
planning,
problem solving
speech,
movement,
emotions,
Parietal Lobe
Sensation,
orientation,
recognition
Occipital Lobe
vision
Temporal Lobe
Hearing, memory,
understanding. Cerebellum
Coordination
of movement,
balance
Brain stem
reathing, heartbeat, &
blood pressure
58. Common Clinical Features of CI & ICH
Abrupt-onset of
• Hemi, mono, quadri-
paresis
• Hemisensory deficits
• Monocular or
binocular visual loss
• Visual field deficits
• Diplopia
• Dysarthria
• Ataxia
• Vertigo
• Aphasia
• Altered level of
consciousness
• They are more likely to occur in combination
59. Common Clinical Features
• Raised ICP
– Nausea
– Vomiting
– Headache
– Altered level of consciousness
– Seizures
– More common with ICH and large CI
– Neckache/neck stiffness – ventricular extension of an
ICH or SAH
• Not enough to distinguish ischemic from
hemorrhagic
60. Ischemic vs Hemorrhagic
Clinical Variables
• Activity at onset
• Hemiparesis
• Hemisensory symptoms
• Headache
• Vomiting
• Loss of consciousness
• Time to maximum disability
• Changes in deficit after maximum disability
62. Temporal profiles
• Embolic Stroke
– abrupt in onset, with more rapid resolution
– tend to cause smaller deficits than a thrombotic
stroke
• Thrombotic Strokes –
– may demonstrate gradual, stuttering, or stepwise
evolution
– 1/3-1/2 may be preceded by TIA
• Hemorrhagic Strokes (ICH & SAH)
– devastating events of abrupt onset
– accompanied by a significant headache and other
signs of raised ICP
63. Clinical Features of SAH
• Asymptomatic –> sudden death
• Headache
– Severe, sudden onset "thunderclap headache"
• Sentinel headache:
– 50-60%, lasts days – 1wk
– Hours - months, median - 2 wks, b/f rupture.
• Meningism
– > 75% of SAH
– many take several hours to develop.
• Nausea / Vomiting: ICP
64. Clinical Features of SAH
• LOC:
– From sudden rise in ICP
– Transient/persistent – 50% at onset.
• Seizures:
– ICP / cortical irritation – 20-25%
– Occurs close to onset
• Focal neurological deficits:
– 10-15%, may antedate rupture,
– Reflect mass effect of an., ICH, SDH, large SA clot,
vasospasm, CI –intraaneurysmal thrombi.
69. Aims of Management
• Rx underlying disease process if possible
• Protect ischemic brain tissue from necrosis
– attempt to reverse/limit the degree of brain
dysfunction
• Prevent and treat complications
• Rehabilitate the disabled patient physio/
occupational/speech/swallow therapy
• Prevent recurrence (Cardiovascular risk
modification)
70. Comprehensive Stroke Care
• Acute management
• Secondary prevention
• Early mobilization
• Rehabilitation
• Nursing care
• Speech therapy (lagopaedics)
• Swallow therapy
71. Phases of Contemporary Stroke
Management
Phase Period from
onset
Activities Prefered location
1Acute
(emmergency)
care
1st-7th day a)Assessment
b)Early supportive care
Hospital
2 Early sub-
acute(supportive)
care
2nd-4th
week
a)prevention and
treatment of
complications
Hospital
3 Late sub-
acute(maintananc
e) care
2nd-6th
month
a)Rehabilitation
b)Psychological support
c)Prevent recurrence
Hospital/Community
4.Long-term
(chronic) care
7th month
onwards
a)Rehabilitation
b)Psychological support
c)Social support
d)Prevent recurrence
Community
72. Highlights of Acute Stroke
Management
• Organized protocol
• Acute stroke team
• Oral ASA within 24-48
hrs of stroke onset 1st
dose 325mg
• Long term
anticoagulation for
patients in AF (INR of 2-
3); or other high risk
cardiac conditions
• Prophylactic
anticoagulation: only to
prevent DVT.
• BP management
principle; lower by 15%
if DBP>120,SBP>220
• Early mobilization and
rehab.
• Treat blood glucose
>140mg/dl
• Thrombolytic: IV or IA
recombinant Tissue
Plasminogen Activator
• Carotid endarterectomy
• Treat co-morbidity
73. Emergency Evaluation
• History
– Take a brief History
– Generally, History tells you what it is, examination
tells you where it is.
– A history of sudden onset neurological deficit is
suggestive
• Quick, Targeted Physical Examination
– Corroborative, acaization, severity
– General, systemic, neurologic (+ GCS)
74. Time is Brain!
• If history is suggestive, ACT FAST
• Every minute counts, time lost is brain lost!
• There are ~200 billion neurons in the brain
• The brain ages by 3.6 years per hour of hypoxia
Lost with each hour of stroke (per minute)
120 million neurons (1.9 m neurons)
830 billion synapses (14 billion synapses)
714 kilometers of myelinated
fibres
(12 km fibres)
81. Management
• Admit every patients with a Diagnosis of acute
stroke
• Use of comprehensive specialized stroke care
(stroke units) improves outcome
• Standardized stroke care order improves
outcome
• The goal of management is to stabilize the
patient and to complete initial evaluation and
assessment, including imaging and laboratory
studies, within 60 minutes of patient arrival
82. Management
Step 1: Immediate General Assessment (<10
minutes)
• ABC Management
• Full vital signs including pulse oxymetry
– Deliver O2 by nasal cannula if SAO2 < 92%, keep >92%
– Utility of hyperbaric oxygen is not established
• Obtain Intravenous Access
• Bedside Random Plasma Glucose
• Avoid urethral catheterization if no obstruction
83. Supplemental Oxygen
• Hypoxia (oxygen saturation <96% for >5
minutes) occurred in 63% within 48 hours of
stroke onset
• Common causes of hypoxia
– partial airway obstruction, hypoventilation,
aspiration, atelectasis, and pneumonia.
• Deliver O2 by nasal cannula if SAO2 < 94%,
maintain SAO2 >94%
• Utility of hyperbaric oxygen is not established
85. Patient Positioning
• 15° to 30° head-up if suspected elevated ICP,
at risk for airway obstruction or aspiration
• When position is altered, close monitoring of
the airway, oxygenation, and neurological
status
• Nurse lying flat if non-hypoxic and able to
tolerate
86. IV Fluid Management
• Volume:
– Euvolemic patients: maintenance IVF (apart from
unusual losses) - 30 mL per kg body weight.
– Hypovolemic patients: Rapid fluid replacement,
then maintenance
• Type:
– 0.9% saline
– Avoid hypotonic solutions – 5%DW etc
87. Management
• Labs to obtain in all
patients
– ECG
– FBC, ESR
– E, U, Cr
– Lipid profile
– PT, PTTK, platelets
• Labs in selected
patients
– Liver Function Tests
– Urine toxicology screen
– Blood Alcohol level
– Pregnancy Test
– Arterial Blood Gas
– Chest Xray - altered mx
in only 3.8% of patients
• Step 1: Immediate General Assessment (<10
minutes)
88. Management
• Step 2: Immediate Neurologic Assessment
(<25 minutes)
• Obtain history
– Determine onset of CVA symptoms
– Consider Thrombolytics within 3 hours of onset
• General physical examination
• Targeted neurologic examination
– Level of Consciousness (Glascow Coma Scale)
• Carotid bruit, CVS.
94. Question
• A 59-year-old woman
with hypertension
presents with sudden
left-sided weakness
1. What is the most
obvious abnormality?
2. List 4 other possible
clinical features
3. What is the
Diagnosis?
95. Question
• Cranial CT of a 65 year
old farmer
1. What is the most
obvious abnormality?
2. List 5 risk factors
3. What is the arterial
territory involved?
96. Question
•Which of the following may be
found on examination of this
patient?
A. Dysdiadokokinesia on the
right
B. Right hemichorea
C. Past-pointing on the left
D. Hypertonia on the left
E. Intension tremor on the
right
•A 62-year-old known hypertensive with a history of
acute-onset ataxia and confusion
97. Ischaemic Stroke Management
• Step 4: Thrombolytic Therapy (if indicated in
CI)
• Review Thrombolytic Contraindications
• Review risks and benefits of Thrombolytic
therapy
• Review indications for Thrombolytic therapy
– IV <3-4.5 hours, IA < 6hours
• The rate of thrombolytic therapy
was < 6% in the US in 2009!
98.
99. Management
• Step 4: Specific Medical Treatment of ICH
• Activated Factor VII
– No clear clinical benefit so not recommended in
unselected patients
– Can limit the extent of hematoma expansion in
non-coagulopathic ICH patients, there is an
increase in thromboembolic risk
• Replacement therapy in coagupathies
100. Management
• Step 4: Specific Medical Treatment of SAH
• Antifibrinolytic therapy:
– Recent evidence of benefit with early, short course
– Epsilon aminocaproic acid (36 g/d)
– Tranexamic acid (6 to 12 g/d)
• Vasospasm:
– Preventin: Oral nimodipine 60mg 6hry x 21 days
– Rx - volume expansion, induction of hypertension, and
hemodilution (triple-H therapy)
– cerebral angioplasty and/or selective intra-arterial
vasodilator therapy
101. Management
• Step 5: General Measures
• NPO acutely to lower the risk of aspiration
• Gentle IVF hydration only (avoid D5W)
– Normal saline or lactated ringers at 50 cc/hour
• Maintain normal body temperature
– Increased body temperature is associated with poor
neurological outcome
– Treat sources of fever, give antipyretic – PCM
– Utility of hypothermia not established
• Consider Thiamine in Alcoholics and malnutrition
102. Management
• Step 6: Observe for and treat complications
• Blood Sugar Monitoring
– Treat Hypoglycemia: Bolus D50W (do not over
correct)
– Treat Hyperglycemia (>180 mg/dl) – Insulin, GKI
• Seizures
– If seizures or electrographic seizures on EEG
– Evaluate with glucose and Serum Sodium
– Treat with Diazepam and Phenytoin
103. Step 6: Observe for and treat complications
• Blood Glucose
• Treat Hypoglycemia (<60mg/dl):
– Slow IV push of 25 mL of D50W (or as required)
– Do not over correct
• Treat Hyperglycemia (>180 mg/dl)
– Occurs in up to 40% of patients with CI
– Associated with worse clinical outcomes
– Insulin vs GKI (no difference in outcomes)
– feasibility and safety of rapid reductions have
been demonstrated
– Goal: 140 to 180 mg/dL
104. Management
• Step 6: Observe for and treat complications
• Blood Pressure Control
– Both elevated and low BPs are associated with poor
outcome
– Elevated BP may be due to the stress of the event, full
bladder, nausea, pain, hypoxia, raised ICP, so address
these 1st
– Withhold antihypertensive unless
• CI: SBP >220 mm Hg or DBP >120 mm Hg
– ~ 15% reduction during the first 24 hours
• ICH: SBP > 140 mm Hg DBP > 90 mmHg
• SAH: SBP > 140 mm Hg DBP > 90 mmHg
• End organ damage
105. Management
• Step 6: Observe for and treat complications
• Blood Pressure Control
– Aggressive treatment of BP may lead to
neurological worsening
– CPP = MAP – ICP; MAP = DBP + 1/3 PP
– Mild to moderate strokes not at high risk for
raised ICP may have their pre-stroke
antihypertensives restarted ~24 hours
• Hypotension
– Find the cause and treat - hypovolemia, cardiac
arrhythmias, vasopressive agents
106. Management
• Step 6: Observe for and treat complications
• Cerebral edema (peaks on day 3-5, duration
10/7
– Intubate and hyperventilate to pCO2 of 35 mmHg
– Mannitol – 0.25-0.5g/kg/dose over 20 mins, q6hrs
– Neurosurgery consultation for decompression
– Corticosteroids are not indicated
• Other common complications
– SIADH, Pneumonia, UTI, Pulmonary Embolism
107. Management
• Step 7: Adjunctive Therapy
• Aspirin 325 mg stat within 24-48 hours then,
75mg daily
– Prevents CI recurrence
– Avoid in ICH & SAH until after several weeks
– Ticlopidine, clopidogrel, or dipyridamole – not
recommended
• Dysphagia - timely swallow assessment
– Nasogastric, nasoduodenal, or PEG feedings for
Patients who cannot take orally
108. Don’ts
• Avoid urethral catheterization in men if no obstruction
(use Paul’s tube)
• Do not administer excessive IV fluids
• Do not administer dextrose-containing fluids in
nonhypoglycemic patients
• Do not feed or administer medications by mouth
(maintain NPO)
• Do not initiate interventions for hypertension in CI
unless there is a compelling indication
• Do not delay consult, referral or transfer if indicated
109. Management
• Surgery:
• CI:
– Not sufficient data on the safety and effectiveness of
carotid endarterectomy and other operations
• ICH:
– clot removal in cerebellar hemorrhage deteriorating
neurologically, brainstem compression and/or,
hydrocephalus from ventricular obstruction
– lobar clots >30 mL and within 1 cm of the surface
might be considered
110. Management
• Surgery:
• SAH:
– Surgical clipping or endovascular coiling of
aneurysm
– Temporary or permanent CSF diversion in
symptomatic chronic hydrocephalus
– Ventriculostomy – ventriculomegaly and
diminished level of consciousness after acute SAH
111. Management
• Endovascular interventions for CI:
– The usefulness of mechanical endovascular
treatments is not established
• Prevention of DVT/PE
– SC anticoagulants – within 24hrs not advisable in
CI, avoid in ICH & SAH
– Intermittent external compression devices +
elastic stockings for patients who cannot receive
anticoagulants
112. Management
• Neuroprotective Agents:
– Including Vits E & C
– No intervention with putative neuroprotective
actions has been established to be effective
• Early mobilisation & rehabilitation within 24
hours of onset of symptoms
• Swallow test before oral intake
• Treatment of concomitant medical diseases
and complications
• Prophylactic antibiotics not recommend
113. Nutrition
• Malnutrition may slow recovery
• Impairments of swallowing are associated
with a high risk of pneumonia & death
• A preserved gag reflex may not indicate safety
with swallowing
• NPO till swallowing assessment is performed
– 50 mls of water PO; impaired if cough, wet voice
• Early NG tube feeding, commence ASAP
• PEG for prolonged tube feeding
114. Bowel Care
• Constipation - associated with poor outcomes
at 12 weeks
• Bowel management to avoid constipation,
faecal impaction or diarrhoea
115. Infections
• Pneumonia and UTI – most common
• Appearance of fever should prompt a search
for pneumonia or UTI
• Prophylactic antibiotics not useful
• Investigate and treat with appropriate
antibiotics when suspected
116. Infections
Pneumonia prevention
• Ventilation in a
semirecumbent position
• Suctioning
• Early mobilization
• Shortened use of
intubation
• Treat nausea and vomiting
• Exercise and deep breaths
UTI prevention
• Avoid indwelling
catheters if possible
• Assess for UTI if there is
a change in level of
consciousness
• Acidification of the
urine may lessen the
risk of infection
117. Management- Nursing
4/12/07 118
Observation How often Target Parameters
SSS, GCS 3hrly first 12 hours, then 6 hrly GCS only if drowsy
BP 6 hourly Target 160-180/90-100 in normotensives
Target 180/100-105 in hypertensives
Heart rate 6 hourly Cardiac monitoring for history of
arrhythmias, unstable BP
Temperature 6 hourly Keep below 37.5C
Respiration 6 hourly Treat if saturation <92%
Oxygen
Saturation
6 hourly Treat if saturation <92%
Glucose Daily (increase frequency if
abnormal)
Keep < 10mmol/L
Hydration Use normal saline first 24hrs (preventing
blood glucose increasing, EUSI 2003)
Nutrition Introduce NG tube within 24 hours
European Stroke Initiative 2003 (http://eusi-stroke.com/recommendations) unchanged November, 2007
118. Question
• A 54 year old School teacher presents in the
emergency room with a 17 hour history of
sudden weakness of the right side of the body.
GCS is 11, BP 242/156mmHg and RBS
240mg/dl. Cranial CT done 30 minutes after
presentation reveals a hypodense lesion in the
deep left parietal lobe with significant cerebral
edema. Discuss his acute management.
120. Transient Ischemic Attack
• The epidemiology essentially mirrors that of
stroke
• > 10% of TIAs will develop CI within 90 days
• (4-8% of CI will recur within 90 days)
• 2.6% of TIAs will develop other major CV
events within 90 days
• 10-15% of patients have a stroke within 3
months, with half occurring within 48 hours
• CF: Amaurosis fugax, transient stoke-like
syndromes
121. Transient Ischemic Attack
• Controversy exists regarding the need for
admission
– Admission to a "rapid evaluation unit" or
"observation unit", dropped the 90-day stroke risk
from 10% to 4-5%
• No controversy regarding the need for urgent
evaluation, risk stratification, and initiation of
stroke prevention therapy
122. Initial Evaluation
• Level of consciousness and neurologic
examination are usually at the patient's
baseline.
• Initial assessment is aimed at excluding
conditions that can mimic a TIA, eg, ICH,
hypoglycemia, seizure.
• Laboratory studies- within 24 hours
– RPG, ECG, CT, FBC, coagulation studies, E,U.Cr.
– MRI preferred to CT
– Echo, carotid and vertebral doppler uss
123. Risk Stratification – ABCD2
• Age ≥ 60 years (1)
• Blood pressure 140/ 90 mm Hg on first
evaluation (1)
• Clinical symptoms of focal weakness with the
spell (2) or speech impairment without
weakness (1)
• Duration ≥ 60 minutes (2) or 10 to 59 minutes
(1)
• Diabetes (1).
124. Risk Stratification – ABCD2
• 2-day risk of stroke
– 0% for scores of 0 or 1
– 1.3% for 2 or 3
– 4.1% for 4 or 5
– 8.1% for 6 or 7
125. Decision to Admit
• If presents within 72 hours, hospitalize if:
– ABCD2 score of 3
– ABCD2 score of 0 to 2 and uncertainty that
diagnostic workup can be completed within 2 days
as an outpatient
– ABCD2 score of 0 to 2 and other evidence that
indicates the patient's event was caused by focal
ischemia
- AHA
126. Management
• Admit for
– Restoration of Vital Signs
– Cardiac monitoring, pulse oximetry
– Intravenous access
– Management of hypertension, hyperglycemia etc
Non-cardioembolic TIA
• Aspirin (50-325 mg/d), combination
aspirin/extended-release dipyridamole, and
clopidogrel
127. Management
Cardioembolic TIA
• Atrial fibrillation, MI, DCM, RHD,
• After TIA, long-term anticoagulation with
warfarin (goal INR, 2-3) is typically
recommended.
• LMW heparin if warfarin is interrupted
• Aspirin, 325 mg/d
• Mechanical prosthetic valves, warfarin (goal
INR 2.5-3.5), aspirin, 75-100 mg/d
• Bioprosthetic valves, warfarin (goal INR 2-3)
128. Management
Carotid Stenosis
• CEA if
– Ipsilateral severe (70% to 99%) carotid stenosis
– Ipsilateral moderate (50% to 69%) stenosis
– depending on patient-specific factors - age, sex,
and comorbidities (CAS – an alternative)
• Stenosis <50%, no indication for CEA/CAS
• CEA within 2 weeks is reasonable
130. Prevention
• Stroke is best treated by prevention!
• Up to 90% of strokes are preventable
• Stroke prevention hinges on risk modification
– Treatment of cardiovascular risk diseases
– Lifestyle modification
131. Prevention
Risk modification
• Hypertension
– Antihypertensive therapy reduces stroke risk by
about 38%
– Reduction of diastolic BP by 6 mmHg reduces
stroke risk by more than 33%
– Reduction of systolic BP by 3mmHg reduces risk by
8%
• Diabetes
– No demonstrated benefit in stroke reduction with
tight glycemic control
– BP control and statins reduce stroke risk in DM
132. Prevention
• Aspirin - 25% risk reduction
• Carotid endarterectomy: symptomatic
atherosclerotic stenosis of > 70% in the carotid
artery
• High Blood Cholesterol
– Stroke risk reduction of 27% to 32% is achieved with
statins
– 25% reduction in TIAs
• Smoking Cessation
– Reduces risk by 50% within 1 y; to baseline after 5
years
133. Prevention
• Avoid alcohol drinking
– Recommendation: No drinks at all
• Weight control
– An average weight loss of 5.1 kg reduced systolic
BP by 4.4 mmHg and diastolic BP by 3.6 mmHg
• Exercise
– Recommendation: 30 minutes of moderate-
intensity activity daily
135. Asymptomatic carotid stenosis
• RR = 2.0
• 50% reduction with endarterectomy
• Aggressive management of other identifiable
vascular risk factors
136. Weight Control
• No clinical trial has tested the effects of
weight reduction on stroke risk
• An average weight lossof 5.1 kg reduced
systolic BP by 4.4 mmHg and diastolic BP by
3.6 mmHg
– Therefore, weight reduction is reasonable as a
means of reducing stroke risk
• Don’t just advise, set SMART weight
management goals
137. Physical Inactivity
• Mechanisms: BP, DM, weight, plasma
fibrinogen, platelet activity & plasma tPA
activity and HDL-cholesterol.
• Recommendation (The 2008 Physical Activity
Guidelines for Americans):
– At least 150 minutes per week of moderate
intensity
– or 75 minutes per week of vigorous intensity
aerobic physical activity
– or an equivalent combination of moderate and
vigorous intensity aerobic activity
138. Prevention
Sickle Cell Disease
• Screening with TCD starting at age 2 years
– Optimal interval not yet established, more
frequently in younger children and with borderline
abnormal TCD velocities
• Transfusion therapy (target reduction of Hb S
from a baseline of >90% to <30%)
– Reduced risk from 10% to 1%
• Hydroxyurea or bone marrow transplantation
141. Prevention - Diet
• Carbohydrates
– Include at least one starchy food in each main meal
– Use refined carbohydrates sparingly
• Fats
– Low-fat dairy products and low saturated and total
fat diets reduce BP and stroke risk
– Yoruba diet has lower mean cholesterol level
(166mg/dl) compared to that of the African
Americans (220mg/dl) (Ogunniyi et al ,2000)
142.
143. Prevention - Diet
• Proteins
– Red Meat - Use Sparingly
– Fish, Poultry, and Eggs - 0-2 times a day
– Nuts and Legumes - 1- 3 times a day
– Nuts and legumes are an excellent source of protein,
fiber, vitamins, and minerals.
• Examples: Brown beans, soya beans.
• Contain healthy fat, good for the heart.
Milk
• A good source of calcium
• Try to stick to low or no fat milk
144. Fruits and Vegetables
• Increased fruit and vegetable consumption is
associated with a reduced risk of stroke in a
dose-response fashion
• For each 1-serving/day increment in fruit and
vegetable intake, the risk of stroke was reduced
by 6%
- Nurses’ Health Study & the HealthProfessionals’ Follow-Up Study
• Vegetables- to be taken in abundance, every
meal, every day.
• Fruits (2-3 times a day)
145.
146.
147.
148.
149. Prevention - Salt
• 75% of the salt we eat is already in food when
we buy it
• Avoid foods high in salt
– Fast foods, canned foods, tomato ketchup,
mayonnaise, roasted nuts, smoked meat and fish.
• No added salt at table
• Recommended daily intake of table salt for
adults: not more than 6g a day: around one
full teaspoon
150. Conclusion
• Stroke is a disease of major public health
importance in Nigeria & mortality is still very
high
• Recognition by patients and care providers
that stroke is a medical emergency will change
the current picture
• Stroke is preventable and prevention is the
only affordable option for developing
countries
• TIA is not benign