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STROKE.pptx
- 2. A stroke occurs when a blockage or bleed of the blood vessels either interrupts or reduces the supply of blood to the brain. When this happens, the brain does not receive enough oxygen or nutrients, and brain cells start to die. Stroke is a cerebrovascular disease. This means that it affects the blood vessels that feed the brain oxygen. If the brain does not receive enough oxygen, damage may start to occur. This is a medical emergency. Although many strokes are treatable, some can lead to disability or death.
- 3. There are three main types of stroke: Ischemic stroke: This is the most common type of stroke, making up 87% of all cases. A blood clot prevents blood and oxygen from reaching an area of the brain. Hemorrhagic stroke: This occurs when a blood vessel ruptures. These are usually the result of aneurysms or arteriovenous malformations (AVMs). Transient ischemic attack (TIA): This occurs when blood flow to a part of the brain is inadequate for a brief period of time. Normal blood flow resumes after a short amount of time, and the symptoms resolve without treatment. Some people call this a ministroke.
- 4. Ischemic stroke This is the most common type of stroke. It happens when the brain's blood vessels become narrowed or blocked, causing severely reduced blood flow (ischemia). Blocked or narrowed blood vessels are caused by fatty deposits that build up in blood vessels or by blood clots or other debris that travel through your bloodstream and lodge in the blood vessels in your brain.
- 5. Haemorrhagic stroke Hemorrhagic stroke occurs when a blood vessel in your brain leaks or ruptures. Brain hemorrhages can result from many conditions that affect your blood vessels. Factors related to hemorrhagic stroke include: 1. Uncontrolled high blood pressure 2. Overtreatment with blood thinners (anticoagulants) 3. Bulges at weak spots in your blood vessel walls (aneurysms) 4. Trauma (such as a car accident) 5. Protein deposits in blood vessel walls that lead to weakness in the vessel wall (cerebral amyloid angiopathy) 6. Ischemic stroke leading to hemorrhage A less common cause of bleeding in the brain is the rupture of an abnormal tangle of thin-walled blood vessels (arteriovenous malformation).
- 6. Transient ischemic attack (TIA) A transient ischemic attack (TIA) — sometimes known as a mini stroke — is a temporaryperiod of symptoms similar to those you'd have in a stroke. A TIA doesn't cause permanent damage. They're caused by a temporary decrease in blood supply to part of your brain, which may last as little as five minutes. Like an ischemic stroke, a TIA occurs when a clot or debris reduces or blocks blood flow to part of your nervous system.
- 10. DIAGNOSIS- Blood Tests Complete blood count. This includes a check for your level of platelets, which are cells that help clot blood. A lab will also measure electrolyte levels in your blood to see how well your kidneys are working. Clotting time. A pair of tests called PT (prothrombin time) and PTT (partial thromboplastin time) can check how quickly your blood clots. If it takes too long, it could be a sign of bleeding problems. Imaging Tests Computerized tomography (CT). Your doctor takes several X-rays from different angles and puts them together to show if there's any bleeding in your brain or damage to brain cells. They may put dye in your vein first to look for an aneurysm, a thin or weak spot on an artery.
- 11. Magnetic resonance imaging (MRI). This uses powerful magnets and radio waves to make a detailed picture of your brain. It's sharper than a CT scan and can show injuries earlier than a traditional CT. Carotid ultrasound. This uses sound waves to find fatty deposits that may have narrowed or blocked the arteries that carry blood to your brain. Echocardiogram. Sometimes a clot forms in another part of the body (often the heart) and travels to the brain. This imaging test of the heart can look for clots in the heart or enlarged parts of the heart. Angiograms of your head and neck. Your doctor will put dye in your blood so they can see your blood vessels with X-rays. This can help find a blockage or aneurysm. Swallow tests, Carotid ultrasound,
- 12. Ischemic stroke. TREATMENT OF STROKE- For this type of stroke, treatment focuses on restoring blood flow to the brain. You may get a clot-dissolving medicine called tissue plasminogen activator (TPA). This medicine can improve recovery from a stroke, especially if it's given as soon as possible after the stroke happens. Doctors try to give this medicine within 3 hours after symptoms start. Some people may be helped if they are able to get this medicine within 4½ hours of their first symptoms. You may also get aspirin or another antiplatelet medicine. In some cases, a procedure may be done to restore blood flow. The doctor uses a thin, flexible tube (catheter) and a tiny cage to remove the blood clot that caused the stroke. This procedure is called a thrombectomy.
- 13. Haemorrhagic stroke. For this type of stroke, treatment focuses on controlling bleeding, reducing pressure in the brain, and stabilizing vital signs, especially blood pressure. To stop the bleeding, you may get medicine or a transfusion of parts of blood, such as plasma. These are given through an IV. If the bleeding is from a ruptured brain aneurysm, surgery to repair the aneurysm may be done. In some cases, medicines may be given to control blood pressure, brain swelling, blood sugar levels, fever, and seizures. If a large amount of bleeding has occurred and symptoms are quickly getting worse, you may need surgery. The surgery can remove the blood that has built up inside the brain and lower pressure inside the head.
- 14. SURGICAL Surgery is an option for preventing stroke for patients with certain conditions. There are a number of conventional surgical techniques that have been in use for some time, including "clipping" aneurysms to prevent further bleeding and removing AVMs. Carotid endarterectomy Carotid endarterectomy is a procedure used to remove atherosclerotic plaque from the carotid artery when this vessel is blocked. It has recently been proven that for certain patients with minor strokes or TIAs, carotid endarterectomy is highly beneficial in preventing future strokes. This procedure is also beneficial for some patients with blockage of the carotid arteries who have not had previous symptoms.
- 15. Stereotactic microsurgery for AVMs and aneurysms Stereotactic microsurgery is one of the most dramatic new surgical procedures for AVMs and certain aneurysms that were once considered untreatable. It employs sophisticated computer technology and geometric principles to pinpoint the precise location of the AVM. During the procedure, a custom-fitted frame is attached to the patient's head and three-dimensional reference points are established using CT or MRI. This technique allows neurosurgeons to locate the AVM within one or two millimeters so they can operate, using microscope-enhanced methods and delicate instruments, without affecting normal brain tissue.
- 16. Stereotactic radiosurgery for AVMs Stereotactic radiosurgery is a minimally invasive, relatively low-risk procedure, that uses the same basic techniques as stereotactic microsurgery to pinpoint the precise location of the AVM. Once located, the AVM can be obliterated by focusing a beam of radiation that causes it to clot and then disappear. Due to the precision of this technique, normal brain tissue usually is not affected. This procedure is generally performed on an outpatient basis. Revascularization of the blood supply Revascularization is a surgical technique for treating aneurysms or blocked cerebral arteries. The technique essentially provides a new route of blood to the brain by grafting another vessel to a cerebral artery or providing a new source of blood flow to the brain. Stanford has been at the forefront of advances in revascularization techniques.
- 17. Interventional Neuroradiology Techniques Endovascular treatment of aneurysms Endovascular treatment of aneurysms is a new interventional neuroradiologic technique, which greatly benefits patients with serious medical conditions who are unable to sustain the stress of surgery. Platinum coils developed at Stanford are guided into the aneurysm via a catheter, creating a clot that effectively closes the aneurysm off from the surrounding circulation, preventing the risk of hemorrhagic stroke in the future. Endovascular treatment of AVMs One innovative form of treatment involves use of a "super glue" substance introduced via a tiny catheter to reduce the size of the AVM and facilitate further microsurgical or radiation treatment. In some cases, it is possible to completely block off and cure the AVM with endovascular treatment alone. Angioplasty and stenting of vessels in the neck and brain Angioplasty and stenting of vessels in the neck and brain are other new endovascular procedures available at only a few institutions nationwide. Cerebral angioplasty is similar to a widely used cardiology procedure and is used to open partially blocked vertebral and carotid arteries in the neck, as well as blood vessels within the brain.
- 18. Drugs for Emergency Care Much of the damage caused by a thrombotic or embolic stroke occurs in the first few hours after the event. Research has focused primarily on the development of new clot- dissolving drugs and medications (neuroprotective agents) that make the brain more resistant to stroke. Thrombolytic agents Tissue plasminogen activator [tPA], widely used to dissolve clots that cause heart attacks, is now being used to dissolve artery-blocking clots in the brain during the critical early stages of stroke. Administration of tPA early after a stroke reduces neurological damage significantly. The drug is most effective when administered within the first three hours of stroke onset but is being tested at Stanford for selected patients up to six hours after stroke onset. Neuroprotective agents Medications that make the brain less susceptible to the damaging effects of a stroke are called neuroprotective agents.
- 19. Drugs for Prevention of Stroke Anticoagulants may be given orally or intravenously. These drugs work by thinning the blood and preventing clotting. They are also used for deep vein thromboses and pulmonary emboli. Antiplatelet agents work by preventing or reducing the occurrence in the bloodstream of a phenomenon known as platelet aggregation. When there is damage or injury to a blood vessel, platelets (one type of blood particle) migrate to the scene to initiate a healing process. Large numbers of platelets clump together (aggregate) and form what is essentially a plug. This aggregation can sometimes result in formation of a thrombus (blood clot) that may block the artery or break loose and block a smaller artery. By preventing this, antiplatelet agents can reduce the risk of stroke in patients who have had TIAs or prior ischemic strokes.
- 20. REHABILITATION Strokes are life-changing events that can affect a person both physically and emotionally, temporarily or permanently. After a stroke, successful recovery will often involve specific rehabilitative activities such as: Speech therapy - to help with problems producing or understanding speech. Practice, relaxation and changing communication style, using gestures or different tones for example, all help. Physical therapy - to help a person relearn movement and co- ordination. It is important to get out and about, even if it is difficult at first
- 21. Occupational therapy - to help a person to improve their ability to carry out routine daily activities, such as bathing, cooking, dressing, eating, reading and writing . Joining a support group - to help with common mental health problems such as depression that can occur after a stroke. Many find it useful to share common experiences and exchange information Support from friends and family - to provide practical support and comfort. Letting friends and family know what can be done to help is very important.