This document provides an overview and update on strokes in 2020. It defines strokes as the acute neurological impairment caused by interrupted blood supply to the brain. The main types of strokes are ischemic, caused by clots, and hemorrhagic, caused by bleeding. Risk factors include high blood pressure, smoking, diabetes, and high cholesterol. Symptoms depend on the affected brain region and may include weakness, speech problems, or visual issues. Diagnosis involves imaging tests like CT or MRI. Treatment focuses on dissolving clots with thrombolytics or removing clots with procedures, managing risk factors, and rehabilitation.

1. Topic :- Update on STROKE (2020)
Dr Rahul JainDr Sharda Jain
for Gynaecologist & Surgery Specialist

2. Over 400 ppts are available on
slideshare.net ***for use of public/Doctors
www.slideshare.net / Lifecarecentre

3. CONTENTS-
• DEFINITION
• TERMINOLOGIES
• TYPES
• PATHOGENESIS
• CLINICAL FEATURES
• NORMAL FUNCTIONS
• INVESTIGATIONS
• TREATMENT

4. DEFINITION-
• IT REFERS TO ACUTE NEUROLOGICAL IMPAIRMENT
THAT FOLLOWS INTERRUPTION IN BLOOD SUPPLY
TO SPECIFIC AREA OF BRAIN.
• WHO DEFINITION-RAPIDLY DEVELOPING CLINICAL
SIGNS OF DISTURBANCE OF CEREBRAL FUNCTION
LASTING MORE THAN 24HRS OR LONGER OR
LEADING TO DEATH WITH NO APPARENT CAUSE
OTHER THAN VASCULAR.

5. TERMINOLOGIES
• TRANSIENT ISCHEMIC ATTACK
• REVERSIBLE ISCHEMIC NEUROLOGICAL
DEFICIT(RIND)

6. TYPES-
• STROKE IS MAINLY OF 2 TYPES-
• ISCHEMIC STROKE
• HAEMORRHAGIC STROKE

7. ISCHEMIC
STROKE
EMBOLIC
STROKE
LACUNAR
STROKE THROMBOTIC
STROKE(AS)

8. HAEMORRHAGIC
STROKE
SUBARACHNOID HG
SUBDURAL HG
OR EXTRADURAL HG
INTRAPARENCHYMAL
BLEED

9. PATHOGENESIS-
• RISK FACTORS(LIPID
LEVELS,HTN,SMOKING,ALCOHOL,DM,VA
SCULITIS,AGE,OCP)
• THROMBOSIS OF VESSEL CAUSING
TISSUE DEATH CAUSING LIQUEFACTIVE
NECROSIS
• PENUMBRA SIZE
WORSENING WITH
FEVER AND
HYPERGLYCEMIA

10. PATHOGENESIS(HG STROKES)-
• RUPTURE OF BLOOD VESSEL WITHIN
PARENCHYMA DUE TO VERY HIGH BP(HTN
EMERGENCY)
• COMMON SITES-BASAL
GANGLIA,THALAMUS,CEREBELLUM,PONS

11. CLINICAL FEATURES-
• MODE OF ONSET
1. EMBOLISM-SECONDS
2. THROMBOSIS-MINUTES TO HOURS(SLEEP)
3. HAEMORRHAGE-HT OF EXERTION OR STRESS
• PRECIPITATING FACTORS-
1. EMBOLISM-EXERTION
2. THROMBOSIS-SLEEP
3. HAEMORRHAGE-HEIGHT OF EMOTION

12. CLINICAL FEATURES-
• EVOLUTION OF PARALYSIS-
1. EMBOLISM-MAXIMAL WEAKNESS AT
PRESENTATION
2. THROMBOSIS-INCREASES IN HOSPITAL
3. HAEMORRHAGE-CAN IMPROVE OR
DETERIORATE.
• RELEVANT H/O-
1. EMBOLISM-H/O HEART DISEASE
2. THROMBOSIS-H/O TIA,
3. HAEMORRHAGE-
HTN,SEIZURES,VOMITING,HEADACHE

13. CLINICAL FEATURES-
• INCREASED ICP-
SEIZURES,VOMITING,HEADACHE,BLURRING
OF VISION
• SPECIFIC SYMPTOMS-
1. SPECIFIC TO SPECIFIC BRAIN PART INVOLVED
2. STROKE DUE TO LENTICULOSRIATE BRANCH
OF MCA OCCLUSION-POSTERIOR LIMB OF
INTERNAL CAPSULE PRESENTING AS C/L
HEMIPLEGIA AND C/L UMN 7TH NERVE PALSY

15. 7th CRANIAL NERVE LESION-

16. NORMAL FUNCTIONS-
• FRONTAL LOBE-MOTOR
AREA,MICTURATION AREA,WORD
FORMATION
AREA(BROCS’S),EMOTIONAL CENTRE
• PARIETAL LOBE-SENSORY AREA,OPTIC
RADIATION,TASTE
• TEMPORAL LOBE-AUDITORY
AREA,SPEECH COMPREHENSION
AREA,OLFACTION,OPTIC
RADIATION,MEMORY
• OCCIPITAL LOBE-VISION

18. INVESTIGATIONS
• CINCINNATI PREHOSPITAL STROKE SCALE
• NCCT BRAIN
• If NCCT BRAIN NORMAL►
MRI BRAIN,FLAIR,DWI
• VASCULAR
IMAGING(MR,CTANGIOGRAPHY)
• ECG,2D ECHO

19. EDHCT SCAN -SDH

20. • MRI ISCHEMIC STROKE

21. CINCINNATI PREHOSPITAL STROKE
SCORE-
• FACIAL DROOP
• ARM DRIFT
• ABNORMAL SPEECH
• SENSTIVITY-59%
• SPECIFICITY-89%

22. MANAGEMENT OF HG STROKE-
• REVERSAL OF COAGULOPATHY(VIT K,FFP)
• BP>185/110 SHOULD BE LOWERED USING NON
VASODILATING DRUGS-LABETALOL,NICARDIPINE
• ICP CONTROL(MANNITOL,BARBITURATES)
• SEIZURE PROPHYLAXIS
• STEROIDS(DEC VASOGENIC CEREBRAL EDEMA)
• HYPERVENTILATION
• COMPLICATIONS MONITORING
• SUPPORTIVE MANAGEMENT

23. MANAGEMENT-(ISCHEMIC STROKE)
• GOLDEN PERIOD-4.5HRS(6HRS-EUROPE ,3HRS-
US)
• THROMBOLYTICS-RECOM TISSUE
PLASMINOGEN ACTIVATORS 0.9MG/KG(UPTO
90MG)
• ENDOVASCULAR MECHANICAL
THROMBECTOMY
• ANTIPLATELETS
• ANTICOAGULANTS

24. ISCHEMIC STROKE
MANAGEMNET-
• STATINS
• NEUROPROTECTION-NIMODIPINE,MAGNESIUM
• SUPPORTIVE
1. BP MANAGEMENT
2. FEVER CONTROL
3. SERUM GLUCOSE
4. ICP CONTROL
5. ANTIBIOTICS(PNEUMONIA),RT FEEDS
6. DVT MANAGEMENT
• REHABILITATION-PHYSIOTHERAPY

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