Ischemic-Stroke

IschemicStrokePengBinDepartmentofNeurology,PekingUnionMedicalCollegeHospitalWhatdoweneedtoknow……DefinitionandclassificationVascularanatomyMechanismClinicalfeaturesDiagnosisanddifferentiatediagnosisTreatmentDefinitionStroke:WorldHealthOrganization(WHO)hasdefinedstrokeas“rapidlydevelopingclinicalsignsoffocal(attimesglobal)disturbanceofcerebralfunction,lastingmorethan24hoursorleadingtodeathwithnoapparentcauseotherthanthatofvascularorigin.”Ischemicstroke:deprivationofbloodflowtoanareaofthebrain,generallyasaresultofthrombosis,embolism,orreducedbloodpressure.---Onset:Rapidly---Symptom:Focalorglobalcerebraldysfunction---Duration:Morethan24hours---Vascularorigin:ClassificationofIschemicStrokeAtherothromboticcerebralinfarctionCerebralembolismLacunarinfarctionCerebralwatershedinfarctionVascularAnatomyThebrainisperfusedbythecarotidandvertebralarteries---Anteriorcirculation:carotidartery,etc---Posteriorcirculation:vertebrobasilarartery.Howdoesithappen?ClinicalmanifestationsIschemicsyndromesofspecificvesselsdependon-----thesiteoftheocclusion-----thepresenceofpreviousbraindamage-----collateralcirculationMCAACAPCAExampleInternalcarotidarteryocclusion(MCA+ACA)*Symptomatic--Contralateralhemiparesis--Hemianesthesia--Hemianopia*AsymptomaticMCAACAAsymptomaticDiagnosisOnsetCausesorriskfactorsClinicalfeatures---StrokesyndromesTests---BrainCTscan---BrainMRI---TCD,CTAorDSADifferentiateDiagnosisIntracerebralhemorrhageGeneralManagementStandardfrequencyofobservationsandmonitoredparametersDeepveinthrombosis(DVT)prophylaxisTreatmentofincreasedbloodsugarlevels(BSL)TreatmentofincreasedtemperatureTreatmentofincreasedbloodpressure(BP)SpecifictreatmentThrombolytictherapy--Intravenousthrombolytictherapywithrt-PA--IntraarterialthrombolytictherapyInclusionCriteria--Patientorfamilyareabletoindicateconsent--Age18--Onsetofstrokesymptomsdefined,andwithin4.5hoursofcommencementofinfusion--Moderatetosevereneurologicaldeficit(NIHSS7and25)ExclusionCriteria--Timeofonsetunknown,patientawokewithdeficitAntiplatelettherapyAnticoagulation--Indications:Atrialfibrillation(chronicorparoxysmal)--ContraindicationsSecondaryPreventionSpecificInterventionsCarotidendarterectomyAngioplasty/stenting:Extracranial(carotid)andintracranialRehabilitationAfterclassDefinitionandvascularanantomyDiagnosisandtreatmentSuggestedreadings---Cerebralvasculardisease4thediton---Merrit’sHandbookofNeurologyThanks!