Patofisiologi Stroke

Stroke
Stroke Iskemik
Hemoragik
Neurochemical Injury
 Lactate Acidosis
In the area of reduced blood supply,
ATP consumption continues despite
insufficient synthesis
Lack of ATP cause cell to shift into
anaerobic pathway
Lactate acidosis lead to ion
pumpsfailure causing loss of ionic
homeostasis in neurons.
 Glutamate Ischemia
Glutamate binds to ionotropic NMDA and
AMPA receptors, promoting a major influx
of calcium.
Calcium overload triggers phospholipases
and proteases that degrade essential
membranes and proteins.
Massive calcium influx activates a
catabolic process mediated by proteases,
lipases, and nucleases.
 Oxidative Stress
High calcium, sodium, and ADP levels in
ischemic cells stimulate excessive
mitochondrial oxygen radical production
(ROS)
These ROS directly damage lipids,
proteins, nucleic acid, and carbohydrates.
ROS is toxic to cell because antioxidant
enzymes and scavenging mechanism are
too slow to offset ROS production.
Neuroinflammation Injury
 Microglia
Microglia are resident immune cells of the CNS
and serve as sensors and effectors in the
brain
Microglia have macrophagic functions, such as
phagocytosis, secretion of proinflammatory
cytokines, and antigen presentation.
Overactivated microglia can be neurotoxic by
releasing ROS via NADPH oxidase,
proinflammatory cytokines and neurovascular
proteases
Ischemic stroke
Decreased or
absent circulating
blood deprives
neurons of
nessesary
subtance.
Main cause of
ischemic stroke is :
Thrombosis
(related to
atheroschlerosis)
Embolism (related
to atheroschlerosis)
Global Ischemia
Atherosclerosis
A
condition
when
plaque
builds
inside the
arteries
 Relation between atherosclerosis,
thrombosis and embolism
Rupture of erosion of atheromatous
plaques (became emboli) adhesion
of platelets thrombus (thrombosis)
obstruction of blood flow and
source of emboli
Embolism
Blockage-causing
material in the blood
vessel, can be clot,
fibrin, atheromatous
plaque, fat, air,
tumor, metastasis,
bacterial clumps, and
foreign bodies
Embolic stroke
usually causing
hemorrhagis
infarction
Global Ischemic
Occurs when
blood flow to the
brain is stopped or
reduced
This is usually
triggered by
cardiac arrest
Some neurons are
more suceptible to
ischemia than
others
Hemorrhage Stroke
When there is a leakage
in your blood vessel
causing a hemorrhaging
in the brain causing
pressure to the brain
and vasospams of other
vessels
Major cause :
Aneurysm
Arteriovenous
malformation (related to
hypertention)