CEREBROVASCULAR DISEASE.

ISCHEMIC STROKE.
TRANSIENT ISCHEMIC ATTACK
 CLASSIFICATION OF
CEREBROVASCULAR DISEASE
I.ACUTE
A.ISCHEMIC STROKE (CEREBRAL
INFARCTION)
1.Atherotrombotic
2.Cardioembolic
3.Lacunar
4.Other
B.HEMORRAGIC STROKE
1.Intracerebral hemorrhage
2.Subarachnoid hemorrhage
C.TRANSIENT ISCHEMIC ATTACK
II.CHONIC ISCHEMIC BRAIN
DISEASE
 PREVALENCE OF TYPES OF STROKE

INTRACEREBRAL HEMORRHAGE

15 - 20 %
SUBARACHNOID
HEMORRHAGE 3-5 %

70 85 %

CEREBRAL INFARCTION
 STROKE

There are 20 million cases of stroke every year

Stroke is the number three cause of death and the leading cause
of long-term disability
Death after stroke will be during the first month till 30%, during
a year - till 50%
Incidence and mortality rates are higher in black, Asian, Pacific
Islander, and Hispanic-American patients compared to white
patients.
Stroke occurs most often in patients over age 60, with incidence
peaking between the ages of 80 and 84 years.
RISK FACTORS FOR ISCEMIC STROKE

non- modifying
modifying
Age Heart diseases (atrial fibrillation)

arterial hypertension
(>140mmHg systolic, >90mmHg diastolic)
hyperlipidemia
Peripheral artery diseases
diabetes mellitus
cigarette smoking
heredity Alcohol abuse (>60 g of alcohol in men, >40 g
in women)
Low physical activity
male sex Stenosis of corotid artery
transient ischemic attack
PATHOGENIC SUBTYPES OF ISCEMIC STROKE

Atherotrombotic
(30-40%) Cardioembolic
(20-30%)

Other (5-10%)
Lacunar stroke
(20-30%)
CHANCHES IN BRAIN DURING STROKE
CHANCHES IN BRAIN WHEN CBF DECREASES
 THE MAIN SYMPTOMS OF
STROKE
Sudden loss or decrease in level of consciousness
Sudden numbness or weakness of the face, arm, or leg (monoparesis or
hemiparesis)
Sudden confusion, trouble speaking (aphasia or dysarthria), or difficulty
understanding
Sudden difficulty seeing in one or both eyes, including loss of vision or
double vision
Sudden difficulty walking, dizziness, or loss of balance and coordination,
including limb ataxia
Sudden, severe headache which may occur several days before the onset of
other symptoms
Rapid onset of nausea and vomiting
STROKE IN CAROTID SYSTEM
STROKE IN CAROTID SYSTEM
Occlusion of a.ophtalmica

Occlusion of a.cerebri media

Contralateral hemiplegia
Contralateral hemianaesthesia
Conrtalateral hemianopia
Aphasia (dominant)
Signs of neglect are consistent with a
nondominant parietal lobe lesion (non-
dominant)
 STROKE IN VERTEBRO-BASILAR
SYSTEM

Contralateral homonymous Contralateral hemiparesis, sensory loss

hemianopia Ipsilateral bulbar or cerebellar signs
STROKE IN VERTEBRO-BASILAR SYSTEM

Alternative syndromes

Veber syndrome
 STROKE IN VERTEBRO-BASILAR
SYSTEM

taxic gait
positive Romberg test
intentional tremor
positive finger-nose and
heel-knee tests
dysdiadochokinesis
dysmetria
horizontal nystagmus
muscle hypotonia
The diagnosis and investigations
of stroke
 Diagnostic testing
CT scan
Magnetic resonance imaging
Electrocardiography
Ultrasonography
MR-angiography
Cerebral angiography
Blood glucose level, complete blood count, including
platelet count, prothrombin time/international
normalized ratio
Electroencephalogram (if seizures are suspected)
CT is the standard initial imaging
study
ISCHEMIC STROKE IN OCCLUSION
OF A.CEREBRY MEDIA (MRI)
ISCHEMIC STROKE IN OCCLUSION
OF POSTERIOR CEREBRAL ATHERY
ISCHEMIC STROKE IN OCCLUSION
OF A.CEREBRY ANTERIOR (MRI)
LACUNAR STROKE IN BASAL GANGLIA
AND PONS
 CT-PERFUSION
1-day (1h 30 min) 3-day 21-day
PRINCIPLES OF ISCEMIC STROKE TREATMENT

TPA

Monitoring of BP, ECG, blood glucose,

electrolytes

Prevention and treatment of

complications
Rehabilitation
Secondary stroke prevention
 Thrombolysis clot

Thrombolytic therapy
with alteplase may be
initiated within 3 hours
of onset of ischemic
stroke cathether

a.femoralis
 Dosing information of TPA for acute
ischemic stroke
0.9 mg/kg to a maximal dose of 90 mg
10% of the total dose administered as an intravenous bolus over a 1-min
period
90% of the remainder infused continuously over a 60-min period

Follow-up

Monitor vital signs and neurologic status

Maintain blood pressure at 185/110 mm Hg
No anticoagulant or antiplatelet therapy for 24 hr
TRANSIENT ISCHEMIC ATTACK

Risk factors are the same as in ischemic stroke

The presence of neurovascular syndromes which
disappear usually in 10-15 min
The all neurological symptoms and signs resolve
completely within 24 hours
In every 3 patient in future ischemic stroke
occurs