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CEREBROVASCULAR ACCEDENT

CEREBROVASCULAR ACCEDENT. CVA. 3 rd cause of death 2/1000 anully Blood brain supply ( Circle of Willis ) do not open in all people. Types of strokes Ischemic Haemorrhagic TIA Ischemic stroke : 83% -Thrombotic -Embolic Thrombotic strokes:

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CEREBROVASCULAR ACCEDENT

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  1. CEREBROVASCULAR ACCEDENT

  2. CVA 3rd cause of death 2/1000 anully Blood brain supply ( Circle of Willis ) do not open in all people

  3. Types of strokes Ischemic Haemorrhagic TIA Ischemic stroke : 83% -Thrombotic -Embolic Thrombotic strokes: -large vessel thrombi cholesterol -small vessel thrombi (lacunar) high BP Embolic strokes: 80% source from heart

  4. Subarachnoid Haemorrhagic strokes: -youngage -high BP -aneurysm -A-V malformation -haemorrhagic diseases Damage by 2 mechanisms: -anoxia -irritation of brain by leaked blood Location rather than amount of bld determain out come Intracerebral

  5. Risk factors: Alternable: -diet -physical activity -smoking -substance/alcohol abuse -medical conditions:-hyperlipidemia -DM -atherosclerosis -high BP -obesity -cardiovascular dis -TIA -AV fistula &malformation

  6. Risk factors: Unalternable -age -ethnic -heriditary -gender

  7. Clinical Features Artry Supply Features ICA frontal,pariatal& contralateral hemiparesis,hemi temporal lobes anasthesia,hemianopia,aphasia ACA medial cerebrum, contralat.weakness legs >arms sup.frontal&pariat. behaviour abn. MCA lat.cerebrum,deep contralat.hemiplegia,hemianasthia, frontal&pariatal aphasia,visuospatial defect PCA occipital,inf.&lat.of contralat.hmonomus hemianopia temporal Basilar pons,midbrain& crossed hemiplegia,vertigo,atxia, cerebellum dysphagia,dysarthria,Horner

  8. Investigations: -haemorrhagic or thromboembolic -site -risk factors .CT,MRI,MRA,angio,doppler .CBC,lipid, sugar .PT,PTT .ECG,Echo .sickle cell screen .ESR,ANA .CXR,cervical X-ray

  9. Management -physical & rehabilitation -medical -surgical Physical: -feeding -bladder -bed sores -respiratory &limbs physio

  10. Medical Antithrombotic: Risk of haem. Inclusion criteria: -ischemic stroke -measurable deficit -no haem. on CT -within 3 hrs Exclusion criteria: -minor stroke -stroke or head truma within 3m. -GI or urinary haem. 21d.

  11. -major surgery 14d. -history of IC haem. -suspected SAH inspite of normal CT -syst.BP>185 or diastolic >110 -need aggressive ttt for BP -use of anticoagulant -PT>15sec., plat.<100.000 ,glu.<50mg or >400mg *Dose of tPA: 0.9mg/kg 10%as bolus over 1min. ,rest over 1hr

  12. I.V heparin: For cardiogenic emboli Aspirin: Prophylactic Recobinantfactor seven: For haem. stroke Manitol: For raised ICP ttt of risk factors

  13. Surgical: -endarterctomy -clips for AVmalformation -evacuation of haematoma

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