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Stroke Mechanisms and Current Treatments

Stroke Mechanisms and Current Treatments. Qiu Hua Chen, Chang (Helen) Liu, Yi Lun (Elaine) Shang, Kyungmin Lee. PHM142 Fall 2019 Instructor : Chesa Dojo Soeandy Coordinator: Jeffrey Henderson. What is stroke?.

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Stroke Mechanisms and Current Treatments

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  1. Stroke Mechanisms and Current Treatments Qiu Hua Chen, Chang (Helen) Liu, Yi Lun (Elaine) Shang, Kyungmin Lee PHM142 Fall 2019 Instructor: Chesa Dojo Soeandy • Coordinator: Jeffrey Henderson

  2. What is stroke? Stroke results from a loss of blood flow (which contains essential oxygen and nutrients) to the brain. Prolonged loss of blood flow can lead to brain damage and death. Stroke | CVA | Cerebrovascular Accident. (2019, August 21). U.S. National Library of Medicine.

  3. Stroke | CVA | Cerebrovascular Accident. (2019, August 21). World Health Organization.

  4. What are the Signs and Symptoms of a Stroke? (n.d.).Centre for Neuro Skills.

  5. Stroke | CVA | Cerebrovascular Accident. (2019, August 21). U.S. National Library of Medicine.

  6. Types of Stroke 1. Ischemic stroke • caused by a blockage of a blood vessel supplying the brain 2. Hemorrhagic stroke • caused by a leaked/ruptured blood vessel that bleeds into the brain or the areas surrounding the brain Stroke | CVA | Cerebrovascular Accident. (2019, August 21). U.S. National Library of Medicine.

  7. Ischemic stroke • 80% of all strokes are ischemic in nature • Blockage can occur by: • Thrombosis - formation of blood clot in the brain/neck blood vessels • Embolism - clot moved from another area (e.g. heart) to brain • Stenosis - narrowing of artery in the brains Stroke | CVA | Cerebrovascular Accident. (2019, August 21). U.S. National Library of Medicine.

  8. Hemorrhagic stroke • Intracerebral hemorrhage: • Most common • Artery bursts → flooding the surrounding tissue • Subarachnoid hemorrhage • Less common • Bleeding between brain & the thin tissue covering it Stroke | CVA | Cerebrovascular Accident. (2019, August 21). U.S. National Library of Medicine.

  9. Causes/mechanisms Ren, X., Simpkins, J. (2016).

  10. Causes/mechanisms Shirley, R., Ord, E. N., & Work, L. M. (2014). Moskowitz, M. A., Lo, E. H., & Iadecola, C. (2010).

  11. Current Treatments

  12. Timeline of treatments after stroke 2. Recovery and Prevention • Immediately after the Stroke

  13. A case to consider... You are walking with your elderly neighbour at the park when he experiences a sudden onset slurring of speech, has facial droop, and weakness in left side upper and lower limbs. Quickly identifying the key symptoms of a stroke, you immediately call an ambulance which arrives 15 min later to bring him to Toronto General Hospital... Acute Ischemic Stroke Adapted from Stroke:Case Study Section 2. (n.d.)

  14. Treatment Immediately after Stroke Tissue plasminogen activator (tPA) - thrombolytic • Only given to ischemic stroke patients • Improves chances of recovery from stroke • Need to be given within 4 ½ hours of first symptoms Surgery Treatment & Endovascular Procedures • To stop bleeding and/or save brain tissues Stroke Treatment. (n.d.). https://www.cdc.gov/stroke/treatments.htm

  15. Surgical Treatments Endovascular Procedures • Directly to the blocked blood vessel in the brain - Intra-arterial thrombolysis – long and thin catheter to deliver tPA - Stent retriever to trap and remove blood clots Angioplasty and Stents • Balloon-like substance into carotid arteries • Inflated to expand the narrowed artery • Stent maintains the opened artery Endovascular treatment of stroke. (n.d.) https://www.cirse.org/patients/ir-procedures/endovascular-treatment-of-stroke/

  16. Hemorrhagic Stroke - Treatments Focus on stopping bleeding & preventing pressure build up Surgical Clipping • To prevent aneurysm from bursting Endovascular Embolization • To prevent aneurysm from blood flow and to form blood clots Aneurysm Coiling. (n.d.). Retrieved from http://allthingsnp.blogspot.com/2013/02/aneurysm-coiling.html Srxa, P. by. (n.d.). surgical clipping. Retrieved from https://srxa.wordpress.com/tag/surgical-clipping/

  17. 2. Recovery (Rehabilitation) Speech Therapy Physical Therapy Occupational Therapy Stroke Treatment. (n.d.). https://www.cdc.gov/stroke/treatments.htm

  18. 2. Prevention Blood thinners Antiplatelets and anticoagulants Ex. acetylsalicylic acid (ASA), Warfarin Blood Pressure Lowering Medications Antihypertensives Ex. Cilazapril, Bisoprolol Cholesterol Lowering Medications Cholesterol absorption inhibitor, statins Ex. Ezetimibe, Atorvastatin Changes to Lifestyle Diet changes, exercise, treatment for underlying conditions (ex. Diabetes, atrial fibrillation) Medications. (n.d.). https://www.heartandstroke.ca/stroke/treatments/medications

  19. Our case... Discussed with Family & Patient tPA Prescribed and Initiated within 1hr 54mins After Onset Symptoms Endovascular Thrombectomy Initiated at 3hr Admitted to Acute Stroke Unit 24 Hour Monitoring MDT Referral Received within 24 Hours - OT, SLT & PT Adapted from Stroke:Case Study Section 2. (n.d.)

  20. Summary Slide • Stroke results from a loss of blood flow to the brain. • Two types of stroke: 1. Ischemic stroke caused by a blockage of a blood vessel supplying the brain 2. Hemorrhagic stroke caused by a leaked/ruptured blood vessel that bleeds into the brain or the areas surrounding the brain • Deprivation of oxygen causes mitochondrial failure, excess ROS production, and cell death leading to brain injury • Tissue plasminogen activator (tPA) is used for ischemic stroke patients and improves chances of recovery from stroke • There are also surgical treatments (ex: angioplasty to expand blocked arteries)

  21. THANKS! Any questions?

  22. References • Aneurysm Coiling. (n.d.). Retrieved from http://allthingsnp.blogspot.com/2013/02/aneurysm-coiling.html • Endovascular treatment of stroke. (n.d.). Retrieved from https://www.cirse.org/patients/ir-procedures/endovascular-treatment-of-stroke/ • Medications. (n.d.). Retrieved from https://www.heartandstroke.ca/stroke/treatments/medications • Moskowitz, M. A., Lo, E. H., & Iadecola, C. (2010). The science of stroke: mechanisms in search of treatments. Neuron, 67(2), 181–198. doi:10.1016/j.neuron.2010.07.002 • Ren, X., Simpkins, J. (2016). Advances in Our Knowledge of Stroke Mechanisms and Therapy. Dana Foundation. • Shirley, R., Ord, E. N., & Work, L. M. (2014). Oxidative Stress and the Use of Antioxidants in Stroke. Antioxidants (Basel, Switzerland), 3(3), 472–501. doi:10.3390/antiox3030472 srxa, P. by. (n.d.). surgical clipping. Retrieved from https://srxa.wordpress.com/tag/surgical-clipping/ • Stroke | CVA | Cerebrovascular Accident. (2019, August 21). U.S. National Library of Medicine. Retrieved from https://medlineplus.gov/stroke.html • Stroke | CVA | Cerebrovascular Accident. (2019, August 21). World Health Organization. Retrieved from https://medlineplus.gov/stroke.html • Stroke. (2019, September 5). Retrieved from https://www.mayoclinic.org/diseases-conditions/stroke/diagnosis-treatment/drc-20350119 • Stroke:Case Study Section 2. (n.d.). Retrieved from https://www.physio-pedia.com/Stroke:Case_Study_Section_2 • Stroke Treatment. (n.d.). Retrieved from https://www.cdc.gov/stroke/treatments.htm • What are the Signs and Symptoms of a Stroke? (n.d.). Centre for Neuro Skills.Retrieved from https://www.neuroskills.com/brain-injury/stroke/what-are-the-signs-and-symptoms-of-a-stroke

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