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Acute Stroke: Principles of Modern Management

Acute Stroke: Principles of Modern Management. A program of the American Academy of Neurology The AAN Acute Stroke Management courses are supported in part by unrestricted educational grants from Abbott Laboratories, Genentech, Inc., Janssen Pharmaceutical, and Wyeth-Ayerst Pharmaceutica.

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Acute Stroke: Principles of Modern Management

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  1. Acute Stroke: Principles of Modern Management A program of the American Academy of Neurology The AAN Acute Stroke Management courses are supported in part by unrestricted educational grants from Abbott Laboratories, Genentech, Inc., Janssen Pharmaceutical, and Wyeth-Ayerst Pharmaceutica.

  2. Overview of the Course

  3. GOALS OF THE COURSE • Review management of patients with acute stroke. • Diagnosis • Treatment of ischemic stroke • Treatment of hemorrhagic stroke • Review in-hospital management. • Review management to prevent stroke or recurrent stroke.

  4. STROKE FACTS • Third leading cause of death in the United States • Common cause of disability and long-term institutionalized care • Economic consequences more than $40 billion annually • Affects not only the patient but the entire family

  5. STROKE AS A PUBLIC HEALTH PROBLEM • WHO – increased importance of stroke during next 50 years • Developing countries • Industrial societies including U.S. • Decline in stroke incidence to be reversed • Increase due to aging of population • People who survive severe heart disease at high risk

  6. STROKE EPIDEMIOLOGY • Advancing age is the premier predictor of stroke • Stroke is an important cause of death in children • Strokes are relatively common in young adults • More women die from stroke than do men • More women die from stroke than from cancer of breast • Stroke accounts for 10% of maternal deaths during pregnancy or the peripartum period

  7. Under the age of 45, more women die from stroke than from heart attack • Approximately 60% of patients with SAH are women • Atrial fibrillation is an important risk factor for stroke among women older than 75

  8. STROKE IN MINORITIES Survey of Stroke Mortality in Texas Rate-Ratio in Comparison to Non-Hispanic Whites Age Men Women African-American 45-59 4.06 3.22 60-74 2.57 2.31 75+ 1.26 1.10 Hispanic American 45-59 1.73 1.30 60-74 1.09 1.07 75+ 0.77 0.63 Morgenstern et al Stroke, 1997, 28:5-18

  9. SUBTYPES OF STROKE • HEMORRHAGIC STROKE – 20% of cases • Subarachnoid hemorrhage • Intracerebral hemorrhage • ISCHEMIC STROKE – 80% of cases • Large artery atherosclerosis • Cardioembolism • Small artery occlusion (lacunes) • Non-atherosclerotic vasculopathies • Hypercoagulable state

  10. CURRENT STRATEGIESMANAGEMENT OF CEREBROVASCLAR DISEASE • Treatment of risk factors in large populations • Treatment of highest risk persons • Management of acute stroke • Prevention and treatment of medical and neurological complications • Rehabilitation • Prevention of recurrent stroke

  11. TREATABLE RISK FACTORS IN PREVENTION OF STROKE • Hypertension • Smoking • Hypercholesterolemia • Hyperhomocysteinemia • Diabetes mellitus • Alcohol abuse • Drug abuse • Co-developing heart disease

  12. ANTITHROMBOTIC THERAPIES TO PREVENT ISCHEMIC STROKE • Oral anticoagulants • Antiplatelet agents • Aspirin • Aspirin and dipyridamole • Clopidogrel • Ticlopidine

  13. SURGICAL MEASURES TO PREVENT ISCHEMIC STROKE • Carotid endarterectomy • Extracranial/intracranial bypass • Other reconstructive operations • Angioplasty and stenting • Cardiovascular operations

  14. IMPORTANCE OF ACUTEMANAGEMENT OF STROKE • Medical and surgical interventions lower risk of stroke, but they do not eliminate stroke entirely • Some patients have a stroke as their first symptom • Some causes of stroke are not amenable to preventive therapies

  15. BRAIN ATTACK • The causes and effects of acute stroke (brain attack) are similar to those that cause acute myocardial ischemia (heart attack) • Secondary to arterial diseases and life-threatening • Potential for serious medical or neurological complications • Mandate emergent interventions to limit effects • Can be treated successfully and improving outcomes

  16. TIME IS BRAIN Components of Modern Management • Prompt recognition • Call 911 or seek attention • Speedy transport (EMS) • Rapid evaluation • Urgent treatment

  17. Pre and Post Course Self Assessment Goal: To assess patterns of physician behavior change as a result of attending the AAN Acute Stroke Management Course. This goal will be achieved by measurement of knowledge at the following intervals: at the beginning of the course; at the end of the course; six months after the course. 1. Pre Course Self Assessment • 8:40 AM – 9:00 AM Complete pre course self assessment AAN staff will pick-up 2. Post Course Self Assessment • 4:10 PM – 4:30 PM Complete post course self assessment AAN staff will pick-up 3. Six-month follow-up • Assessment tool sent to all participants 6 months after the course

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