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Stroke

Stroke. Stroke. A focal (or sometimes global) neurological defecit of sudden onset and lasting> 24h (or leading to death), and of presumed vascular origin 5-10 per 1000  more common in Asian,s Blacks, Pislands /Maoris 3 rd most common cause of death = developed. Classification.

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Stroke

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  1. Stroke

  2. Stroke • A focal (or sometimes global) neurological defecitof sudden onset and lasting> 24h (or leading to death), and of presumed vascular origin • 5-10 per 1000  more common in Asian,s Blacks, Pislands/Maoris • 3rd most common cause of death = developed

  3. Classification • Ischaemic – Thrombosis/Embolism (80%) • Large vessel disease • Heart – Artery Embolism • Small vessel disease/lacunar infarct (R’ -HT) • Haemorrhagic (20%) • Primary intracerebral (HT) • Secondary (neoplasm, vasculitis, bleeding disorder, prior embolic infarction, aneurysm, vascular malformation, trauma)

  4. Risk Factors

  5. Ischaemic • Pathophys: • Artherosclerosis (50%) • Thrombosis • Embolis • Systemic Hypoperfusion (following Cardiac arrest) • Rarer: Vasculitis, hypercoagulable states (pregnancy, antiphospholipidSx), vasospasm

  6. Haemorragic • In intracerebralhemorrhage (ICH), bleeding occurs directly into the brain parenchyma • Leakage from small intracerebral arteries damaged by chronic hypertension • Other - bleeding diatheses, iatrogenic anticoagulation, cerebral amyloidosis, and cocaine abuse. • Intracerebralhemorrhage has a predilection for certain sites in the brain, including the thalamus, putamen, cerebellum, and brainstem(+/- surrounding brain being damaged by pressure produced by the mass effect of hematoma). • A general increase in intracranial pressure may occur.

  7. Circle of Willis

  8. Clinical Featurtes • Sudden hemiparesis/hemiplegia, • Numbness of the face, arm and the leg on one or both sides of the body • Aphasia/dysarthria • Dimness or loss of vision, particularly in only one eye • Unexplained dizziness, unsteadiness, or sudden falls • Sudden severe headache and/or loss of consciousness • Hemorrhagic strokes more likely to exhibit Sxof  ICP • Headache, often severe and sudden onset • Nausea and/or vomiting

  9. Clinical Symptoms

  10. Bamford / OCSP Classification

  11. Cerebral Lesion – Dominant Hemisphere (usually Left): Aphasia/Dysphasia, Alexia, Agraphia Non dominant: Inattention/neglect, Denial Cerebellar Dysfunction – DANISH Dysdiadochokinesis (pronate/supinate), Ataxia, Nystagmus, Intentional tremor, Slurred Speech, Hypotonia+Hyporeflexia

  12. Most common stroke is by infarction in the internal capsule following thromboembolism in a middle cerebral artery branch and internal carotid occlusion.

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