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Stroke

Stroke. Damrongsak Bulyalert, M.D., Ph.D. db@chiangmai.edu www. metadon.net. What is a Stroke?. I nterruption of blood flow to an area of the brain due to narrowing of blood vessels blockage by clots rupture of blood vessel. 2 t ypes of stroke. Ischemia: thrombosis and embolism

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Stroke

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  1. Stroke • Damrongsak Bulyalert, M.D., Ph.D. • db@chiangmai.edu • www.metadon.net

  2. What is a Stroke? Interruption of blood flow to an area of the brain due to • narrowing of blood vessels • blockage by clots • rupture of blood vessel

  3. 2 types of stroke • Ischemia: thrombosis and embolism • Hemorrhage (intracranial): • intracerebral • subarachnoid • etc.

  4. Pathology • Ischemia or hemorrhage leads to dysfunction of the affected brain tissue.

  5. Symptoms and Signs • Cerebral function • impaired consciousness • language dysfunction • headache • Cranial dysfunction • blurred vision • diplopia • facial weakness • swallowing difficulty • difficulty of speaking

  6. difficulty of maintaining posture • nausea, vomiting • dizziness, vertigo • etc. • Spinal symptoms • weakness • impaired sensation • ataxia • abnormal gait/posture/tone/reflexes • etc.

  7. Why Do People have Stroke? • Non-modifiable risks: • age • sex

  8. Why Do People have Stroke? • Modifiable risks • heart disease • hypertension • diabetes • hypercholesterolemia • physical inactivity • alcohol abuse • etc.

  9. Potential risks • migraine • contraceptive use • drug abuse (pseudoephedrine) • polycythemia • leukemia • etc.

  10. Spectrum of Stroke • Transient ischemic attack (TIA) • 5 minutes to hours (<24 hours) • Reversible ischemic neurological deficit (RIND) • 24 hours to 1 month • Stroke • permanent deficit • paralysis = อัมพาต (อำมะพาด) • paresis = อัมพฤกษ์ (อำมะพรึก)

  11. Differential Diagnoses • seizure • systemic infection • brain tumor • toxic-metabolic encephalopathy

  12. positional vertigo cardiac events syncope trauma subdural hematoma herpes simplex viral encephalitis transient global amnesia dementia demyelinating disease C-spine fracture myasthenia gravis parkinsonism hypertensive encephalopathy conversion disorder Others

  13. Investigation • Imaging • CT • MRI

  14. Treatment • Goals of treatment of stroke • reduction of brain tissue injury • rehabilitation of the brain • prevention of future stroke

  15. Rx • TIA • Manage the risk factors • Progressive stroke • thrombolytic agent • Completed stroke • thrombolytic agent • Embolic stroke • anticoagulant • Intracranial hemorrhage • surgery when indicated

  16. Aspirin • Antiplatelet activity • Indicated in thrombotic process • 25% reduction of stroke in general population • Good for other neoplasms

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