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Emergency Treatment of Stroke
1.
Emergency Treatment of
Stroke
2.
Normal Brain Physiology
2-3% of body weight 15% of cardiac output 20% of all O2 25% of all glucose
3.
Cerebral Ischaemia -
Threshold Normal flow, normal function Synaptic transmission failure Membrane pump failure 20 50 10 0 Time in hours CBF (ml/100g brain) Low flow, raised O2 extraction, normal function 1 2 3 4 5
4.
Cerebral infarct <3hrs
Onset Infarct Ischaemic penumbra
5.
Cerebral infarct 6hrs
Infarct Ischaemic penumbra
6.
Cerebral infarct 24hrs
Infarct Ischaemic penumbra
7.
NA, Dopamine Ca2+
i Ischaemic Brain Injury Ischaemia - 02 glucose Anoxic depolarisation lactate Glutamate Hi Free Fe2+ Free radicals Lipolysis NO synthase Proteolysis
8.
Cerebral Arterial territory
Anterior cerebral Middle cerebral Posterior cerebral Anterior choroidal
9.
10.
11.
12.
13.
Stroke types
Al 35-44 yr Infarct 80% 42% Athero-thrombo-embolism 50% Intracranial small vessel 25% Cardioembolic 20% Rare 5% PICH 10% 10% SAH 5% 38% Unknown 5% 10% 75%
14.
15.
16.
17.
18.
19.
Early sign CT
- Infarction
20.
MRA & MRI
in Stroke
21.
22.
23.
24.
“ Patients who
have improved neurologically but have a persistent neurologic deficit when seen, should be managed as a recent stroke ”
25.
“ Role of
Neuro-protection in Stroke is not clear and not recommended routinely ”
26.
27.
28.
Thrombolysis in acute
stroke Within 3 hour of Stroke Small Vessel Medium Vessel IV rTPA/URK Large Vessel IA rTPA/URK Stop
29.
30.
Left Coronary angiogram
showing severe atherosclerosis
31.
Right
middle cerebral artery block following coronary angiogram
32.
Right middle cerebral
artery reperfusion (AP) following IA Urokinase
33.
Outcome of Thrombolytic
therapy
34.
Complication of Thrombolytic
Therapy
35.
36.
Dec 31 st
1999 Jan 21 st 2000 Feb 11 th 2000 Emergency Carotid Endarterectomy DOA 5 th Feb 00
37.
38.
39.
Thank You
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