CNS Stroke for 5th year med students.

1. CEREBROVASCULAR DISEASE Dr.Mohammad Shaikhani. www.slideshare.net/shaikhani/slideshow

10. Classification of Stroke Stroke Primary Hemorrhagic (20% of Strokes) Primary Ischemic (80% of Strokes) Thrombotic 53% Embolic 31% Intracerebral Hemorrhage 10% Subarachnoid Hemorrhage 6%

13. Syndromes of acute stroke. Total anterior circulation syndrome-TACS (A). Partial anterior circulation syndromes-PACS (B, C, D and E). Pure motor stroke-lacunar syndrome (F). Posterior circulation syndromes-POCS (G, H, I, J and K).

23. INTRACEREBRAL HAEMORRHAGE CAUSES &ASSOCIATED RISK FACTORS Disease Risk factors Complex small vessel disease with disruption of vessel wall Age Hypertension Amyloid angiopathy Familial (rare) Age Impaired blood clotting Anticoagulant therapy Blood dyscrasia Thrombolytic therapy Vascular anomaly Arteriovenous malformation Cavernous haemangioma Substance misuse Alcohol Amphetamines Cocaine

25. Investigations in acute stroke: Diagnostic question Investigation Is it a vascular lesion? CT/MRI Is it ischaemic or haemorrhagic? CT/MRI Is it a subarachnoid haemorrhage? CT Lumbar puncture Is there any cardiac source of embolism? Electrocardiogram (ECG) Echocardiogram What is the underlying vascular disease? Duplex ultrasound of carotids Magnetic resonance angiography (MRA) CT angiography (CTA) Contrast angiography What are the risk factors? Full blood count Cholesterol Blood glucose Is there an unusual cause? ESR Clotting/thrombophilia screen

28. CAUSES AND INVESTIGATION OF ACUTE STROKE IN YOUNG PATIENTS

29. Cause Investigation Cardiac embolism Echocardiography (including transoesophageal) Premature atherosclerosis Serum lipids Arterial dissection MRI Angiography Thrombophilia Protein C,Protein S,Antithrombin III Homocystinuria) Urinary amino acids,Methionine loading test Antiphospolipid antibody syndrome Anticardiolipin antibodies/lupus anticoagulant Systemic lupus erythematosus Antinuclear antibodies Vasculitis ESR,CRP, (ANCA) CADASIL (Cerebral Autosomal Dominant Ateriopathy with Subcortical Infarcts and Leucoencephalopathy) MRI brain Genetic analysis Skin biopsy Mitochondrial cytopathy Serum lactate Muscle biopsy Neurovascular syphilis Syphilis serology Primary intracerebral haemorrhage Arteriovenous malformation (AVM) Delayed MRI Contrast angiography Drug misuse Drug screen (amphetamine, cocaine) Coagulopathy Prothrombin time (PT) and activated partial thromboplastintime (APTT) Platelet count Subarachnoid haemorrhage Saccular ('berry') aneurysm MRI/angiography AVM MRI/angiography Vertebral dissection MRI/angiography

42. STROKE COMPLICATIONS: Complication Prevention Treatment Chest infection Nurse semi-erect Antibiotics Avoid aspiration Physiotherapy Epileptic seizures Maintain cerebral oxygenation Anticonvulsants Avoid metabolic disturbance Deep venous thrombosis/pulmonary embolism Maintain hydration Early mobilisation Anti-embolism stockings Heparin (for high-risk patients only) Anticoagulation (exclude haemorrhagic stroke first) Painful shoulder Avoid traction injury Physiotherapy Shoulder/arm supports Local corticosteroid injections Physiotherapy Pressure sores Frequent turning Nursing care Monitor pressure areas Pressure-relieving mattress Avoid urinary damage to skin Urinary infection Avoid catheterisation if possible Antibiotics Use penile sheath Constipation Appropriate aperients and diet Appropriate aperients Depression and anxiety Maintain positive attitude and provide information Antidepressants

65. Secondary prevention of stroke: