2. STROKE SYNDROME
• The term “STROKE” denotes the sudden and
dramatic development of a focal neurologic
deficit, which may vary from dense hemiplegia
(paralysis on one side of the body) and coma
only a trivial neurologic disorder.
• Stroke also known as acute brain infarction,
most commonly involves the circulation of the
internal carotid arteries and is seen with
symptoms that include acute “hemiparesis”
(weakness of one side of the body) and
“dysarthria” (difficulty in speaking).
4. • CT (initial exam) – a triangular or wedge
– shaped hypodensity on noncontrast scan
• MRI – T2-weighted image produced high
signal intensity of vascular territory
involve
• Diffusion-weighted MRI – hyperintense
signals within 2 hours of onset
• CT/MRI – mass effect seen 7-10 days
after onset.
6. TREATMENT
• Bed rest and reduced external stimuli for
all stroke victims. Medications to treat
increased intracranial pressure if
symptoms arise. Patients with thrombotic
strokes receive anticoagulants and
possibly thrombolytic agents.
7. Transient Ischemic Attacks
• TIAs present as focal neurologic deficits that
completely resolve within 24 hours. They may
result from emboli originating from the surface of
an arteriosclerotic ulcerated plaque (embolic
stroke), which causes temporary occlusion of
cerebral vessels, or from stenosis of an
extracerebral artery, which leads to a reduction in
critical blood perfusion.
9. LOCATION
• The most common location of surgically treatable
arteriosclerotic disease causing TIAs is the region
of carotid bifurcation in the neck.
• In patients with an asymptomatic bruit (a
rumbling noise heard by stethoscope) or an
unclear history of a TIA, carotid duplex color-
flow Doppler scanning is often the initial
screening study.
• In most cases, carotid duplex scanning when
combined with MRA can reliably determine
whether the extent of the diseases is sufficient to
warrant more invasive pocedures (angiography).
10. • High-resolution, real-time ultrasound
techniques provide hemodynamic
information about blood flow velocity.
Using ultrasound techniques, it may be
possible to differentiate patients with a total
occlusion of the internal carotid artery from
those with a tiny residual lumen.
• Noninvasive MRA provides accurate
imaging of the carotid bifurcation and it
demonstrates narrowing of the vertebral
arteries.
11. TREATMENT
• Accurate diagnosis and appropriate treatment
(antiplatelet therapy, anticoagulation therapy, or
carotid endarterectomy) are essential to prevent
permanent deficits. Thrombolytic agents may
lso be used.
12. Intraparenchymal Hemorrhage
• Aside from HEAD TRAUMA, the principal
cause of INTRAPARENCHYMAL
HEMORRHAGE is hypertensive vascular
disease.
• Less frequent causes are rupture of acongenital
berry aneurysm oran arteriovenous
malformation.
• Hypertensive hemorrhages results in oval r
circular collections thatvsmdisplace the
surrounding brain and can cause a significant
mass effect.
13. • Hypertensive Hemorrhage are most frequent
in BASAL GANGLIA, WHITE MATTER,
THALAMUS, CEREBELLAR
HEMISPHERS , AND PONS.
• INTRAPARENCHYMAL
HEMORRHAGES resulting from congenital
berry (saccular) aneurysms usually are
associated with subarachnoid hemorrhage
and tend to develop in regions where these
congenital vascular anomalis most
commonly occur. Include the sylvian fissurr
and the midline subfontal area.
15. LOCATION
• It should be evaluated with MRI or a
noncontrastCT scan.
• On CT - fresh hematoma appears homogeneously
dense, well defined lesionwith a tound to oval
configuration.
• Cobtrast enhancement usually develops about the
periphery of hematoma after 7-10 days.
• On MRI - an aneurysm produces a flow void on
both T1 AND T2 -wieghted images.
• CTA & MRI can visualize large and medium
anuerysms, along with feeding and draining
vesseks associated with an arteriovenous
malformation.
16. TREATMENT
• Steroid therapy, especially in
nontraumatichematomas.
• In casebof hemorrhagic strokes, first line of
treatment consists of stopping the bleeding ,
and second is to try to prevent a recurrence
of bleeding, and finally surgery.
• For aneurysm ,SURGICAL PLACEMENT
of a clip at the neck of the lesion .
• AVMs require sugery / neurointerventional
procedures
17. Subarachnoid Hemorrhage
• A major cause of subarachnoid hemorrhage
(hemorrhagic stroke) is rupture of a berry
aneurysm. Patients with this condition usually have
a generalized excruciating headache followed by
unconsciousness.
19. LOCATION
• The most common locations for berry ane
urysms are the origins of the posterior cer
ebral and
• anterior communicating arteries and the tr
ifurcation of the middle cerebral artery.
• Bleed beneath arachnoid layer of meninge
s
20. TREATMENT
• If emergency surgery within the first 72
hours after the hemorrhage is planned,
emergency
• selective angiography is indicated. If
surgical intervention is to be delayed,
angiography should
• be postponed until just before surgery
