This document discusses acute onset hemiplegia, including its etiology, symptoms, risk factors, investigation, and treatment. The main causes of acute onset hemiplegia are ischemic stroke and hemorrhagic stroke, which have various underlying etiologies like cardiac disorders, blood disorders, infections, and vascular malformations. Evaluation involves a neurological exam and imaging tests. Treatment depends on the underlying cause but may include medications like anticoagulants, antiplatelets, or immunosuppressants, as well as procedures like neurosurgery or interventional radiology. Outcomes range from full recovery to neurological deficits or mortality in 20-30% of cases.
15. IncidenceIncidence
Exact Data is not availableExact Data is not available
Upto 9% undergoing fontan surgeryUpto 9% undergoing fontan surgery
50% occurred within 72 hr of50% occurred within 72 hr of
surgerysurgery
16. Hematological and hypercoagubleHematological and hypercoaguble
statesstates
22ndnd
most important causemost important cause
2 to 7% of young patient2 to 7% of young patient
Factor v leiden mutation,Factor v leiden mutation,
homocystinemia, deficiency ofhomocystinemia, deficiency of
protein c and protein sprotein c and protein s
17. Sickle cell anemiaSickle cell anemia
300per 100,000 sickle cell patient300per 100,000 sickle cell patient
Above 5 yrAbove 5 yr
Silent infarcts are presentSilent infarcts are present
Associated with seizures, cranialAssociated with seizures, cranial
nerves ,cognitive declinenerves ,cognitive decline
Prone for recuurences, chronicProne for recuurences, chronic
seizure disorderseizure disorder
18. Keep good hydrationKeep good hydration
Transfusion to keep HbS <30%Transfusion to keep HbS <30%
19. InfectionInfection
5 to 12 % of meningitis5 to 12 % of meningitis
Systemic infectionSystemic infection
post varicella angiopathy,post varicella angiopathy,
pneumonia, borrelia, HIV,pneumonia, borrelia, HIV,
helicobacter,helicobacter,
May occur after weeks to months ofMay occur after weeks to months of
infectioninfection
Post varicellea and herpes isPost varicellea and herpes is
commoncommon
20. Moya moyaMoya moya
Chronic,prgrssive,stenotic disease ofChronic,prgrssive,stenotic disease of
arteryartery
Mainly females are involved. 6 timesMainly females are involved. 6 times
Multiple telengtesia seen in brainMultiple telengtesia seen in brain
mainly in basal ganglonmainly in basal ganglon
seizure seen in 335 of patientsseizure seen in 335 of patients
Recurrent ischemic attack, mentalRecurrent ischemic attack, mental
retardation,,infarction on CTretardation,,infarction on CT
Treatment is surgeryTreatment is surgery
21. vasculitisvasculitis
Takayasu, SLE, MCTD,PANTakayasu, SLE, MCTD,PAN
Present with associated symptomsPresent with associated symptoms
Steroid and immunotherapySteroid and immunotherapy
22. MetabolicMetabolic
Homocystenemia, MELA, FamilialHomocystenemia, MELA, Familial
HypercholesteremiaHypercholesteremia
Family history, and charactersticsFamily history, and characterstics
featurefeature
23. MigraineMigraine
More common in femalesMore common in females
FamilialFamilial
Occasionaly permanent deficitOccasionaly permanent deficit
24. TraumaTrauma
Dissecting aneurysm in arteryDissecting aneurysm in artery
Barbershop,fall on pencil in mouth,Barbershop,fall on pencil in mouth,
popstick,barbershoppopstick,barbershop
Symtoms come after 1 to 2 daysSymtoms come after 1 to 2 days
28. OutcomeOutcome
53% normal53% normal
25% neurological deficit and seizure25% neurological deficit and seizure
5% seizure alone5% seizure alone
9% died9% died
Perspective study of 80 infantsPerspective study of 80 infants
30. Intracerebral hemorrhageIntracerebral hemorrhage
At the entry point of brainAt the entry point of brain
Hematoma and cerebral edemaHematoma and cerebral edema
produces mass like lesionproduces mass like lesion
31. FeaturesFeatures
Severe headache,Severe headache,
SeizuresSeizures
Focal signsFocal signs
Decrease in conciousnessDecrease in conciousness
AtaxiaAtaxia
Dysconjugate gaitDysconjugate gait
comacoma
32. Risk factorRisk factor
Trauma most commonTrauma most common
Vascular malformationVascular malformation
Degenerative vasculopathyDegenerative vasculopathy
Hemophilic disorderHemophilic disorder
33. Subarachnoid hemoorrhageSubarachnoid hemoorrhage
Ateries forming circle of willis andAteries forming circle of willis and
surrounding itsurrounding it
Circle of willis seen more in adulutCircle of willis seen more in adulut
34. Erythrocytes in subarachnoid spaceErythrocytes in subarachnoid space
can cause severe spasm leading tocan cause severe spasm leading to
secondary ishemic infarctionsecondary ishemic infarction
44. Current recommendations……Current recommendations……
Neonatal AIS – no therapyNeonatal AIS – no therapy
Dissecting vasculopathy –Dissecting vasculopathy –
anticoagulation 3-6 monthsanticoagulation 3-6 months
Cardiogenic embolism –Cardiogenic embolism –
anticoagulation but no consensus onanticoagulation but no consensus on
length of timelength of time
Vasculopathy – ASA (no consensusVasculopathy – ASA (no consensus
on dose 1-5mg/kg/day)on dose 1-5mg/kg/day)
Recurrent stroke – considerRecurrent stroke – consider
anticoagulationanticoagulation
45. HeparinHeparin
For rapid anticoagulationFor rapid anticoagulation
Bolus heparin 75-100u/kgBolus heparin 75-100u/kg
Maintainence at 28 unit/kg/hr forMaintainence at 28 unit/kg/hr for
infantinfant
20u/hr for >1 yr20u/hr for >1 yr
Adjust APTT to 1.5 to 2Adjust APTT to 1.5 to 2
Check APTT 4 hr after bolusCheck APTT 4 hr after bolus
Daily APTT and CBCDaily APTT and CBC
46. LMW heparinLMW heparin
LovenexLovenex
1mg/kg in >1yr every 12 hr1mg/kg in >1yr every 12 hr
1.5mg/kg in neonate1.5mg/kg in neonate
Monitor by antifactorXa weeklyMonitor by antifactorXa weekly
47. AspirinAspirin
3-5 mg/kg3-5 mg/kg
Dose in less then 10% of antipyreticDose in less then 10% of antipyretic
dosedose
48. WarfarinWarfarin
Used if secondary prevention withUsed if secondary prevention with
ASA failsASA fails
Maintain INR of 2 to 3Maintain INR of 2 to 3
In case of mechanical valve 2.5 toIn case of mechanical valve 2.5 to
3.53.5
50. OutcomeOutcome
Mortality 20 to 30%Mortality 20 to 30%
Residual neurological deficit in >50%Residual neurological deficit in >50%
Risk of stroke recurrence is as highRisk of stroke recurrence is as high
as 20%as 20%