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Approach to a patient with stroke

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A
Ashwin Haridas

An overview of the approach to a patient presenting with symptoms suggestive of a CVA

Health & Medicine
1 of 92
Ashwin Haridas Asem Ali Ashraf Adam Ebrahim
Definitions ,[object Object],[object Object],[object Object],[object Object],[object Object]
Definitions ,[object Object],[object Object],[object Object],[object Object],[object Object]
Epidemiology ,[object Object],[object Object],[object Object],[object Object],[object Object]
Stroke Risk Factors ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Anterior Circulation Posterior Circulation
Middle Cerebral Artery
Anterior Cerebral Artery
Posterior Cerebral Artery
Types of Stroke ,[object Object],[object Object]
Ischemic Stroke ,[object Object],[object Object],[object Object],[object Object],[object Object]
Etiology of ischemic stroke ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Thrombotic Stroke ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Thrombotic Stroke
Embolic Stroke ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Etiology of ischemic stroke
[object Object],[object Object],[object Object],[object Object],[object Object],Pathophysiology of Ischemic Stroke
 
Ischemic Penumbra ,[object Object],[object Object],[object Object],[object Object]
ATP depletion Hypoperfusion Failure of Na + /K + ATPase membrane ionic pump Calcium entry Glutamate release Activation of lipid peroxidases, proteases & NO synthase Destruction of intracellular organelles, cell membrane & release of free radicals Free fatty acid release Activation of pro-coagulant pathways Liquefactive necrosis Thrombus/embolus Membrane depolarization & cytotoxic cellular edema
Hemorrhagic Stroke ,[object Object],[object Object],[object Object],[object Object]
Intracerebral Hemorrhage ,[object Object],[object Object],[object Object],[object Object]
Subarachnoid Hemorrhage ,[object Object],[object Object],[object Object]
Pathophysiology Of Hemorrhagic Stroke ,[object Object],[object Object],[object Object],[object Object],[object Object]
CLINICAL FEATURES
History ,[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],History
Examination of a stroke patient ,[object Object],[object Object],[object Object]
Examination of a stroke patient ,[object Object],[object Object],[object Object],[object Object]
General feature ,[object Object],[object Object]
‘ HAND OF GOD’
CLINICAL CLASSIFICATION
 
Stroke Syndromes ,[object Object],[object Object],[object Object]
Stroke Within the Anterior Circulation ,[object Object]
Middle cerebral artery ,[object Object],[object Object],[object Object],[object Object],[object Object]
Cont…. ,[object Object],[object Object],[object Object],[object Object],[object Object]
Cont.. ,[object Object],[object Object],[object Object]
Deficits Due To ACA Occlussion ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Internal Carotid Artery ,[object Object]
Internal Carotid Artery ,[object Object],[object Object]
Internal Carotid Artery ,[object Object]
Internal Carotid Artery ,[object Object]
Internal Carotid Artery ,[object Object]
Posterior Circulation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
CLASSICAL PRESENTATIONS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
DIFFERENTIAL DIAGNOSIS ,[object Object],[object Object],[object Object],[object Object],[object Object]
Hypoglycemia ,[object Object],[object Object]
Space Occupying Lesions ,[object Object],[object Object]
SEIZURES AND POST ICTAL STATES ,[object Object]
MIGRAINE ,[object Object],[object Object]
SUMMARY ,[object Object],[object Object],[object Object]
 
INVESTIGATION OBJECTIVES ,[object Object],[object Object],[object Object],[object Object]
INVESTIGATION MODALITIES: BRAIN ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
PATHOLOGICAL TYPES STROKE HAEMORRHAGIC ISCHAEMIC
CT SCAN ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
ISCHAEMIC LESION
CT SCAN/MRI VASCULAR NATURE CONFIRMED HAEMORRHAGE ISCHAEMIA Cont’d… STROKE PATIENT
SEARCH FOR SOURCE Cont’d… SEARCH FOR SOURCE CEREBRAL ARTERIOGRAPHY MRA/CTA DOPPLER PET/SPECT
 
Carotid Artery Ultrasound Showing a Completely Calcified Atherosclerotic Plaque
 
3-D reconstruction of CT angiogram showing stenosis at the carotid bifurcation
Intra-arterial angiography showing arteriovenous malformation
MR angiogram showing giant aneurysm at the middle cerebral artery bifurcation
HAEMORRHAGE CONFIRMED NORMAL CT SCAN HAEMORRHAGE SUSPECTED LUMBAR PUNCTURE CSF WITH BLOOD/ XANTHOCHROMIA
UNDERLYING DISEASE ,[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],UNDERLYING DISEASE
UNDERLYING DISEASE ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
TREATMENT OBJECTIVES ,[object Object],[object Object],[object Object],[object Object]
MANAGEMENT OF A TRANSIENT ISCHAEMIC ATTACK (TIA) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
MANAGEMENT OF A TRANSIENT ISCHAEMIC ATTACK(TIA) – Cont’d ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
MANAGEMENT OF AN ACUTE EPISODE OF STROKE ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
MANAGEMENT OF AN ACUTE EPISODE OF STROKE Cont’d ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
EARLY MANAGEMENT
 
ISCHAEMIC STROKE ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
ANTI PLATELET THERAPY ,[object Object],[object Object],[object Object],[object Object],[object Object]
ANTI COAGULANTS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
ANTI COAGULANTS - Cont’d ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
HAEMORRHAGIC STROKE ,[object Object],[object Object],[object Object],[object Object],[object Object]
REHABILITATION ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
REHABILITATION - Cont’d ,[object Object],[object Object]
STROKE UNITS – A MULTIDISCIPLINARY APPROACH ,[object Object],[object Object],[object Object],[object Object],[object Object]
SECONDARY PREVENTION ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
COMPLICATIONS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
COMPLICATIONS – Cont’d ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
PROGNOSIS ,[object Object],[object Object],[object Object],[object Object],[object Object]
PROGNOSIS – Cont’d ,[object Object],[object Object],[object Object],[object Object]
 

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