2. Stroke occurs when the supply of blood to the brain is either interrupted or reduced
Brain does not get enough oxygen or nutrients which causes brain cells to die.
3. Stroke Classification:
Ischemic
-Ischemic strokes are the most common ( 80%) of stokes
-occur when there is an occlusion of a blood vessel impairing the flow of blood to the brain
-Ischemic strokes are divided into:
a) thrombotic b) embolic c) systemic hypoperfusion.
Hemorrhagic
4. Red Flags
Pain in Acute Stroke Patient:
AMI
Aortic Dissection
Pneumothorax
Limb Ischemia
5. Low BP in Acute Stroke Patient:
Silent MI
Infective Endocarditis
6. Mimics of Stroke:
Hypoglycemia
Neuropathies/plexopathies
Structural Brain Lesion(SDH)
Focal Epilepsy with Todd’s Paralysis
Migraine Aura
Transient Global Amnesia
Labyrithine D/O
Parkinsons Disease
Alcohol Intoxication
7. Golden Hour:
within 3.5 hours thrombolysis
Apply ABC
HTN: treat only if BP >220/110
12. Total anterior circulation syndrome
Unilateral motor, sensory deficit, or both affecting at least two of face, arm, and leg
Higher cerebral dysfunction, e.g. dysphasia, dyspraxia, neglect, dyscalculia
Homonymous hemianopia
13. Partial anterior circulation syndrome
Two of the three components of TACS or pure higher cortical dysfunction or pure motor or sensory deficit not as extensive as for lacunar syndromes
14. Lacunar syndrome (LACS):
Pure motor or pure sensory deficit affecting at least two of face, arm, or leg
Sensorimotor deficit
Ataxic hemiparesis
Dysarthria, clumsy hand syndrome
Acute onset movement disorder
16. Mechanism of Stroke
Atherosclerosis:
- AKA “hardening of the arteries,”
-calcified lipid or fatty deposits accumulate circumferentially along the innermost intimal layer of the vessel wall
-Atherosclerosis and the development of arterial plaques are the product of a host of independent biochemical processes (oxidation of LDL, formation of fatty streaks, and the proliferation of smooth muscle cells)
-As the plaques form, the walls become thick, fibrotic, and calcified
-lumen narrows, reducing the flow of blood to the tissues the artery supplies
17. Thrombus
A thrombus is a blood clot (aggregation of platelets and fibrin) formed in response to atherosclerotic lesion or to vessel injury
In response to vessel or tissue injury, the blood coagulation system is activated, which initiates the following cascade of processes transforming prothrombin and resulting in a fibrin clot: Prothrombin⇒Thrombin⇒Fibrinogen⇒ Fibrin⇒Fibrin Clot
Approximately 33% of all stroke cases are attributed to thrombi.
18. CVD
Cardiovascular diseases:
atrial fibrillation and myocardial infarction weaken the cardiac wall and introduce abnormalities in the physiological function of the heartbeat
result in reduced systemic pressure and conditions of ischemia.
19. HTN in Stroke (Ischemic)
Not to start anti-HTN in 24hours
To aim <140/90 in 2weeks post stroke
Lacunar Stroke: AIM: <130/90
With IHD: use bets blocker / ACEI
With DM: use ACEI
Severe Intracranial Disease: allow SBP 130- 150; to drop BP slowly
20. Statins in Stroke
<75 yo: use high intensity statins ( to drop LDL by 50%
-Use atorvastatin or rusovastatin
-Moderate intensity ( drop LDL by 30-50%)
-AIM: LDL <100 or < 2.6
22. Anticoagulation in AF
Target INR: 2-3
NOAC vs Warfarin
Pt with contraincation for warfarin: Aspirin + clopidogrel
Pt with Intracranial Stenosis: DAPT x 3/12 then back to single antiplate
CHANCE TRIAL: Aspirin + Plavix x 3/52 then LIFELONG Aspirin
