Stroke updated presentation 2023.pptx

CP2001 Stroke Stroke Facts Ireland • Affects ~ 10,000 people per year • Leading cause of acquired disability, cognitive impairment • Third leading cause of death • One third of Strokes occur in people under 65 CP2001 2 Stroke Facts USA • Affects ~ 800, 000 people per year • Leading cause of dis...

CP2001 Stroke Stroke Facts Ireland • Affects ~ 10,000 people per year • Leading cause of acquired disability, cognitive impairment • Third leading cause of death • One third of Strokes occur in people under 65 CP2001 2 Stroke Facts USA • Affects ~ 800, 000 people per year • Leading cause of disability, cognitive impairment, and death in the United States • Accounts for 1.7% of national health expenditures. • Estimated U.S. cost for 2012 = $71.5 billion CP2001 3 Stroke Definition • A sudden focal neurologic syndrome due to cerebrovascular disease • Lasts more than 24 hours CP2001 4 Transient Ischaemic Attack TIA • Neurological symptoms of vascular aetiology • Lasts less than 24 hours (symptoms usually resolve within the first hour – with no loss of consciousness) • 33% of those who have a TIA have a stroke within 5 years CP2001 5 Three Stroke Types Ischemic Stroke Intracerebral Hemorrhage Subarachnoid Hemorrhage Clot occluding artery 85% Bleeding into brain 10% Bleeding around brain 5% CP2001 6 Three Stroke Types The underlying pathology responsible for stroke is either infarction or haemorrhage. Arterial disease and atherosclerosis is the main pathological process causing stroke Cerebral infarction is mostly caused by thromboembolic disease secondary to atherosclerosis in the major extracranial arteries (carotid artery and aortic arch). CP2001 7 Aetiology of Strokes (infarction) LARGE VESSEL THROMBOTIC: Virchow’s Triad…. • Blood vessel injury - Atherosclerosis, Vasculitis • Stasis/turbulent blood flow - Atherosclerosis, Atrial fibrillation, Valve disorders • Hypercoagulable state - Increased number of platelets - Deficiency of anti-coagulation factors - Presence of pro-coagulation factors - Cancer CP2001 8 Aetiology of Strokes (infarction) LARGE VESSEL EMBOLIC: • The Heart • Valve diseases, Atrial fibrillation • Arterial Circulation (artery to artery emboli) • Atherosclerosis of carotid arteries,, Vasculitis CP2001 9 Aetiology of Strokes (haemorrhage) Intracerebral haemorrhage causes about 10% of acute stroke events It usually results from rupture of a blood vessel within the brain parenchyma Major risk factor is hypertension CP2001 10 Risk Factors for Strokes CP2001 11 Risk Factors for Strokes CP2001 12 Clinical Features of Strokes Acute stroke and TIA are characterised by a rapid-onset, focal deficit of brain function. The typical presentation occurs over minutes, affects an identifiable area of the brain and is ‘negative’ in character (i.e. abrupt loss of function without positive features such as abnormal movement). CP2001 13 Clinical Features of Strokes The clinical presentation of stroke depends upon which arterial territory is involved and the size of the defecit. The neurological deficit can be identified from the patient’s history and (if it is persistent) the neurological examination. CP2001 14 Clinical Features of Strokes The presence of a unilateral motor deficit, a higher cerebral function deficit such as aphasia or neglect, or a visual field defect, usually places the lesion in the cerebral hemisphere. Ataxia, diplopia, vertigo and/or bilateral weakness usually indicate a lesion in the brainstem or cerebellum. CP2001 15 Clinical Features of Strokes CP2001 16 CP2001 17 Determining the Location • Large Vessel: • Look for cortical signs • Small Vessel: • No cortical signs on exam • Posterior Circulation: • Crossed signs • Cranial nerve findings CP2001 18 Aphasia • Broca’s Area • Expressive aphasia • Left posterior inferior frontal gyrus • Wernicke’s Area • Receptive aphasia • Posterior part of the superior temporal gyrus • Located on the dominant side (left) of the brain CP2001 19 Brainstem Stroke Syndromes • Rarely presents with an isolated symptom • Usually a combination of cranial nerve abnormalities, and crossed motor/sensory findings such as: • Double vision • Facial numbness and/or weakness • Slurred speech • Difficulty swallowing • Ataxia • Vertigo • Nausea and vomiting • Hoarseness CP2001 20 Investigations Investigation of acute stroke aims to: • confirm the vascular nature of the lesion and distinguish cerebral infarction from haemorrhage CT /MRI • identify the underlying vascular disease and risk factors ECG / US of Carotids / Echocardiogram / 24 hour BP CP2001 21 Stroke Management Management is aimed at: •minimising the volume of brain that is irreversibly damaged •preventing complications •reducing the patient’s disability and handicap through rehabilitation, •reducing the risk of recurrent stroke or other vascular events. •With TIA there is no brain damage and disability, so the priority is to reduce the risk of further vascular events. CP2001 22 Management Stroke CP2001 23 Stroke Reading Relevant Chapter(s) on Stroke: Medicine at a Glance / Davidson / Kumar and Clarke Reading material on CANVAS CP2001 24 CP2001 End