Transcript Stroke - Metadon.net

Stroke
• Damrongsak Bulyalert, M.D., Ph.D.
• [email protected]
• www.metadon.net
What is a Stroke?
Interruption of blood flow to
an area of the brain due to
• narrowing of blood vessels
• blockage by clots
• rupture of blood vessel
2 types of stroke
• Ischemia: thrombosis and embolism
• Hemorrhage (intracranial):
– intracerebral
– subarachnoid
– etc.
Pathology
• Ischemia or hemorrhage leads to
dysfunction of the affected brain
tissue.
Symptoms and Signs
• Cerebral function
– impaired consciousness
– language dysfunction
– headache
• Cranial dysfunction
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blurred vision
diplopia
facial weakness
swallowing difficulty
difficulty of speaking
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difficulty of maintaining posture
nausea, vomiting
dizziness, vertigo
etc.
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weakness
impaired sensation
ataxia
abnormal gait/posture/tone/reflexes
• Spinal symptoms
• etc.
Why Do People have Stroke?
• Non-modifiable risks:
– age
– sex
Why Do People have Stroke?
• Modifiable risks
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heart disease
hypertension
diabetes
hypercholesterolemia
physical inactivity
alcohol abuse
etc.
• Potential risks
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migraine
contraceptive use
drug abuse (pseudoephedrine)
polycythemia
leukemia
etc.
Spectrum of Stroke
• Transient ischemic attack (TIA)
– 5 minutes to hours (<24 hours)
• Reversible ischemic neurological
deficit (RIND)
– 24 hours to 1 month
• Stroke
– permanent deficit
– paralysis = อัมพาต (อามะพาด)
– paresis = อัมพฤกษ์ (อามะพรึ ก)
Differential Diagnoses
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seizure
systemic infection
brain tumor
toxic-metabolic encephalopathy
Others
positional vertigo
cardiac events
syncope
trauma
subdural hematoma
herpes simplex viral
encephalitis
• transient global
amnesia
• dementia
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• demyelinating
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disease
C-spine fracture
myasthenia gravis
parkinsonism
hypertensive
encephalopathy
conversion disorder
Investigation
• Imaging
– CT
– MRI
Treatment
• Goals of treatment of stroke
– reduction of brain tissue injury
– rehabilitation of the brain
– prevention of future stroke
Rx
• TIA
– Manage the risk factors
• Progressive stroke
– thrombolytic agent
• Completed stroke
– thrombolytic agent
• Embolic stroke
– anticoagulant
• Intracranial hemorrhage
– surgery when indicated
Aspirin
• Antiplatelet activity
• Indicated in thrombotic process
• 25% reduction of stroke in general
population
• Good for other neoplasms