Lectures stroke - Dr. Nguyen Anh Tuan

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Stroke Lecture presented brains to tackle TIA and stroke; time window for thrombolysis, the updated recommendations; treatment of patients with cerebral hemorrhage; blood pressure control in patients with cerebral hemorrhage; Emergency management of subarachnoid hemorrhage. Invite you to read the same reference.

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Nội dung Text: Lectures stroke - Dr. Nguyen Anh Tuan

Dr. Nguyen Anh Tuan
Goals  Work up for TIA and stroke  Window time for TPA, recommendation  Treatment of hemorrhagic stroke  BP control in ICH  SAH: emergency treatment
Stroke – incidence and prevalence Cause of death 1. Cardiovascular disease 2. Cancer 3. Stroke 531.000 new cases of stroke In 22 European countries with a and 200.000 recurrences of combined population of stroke each year in the US approximately 500 million, almost one million strokes are estimated to occur each year Sorelle R. Circulation 2000;102:E9047-9 Brainin M et al. Eur J Neurol 1999;7:5-10
Stroke – definitions An injury to the brain caused by:  Interruption of blood flow (ischaemic stroke) or  Bleeding into or around the brain (haemorrhagic stroke)
Risk factor  Hypertension  Diabetes Mellitus  Cardiac disease  Hyperlipidaemia  Smoking  Family history  Obesity
ANATOMY: Blood supply to the brain
Circle of Willis
Stroke – diagnosis Stroke Common symptoms  Weakness and sensory loss down one side of the body  Disturbances of consciousness and confusion  Impariment of speech, vision and co-ordination of movement
Computed tomography (CT)  Principle: differential absorption of x-ray beams by different tissues  Less time  Less expensive  More available in emergency rooms  Not reliable if done too early CT scan CT Easily detects  Blood products (haemorrhages larger than 1 cm diameter) Blood  Hydrocephalus  Brain oedema Brain tissue  Herniation
Magnetic resonance imaging (MRI) Cerebral infarction  High-resolution neural imaging technique  Different parts of the brain have different signal intensities on T1- or T2-weighted images MRI scan
Diffusion-weighted imaging (DWI) MRI  Best way to image acute stroke  Ischemia can be visualised as early as within 30 minutes of stroke  Relies on reduction of random diffusion (Brownian motion) of water after acute stroke MRI scan Features of ischaemic region  Swollen cells  Reduced extracellular space  Decrease in diffusion of water molecules Ischaemic region
Case  At 6.30pm, a female collapsed at a shopping mall  At 6.40 you find a woman sitting on the bench, she is confuse but response to verbal stimuli  Summary signs and symptoms:  Regular heart rate and adequate perfusion  No chest pain  Right-side paralysis  Dysarthria What additional assessment do you need?
Case  63-y –o woman  Facial drop (ask patient to show teeth and smile)  Arm drift  Speech  Patient demonstrate a right-side facial drop, right arm weakness and slurred speech What is your conclusion from your exam?
Clinical syndrome: occlusion  MCA infarction:  Dominant hemisphere: speech affected, comprehension and expression speech. The other side: hemianopia  Limbs are flaccid and areflexic
Clinical syndrome: occlusion  ACA occlusion: contralateral weakness and cortical sensory loss in the leg  PCA occlusion: cortical bliness  Lacunar infarct: occlusion of small perforating vessels, internal capsule, basal ganglia, thalamus, pons  Brainstem stroke
Cerebral ischaemia Duration of ischaemia  Cerebral ischaemia can produce irreversible injury to highly vulnerable neurons in 5 minutes  If cerebral ischaemia persists for >6 hours, infarction of part or all of the involved vascular territory is completed  Clinical evidence depends on the location of stroke
Strokes are an EMERGENCY  If patients are having a Stroke come to the hospital right away – CALL 9-1-1 in US (115 in Vietnam)