MD DM DNB MNAMS Consultant Neurologist Manipal Goa Hospital STROKE AN OVERVIEW Stroke Brain Attack Sudden loss of function of a part of the brain Due to a problem with blood supply ID: 301782
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Dr Aaron de Souza MD, DM, DNB, MNAMSConsultant Neurologist, Manipal Goa Hospital
STROKE:
AN OVERVIEWSlide2
Stroke: Brain AttackSudden loss of function of a part of the brainDue to a problem with blood supplySlide3
Types of StrokeLoss of blood supply to a part of the brain: Ischaemic (85%)Bleeding within brain matter: Haemorrhagic (15%)Slide4
Types of Stroke Slide5
Not a Single Disease:
Stroke
Subtypes and Incidence
Albers G et al.
Chest
. 2001; 119 (suppl): 300S.
Ischaemic stroke
85%
Hemorrhagic
stroke
15%
Other
5%
Unknown
cause
30%
Cardiac
disease
20%
Small vessel
disease
“
lacunes
”
25%
Atherosclerotic
cerebrovascular
disease
20%Slide6
ThrombosisEmbolismHaemorrhageSlide7
Atherosclerosis and strokeSlide8
Cardiac EmbolismSlide9Slide10
Arterial EmbolismSlide11Slide12
Aneurysms and cerebral haemorrhageSlide13
Why is Stroke Important?Third leading cause of deathHeart diseaseCancerStroke700, 000 strokes per year in USA; 450, 000 in EuropeAlmost 8% of ischaemic and 40% of haemorrhagic strokes die in 30 daysSlide14Slide15
Indian ScenarioIncidence: 150 per lakh(150 persons out of every lakh, or 3 in each 2 000)Most common neurologic disease after migraine and epilepsyOf stroke patients still alive at 6months, over 30% are dependent on others for even basic functionsSlide16
A Deadly Disease,Becoming More FrequentIncreased incidence of strokeAs the population grows older due to longer life expectancy, Lifestyle changes in India High incidence of diabetesSlide17
Blood supply to the brainSlide18
Risk Factors for StrokeSlide19
Cigarettes: potent risk factorSlide20
Myocardial Infarction(Heart Attack)Percent of stroke patientswith subsequent events
Stroke Begets Stroke
Albers G.
Neurology
.
2000; 14(5):1022-8.
CATS
0
2
4
6
8
10
12
14
16
TASS
CAPRIE*ESPS 2Stroke14%3%
13%7%10%2%13%3%Stroke patients are most at risk of another strokeTrialsPrevious stroke is the single most important risk factor for
strokeSlide21Slide22
Facial WeaknessSlide23
Brainstem StrokesMotor & sensory deficitsChange in voiceSwallowing problemsEye deviation, eye paralysisLoss of consciousnessGait change (“drunken” gait)Vertigo / dizzinessSlide24Slide25Slide26
Investigations / Lab TestsCT scan headECG, EchocardiogramHemogramBlood Glucose, Lipid profileCarotid doppler.MRIDiffusion Weighted MRI (DWI), Perfusion-CT and MRI(PWI)Slide27
Uses of CTUsual first investigationPlain & ContrastExclude intracranial haemorrhageExclusion of extensive ischemic infarctions.Slide28
CT scan in strokeSlide29
CT scan in intracerebral haemorrhageSlide30
MRI in strokeT2 weighted / DiffusionSlide31
CT vs MRI / MRASlide32
Doppler StudiesSpecial ultrasound examination for arteries in the neckDetects clot or narrowingHelps plan treatment to prevent recurrent stroke.Slide33
TreatmentPrimary PreventionPersons who have never had a strokeSecondary PreventionPersons with stroke, to prevent anotherTreatment of acute strokeTreatment of chronic strokeSlide34
Primary PreventionModify stroke risk factors (BP, diabetes, cholesterol)Stop smokingExerciseTablets for BP or cholesterolAnticoagulation for heart diseaseSlide35
Secondary PreventionAspirinOther meds (clopidogrel)Carotid artery surgery if block foundTreat heart disease if presentSlide36
Treatment of acute strokeWithin 3 hours of onset: IV Alteplase/tPAMany conditions to be fulfiled before useTreat brain swellingTreat complications of unconsciousness / immobilitySlide37
Intravenous Thrombolysis Uses tPA/alteplaseReduces risk of long-term deficits due to stroke, speeds up recoveryRisky: can cause severe bleedingStrict conditions for usePatient must reach hospital <3hours after onsetSlide38
“Brain Attack”As much of an emergency as heart attackA few minutes can make lots of difference to outcomeGet the patient to hospital FASTSlide39Slide40
Treatment of Chronic DeficitsNeurological rehabilitationPhysiotherapyMedicines to relieve stiffnessSurgery for limb deformitiesBotox injectionsNewer machines developed for faster recoverySlide41
Social RehabilitationProlonged recovery after strokeMany patients with severe deficits in the communityNeed vocational trainingFamily needs counselling Slide42
TIATransient: short lived (<1 day)Ischaemic: lack of blood flowAttack: weakness, numbness, speech, blindnessWarning sign of future stroke riskShould NEVER be ignoredTreatment with aspirinSlide43
Stroke Services at Manipal HospitalDepartment of NeurologyBacked up by 24hr CT, MRI servicesIntravenous thrombolysisFacilities for rehabilitationResearch into strokes in Goa.Slide44
Take Home PointsStroke is a common diseaseWarning signs of stroke should always be treatedLifestyle modifications and control of risk factors Acute stroke: IMMEDIATE transfer to hospitalChronic stroke: needs long term rehabilitationSlide45