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STROKEDEFINITIONA stroke is the sudden death of brain cells in a localized area due to inadequate blood flow.DescriptionA stroke occurs when blood flow is interrupted to part of the brain. Without blood to supply oxygen and nutrients and to remove waste products, brain cells quickly begin to die. Depending on the region of the brain affected, a stroke may cause paralysis, speech impairment, loss of memory and reasoning ability, coma, or death. A stroke also is sometimes called a brain attack or a cerebrovascular accident (CVA).Some important stroke statistics include:

more than one-half million people in the United States experience a new or recurrent stroke each yearstroke is the third leading cause of death in the United States and the leading cause of disabilitystroke kills about 160,000 Americans each year, or almost one out of three stroke victims

three million Americans are currently permanently disabled from strokein the United States, stroke costs about $30 billion per year in direct costs and loss of productivitytwo-thirds of strokes occur in people over age 65 but they can occur at any agestrokes affect men more often than women, although women are more likely to die from a strokestrokes affect blacks more often than whites, and are more likely to be fatal among blacksStroke is a medical emergency requiring immediate treatment. Prompt treatment improves the chances of survival and increases the degree of recovery that may be expected. A person who may have suffered a stroke should be seen in a hospital emergency room without delay. Treatment to break up a blood clot, the major cause of stroke, must begin within three hours of the stroke to be effective. Improved medical treatment of all types of stroke has resulted in a dramatic decline in death rates in recent decades. In 1950, nine in ten died from stroke, compared to slightly less than one in three in the twenty-first century. However, about two-thirds of stroke survivors will have disabilities ranging from moderate to severe.

Risk FactorsRISK FACTORSmodifiableAge, gender , race &heredity non modifiableDmHeart diseasesHeavy alcohol consumptionHypercoagulabilityHyper lipidemieaHtObesityOral contraceptive usePhysical inactivitySmoking

OLD AGEWee Betty lived a long and fruitfull life, RIP Betty (1875-1997). Thats 122 years dont you know!

DRUG ABUSE

OBESITY

SMOKING12

ALCOHOL13causesCerebral thrombosis and cerebral embolism are caused by blood clots that block an artery supplying the brain, either in the brain itself or in the neck. These account for 70-80% of all strokes. Subarachnoid hemorrhage and intracerebral hemorrhage occur when a blood vessel bursts around or in the brain.Cerebral thrombosis occurs when a blood clot, or thrombus, forms within the brain itself, blocking the flow of blood through the affected vessel. Clots most often form due to "hardening" (atherosclerosis) of brain arteries.a transient ischemic attack, or TIA, sometimes called a "mini-stroke." In a TIA, blood flow is temporarily interrupted, causing short-lived stroke-like symptoms. Recognizing the occurrence of a TIA, and seeking immediate treatment, is an important step in stroke prevention.

ComponentsThe Circle of Willis is composed of the following arteries:[3]Anterior cerebral artery (left and right) Anterior communicating artery Internal carotid artery (left and right) Posterior cerebral artery (left and right) Posterior communicating artery (left and right)

Regulation of blood flowThe brain requires a contious supply of blood to provide the o2 &glucose that neuronsneed to function. Normal blood flow : 750 - 1000 ml per mts.if blood flow to the brain totally interruped , neurologic metabolism is altered in 30 seconds.metabolism stops in 2 mts ,& cellular death will occur in 5 mts.The brain normally well producted from changes in mean systemic arteral pressure over a range from 50- 150 mmhg by a mechanism of cerebral auto regulation . Imparied auto regulationChanges in the diameter of cerebral blood flow (ischemia)

Systemic blood pressure ,cardiac output, blood viscosity.

ICP

ATEROSCLEROSISTransient ischemic attackIs a temporary focal loss of neurologic function caused by ischemia of the vascular territories of the brain, lasting less than 24 hours & often 15 mts. Most TIAs may be due to microembolie that temporarily block the blood flow. It is warning signs of cva. Tia depends on the blood vessel. Types of strokeIschemic strokeThrombotic stroke

(lacunar stroke)

embolic strokeHemorrhagic strokeIntra cerebral hemorrhage

Subarachnoid hemorrhage

Clinical manifestationRight brain damageParalyzed left sideleft side neglectSpaital _ perceptual deficitsRapid performances, short attention spanImpulsive, safety problemsImparied judgmentImpaired time conceptsLeft brain damageParalyzed right sideImpaired speech \language aphasiasImpaired RT & LT discriminationSlow performances, cautionsDepression ,anxietyImpaired comprehension r\to language, math

Motor function MobiltyRespiratory function Swallowing & speechGag reflex & self care abilitiesSymptoms caused by the destruction of motor neuronsIn the pyramidal path ways. akinesia ,impaired itergration of movements ,alterations in reflexes (hypo ,hyper )Communication Aphasia _total loss of voiceDysphasia _difficulty to the comprehension (or) use of languag I .non fluent ii. FluentWhen affecting a stroke wernicke,s area receptive Aphasia Brocas area brain cause expressive AphasiaGlobal Aphasia dysarthriaDisturbance in the muscular control of speech (pronunciation ,articulation ,phonation)it affects the mechanics of speech.

AFFECT _depression ,anxiety.

INTELLECTUAL FUNCTION _ MEMORY,judgementSpatial_perceptual alterationsi. incorrect perception of self & illness ii .the patient erroneous perception of self In space,(homonymous hemianopsia in which blindness occurs in the same half of the visual fields of both eyes.Iii . Agnosia _ inability to recognize an object by sight,touch , hearing.Iv. Apraxia _ inability to carry out learned sequential movements on command.Diagnostic evaluationCT,CTA , MRI , MRA, SPECT,MRS ,XENON CT,EEG,CEREBRAL ANGIOGRAPHY,CSF ANALYSIS

Cerebral blood flow measures cerebral angiography, digital subtraction angiography, doppler ultrasonography,transcranial doppler, carotid duplex, carotid angiographyCardic assessmentAdditional studiesCollaborative careControl HTControl DMTreatment of underlying cardiac problemAnticoagulation therapyNo smokingPlatelet inhibitorsLimiting alcohol intakeCEA _carotid endarterctomyStentingTrans luminal angioplastyExtra intra cranial bypass

Acute carePreserving life, preventing further brain damage, Reducing disability.Maintenance of airway

Fluid therapy

Ischemic stroke _tissue plaminogen activator Anticoagulation

Hemorrhagic stroke _surgical decompression

Sub arachnoid Hemorrhage _ surgical obliteration

embolic strokeWarning signs of strokeSudden dimness or loss vision in one or both eyesSudden loss of speech , confusion, difficulty speaking, understanding speechUnexplained sudden dizziness, unsteady ness, loss of balance or coordinationSever headache

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