[29] Cerebrovascular Accidents

• Cerebrovascular Accidents: abrupt onset of neurological deficit attributable to focal vascular cause
• Cerebrovascular Accidents: sudden, focal disruption of blood flow in the brain causing neurological defict
• Ischemic

  • blood clot that blocks with the normal blood flow of the brain
  • white matter
• Ischemic Stroke

  • artery occlusion leading to infarct
  • loss of oxygen for more than 3- 5 minutes in the specific part of the brain
  • due to RBC thickened, plaques, pathological
• Thrombus: blood clot in the vessel

  Embolus: blood clot that travels around the brain; more dangerous
• Cryptogenic: no known cause but can be genetic
• Cardioembolism: thrombus due to heart problems e.g. resuscitation
• Lacunar Stroke (Small Vessel Stroke)

  • occlusion of small arteries supplying deep cortical structures
  • embolus that traveled around the brain
  • mild stroke
• Large Vessel Atherosclerosis

  • plaque build up in intra/extracranial due to fatty diet
• Hemorrhagic: artery ruptures because blood vessel disintegrate causing bleeding around the brain
• Intracranial Hemorrhagic Stroke

  • rupture within the brain usually in subcortical structure
  • high fatality rate cause smaller yung affectations
• Intracranial Hemorrhagic Stroke (Parts)

  • Basal Ganglia
  • Brainstem
  • Thalamus
  • Cerebral lobes
  • Cerebellum
• Subarachnoid Hemorrhagic Stroke

  • bleeding in subarachnoid space that has CSF causing hematoma
  • small vessels
  • increase intracranial pressure
• Subarachnoid Hemorrhagic Stroke (Parts)

  • arteriovenous malformation (AVM)
  • rupture aneurysm
  • head trauma
• Transient Ischemic Attack

  • resolves within 24 hrs post-onset
  • no evidence of neuroimaging
  • prone to having another stroke
• Computed Tomography Scan

  • xray, radiation, pregnancy
  • presence and absence of hemorrhage
  • Inefficient against small infarct
• Magnetic Resonance Imaging

  • magnetic and radiofrequency waves
  • measures the amount of oxygen that flows in the brain using wate
  • hemorrhages in different stages
  • more efficient in ischemic stroke
• ISCHAEMIC STROKE TREATMENT

  • rtPA (recombinant tissue plasminogen activator)
  • Thrombolysis-in-situ
  • Mechanical thrombectomy
  • Oral anti-platelet
  • Anticoagulants
• tPA (recombinant tissue plasminogen activator)

  • oral medicine standard of care for acute Ischaemic stroke
• Thrombolysis-in-situ

  • Intra-arterial IV medication to the thrombus
  • used for large occlusions
• Mechanical thrombectomy

  • Use of stent retriever removing intra-arterial thrombus/embolus
• Oral anti-platelet

  Prevents platelet aggregation
• Anticoagulants

  • Blood thinners that prevent clogging
  • used during acute stage only due to increasing risk for hemorrhage
• Intracranial Hemorrhage treatment

  • to relieve pressure caused by bleeding
  • Anticoagulants and antiplatelet drugs are contraindicated
  • surgery is option
• Subarachnoid Hemorrhage treatment

  • Craniotomy, metal plate to deflate intracranial pressure
• • Endovascular microcoil embolization
  • platinum coil is placed in the aneurysm through a catheter passing from the femoral artery, filling the aneurysm preventing blood flow
• • Ischaemic have better prognosis that hemorrhagic
  • Hemorrhagic strokes are more fatal compared to ischaemic strokes
• 50% of ischaemic stroke patients with moderate or severe hemiplegia and most with milder deficits will have preserved sensorium and eventually progress with ADLs
• 25% of patients who recover from a first stroke is most likely to have another stroke within 5 years
• 35-45% of patients with intracranial hemorrhagic stroke die within the first month
• 35% of patients die after the first aneurysmal subarachnoid hemorrhage; another 15% die within a few weeks because of a subsequent rupture
• Spontaneous recovery refers amount of improvement determined solely by time
• Most improvement occurs within the first 3 – 4 months
• • Acute phase: up to 2 weeks after
  • Subacute phase: 3-6 months
  • Chronic phrase: > 9 month