Boala vasculara cerebrala

Sistemul arterial cerebral

INCIDENTA: toate tipurile de AVC
6 statistici, ambulatori si institutionalizati
Incidenta medie 65 - 84: 8.72 / 1 000 ambe sexe
Incidenta medie 75 + : 17.31 / 1 000 ambe sexe
0
5
10
15
20
25
30
35
40
45
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1
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55-59 60-64 65-69 70-74 75-79 80-84 85-89 90+
Age ranges
Incidenta primului AVC, orice tip, pe grupe de
varsta si sex, in Europa
Males Females
Subtipuri de AVC (CT, RMN)
AVC
Hemoragic
. Intraparenchimatos
. Subarahnoidian
Ischemic
Boala aterosclerotica
vas mare
Artere penetrante
( Lacunar )
Embolie
cardiogena
AVC
criptogenic
Cauze rare
. FIA
. Valvulopatii
. Trombi intraventriculari
. Altele
. Stari protrombotice
. Disectii arteriale
. Arterite
. Migrena/Vasospasm
. Abuz droguri
. Altele
15%
85%
20% 25% 20% 30% 5%
Ischemia cerebrala
Accident vascular cerebral constituit
- durata peste 3 ore
- leziune teritoriu arterial superficial / profund
- invaliditate / deces
Accident vascular cerebral tranzitor
- durata sub 3 ore
- leziune nedecelabila imagistic (+/-)
- recuperare integrala
Etiopatogenie
Boala aterosclerotica
Extracerebrala: aorta
Cerebrala:
Vas mare: tromboza in situ,
embolie arterio-arteriala
Vas mic: lipohialinoza, necroza->
tromboza in situ / hemoragie
Boala cardiaca
FIA
Boala mitrala (stenoza)
Anevrism sept, ventricul
IMA
Fiziopatologie
Necroza ischemica
Central
Perfuzie < 10 ml/100g/min
Ireversibila
Penumbra
Perfuzie < 30 ml/100g/min
Recuperabila
Apoptoza
Metab
Edem vasogenic -> metab
anaerob -> edem citotoxic
Diagnostic clinic
Debut brusc
Deficit neurologic focal: motor, senzitiv,
vizual, limbaj
salt tensional asociat (compensator!)
cefalee

Diagnostic paraclinic
CT / IRM
examen ultrasonografic vascular / cardiac
profil lipidic
profil biologic
teste hematologice
Tratament
Tratamentul fazei acute
Recanalizare: tromboliza - r-TPA

antiedematos
simptomatic
profilaxia complicatiilor: edem cerebral
(HIC), TVP TEP, complicatii decubit,
aspiratie (bronhopneumonie)
decompresie terapeutica de necesitate
Profilaxia secundara
Medical:
antitrombotic: aspirina, clopidogrel, dipiridamol +
aspirina
Anticoagulant: numai AVC cardioembolice confirmate
tratamentul factorilor de risc: IEC/ sartani, statine
Chirurgical:
endarterectomie
Stent
Profilaxia primara
= Tratamentul factorilor de risc:
HTA
dislipidemie
diabet
boli cardiace

fumat, alcool, droguri