Note: Naka-red ay galing sa akin.

Hehe Page 2 Column 1 Transient Ischemic Attack: Explanation on without evidence of acute infarction How I understand it: The patient has symptoms of stroke. You have to check/confirm using CT/MRI. If imaging does not show any signs of infarction, you call it transient ischemic attack. But if imaging shows signs of infarction, then it would be considered as stroke TIA there was resolution/recanalization; fibrinolytic system is in charge (I think this pertains to the resolution of ischemia due to the plaque) Additional Info: Risk factors of stroke classified into two: Modifiable HPN, DM, dyslipidemia (top 3) & smoking, drinking etc Non-modifiable age, genetics, sex Page 2 Column 2 Figure 2 MCA Direct connection with carotid artery Main trunk goes to the Sylvian fissure Has two branches: superior and inferior (these two came from the same trunk) Page 2 Column 2 Figure 3 Lacunar means small infarcts (tiny dots in CT) Cryptogenic means unknown cause Additional Info: In CT Hypodensity ischemia Hyperdensity hemorrhage Page 3 Column 2 Common Sites>Cerebellum Near 4th ventricle Watch out for hydrocephalus Watch out for herniation respiratory problems Page 4 Column 2 Table 3 Factor VII not standard of treatment Page 4 Column 2 ICP Control in Acute ICH>Acute Intervention Hyperventilation decrease CO2 vasoconstriction decrease in blood flow Page 6 Column 2 Extra & Introcranial Atherosclerosis Intracranial Stenosis ACA, MCA, pca Extracranial Stenosis carotid bifurcation Page 6 Column 2 Lacunar Infarction Lipohyalinosis

Due to long standing HPN Lose elasticity, so if pressure goes up, it will rupture

Additional Info: Blood flow is a function of blood pressure over resistance of vessel Why is blood flow in the brain constant in normal conditions? Because the vessels are good vasodilators/constrictors. So if blood pressure increases, it will compensate by increasing the resistance thru constriction. This is called the Phenomenon of Cerebral Autoregulation (note that kidney is another organ which can autoregulate) Additional Info: Tail end of mean arterial pressure is approximately 150 or 160. This is the ultimate limit at which above this value, vessels will burst (or maybe prone to) Page 7 Column 2 Collateral Circulation Collateral circulation occurs more in thrombosis than in embolism. Why? Because collateral formation takes time. Embolism is sudden, no time to form collateral. Thrombosis takes time to form and takes time to occlude; therefore, if the body senses traffic, it may start to form collateral Page 8 Column 2 Diagnosis of Stroke Bells Palsy is one of the most common stroke mimicker Page 9 Column 2 RTPA rTPA (given only within 4.5 hours) acts on plasminogen to form plasmin. If given beyond 4.5 hours, tissue already infarcted. After this, there is potential for haemorrhage somewhere else while it is already established that the originally infarcted tissue cant be salvaged. (Parang useless narin ung pag administer dahil no use sa old wound, plus the fact that it may cause a new wound) rTPA cant be given to alcoholics with cirrhosis due to decreased prothrombin time Additional Info: Blood brain barrier is made up of tight junction + foot process of astrocytes MAY ISA PANG DI KO NAILAGAY DAHIL KAILANGAN NG PICTURE. HEHE. SABIHIN KO NLNG SAYO BUKAS.