m A ²
, previously known medically

as a 

²

  
is the rapidly developing loss
of brain function(s) due to disturbance in
the blood supply to the brain.
m Mhis can be due to ² (lack of blood
flow) caused by blockage
(thrombosis, arterial embolism), or
a 

 (leakage of blood).
blood).
m As a result, the affected area of the brain
is unable to function, leading to inability
to move one or more limbs on one side of
the body, inability
to understand or formulate speech, or an
inability to see one side of the visual
field.
m A stroke is a medical emergency and can
cause permanent neurological damage,
complications, and even death. It is the
leading cause of adult disability in the
United States and Europe and it is the
number two cause of death worldwide.
m Àisk factors for stroke include advanced
age, hypertension (high blood pressure),
previous stroke or transient ischemic
attack (MIA), diabetes, high
cholesterol, cigarette smoking and atrial
fibrillation. High blood pressure is the
most important modifiable risk factor of
stroke.
 6
î major cause of CVA
 M

   
 
Abnormal filtration of lipids in the intimal layer of the
arterial wall
Plaque develops & locations of increased turbulence of
blood - bifurcations
Increased turbulence of blood or a tortuous area
Calcified plaques rupture or fissure
Platelets & fibrin adhere to the plaque
Narrowing or blockage of an artery by thrombus or
emboli
¬
  
 


  



m Strokes can be classified into two major
categoriesî ischemic and hemorrhagic.
m Ischemic strokes are those that are caused by
interruption of the blood supply, while
hemorrhagic strokes are the ones which result
from rupture of a blood vessel or an abnormal
vascular structure.
m About 87% of strokes are caused by ischemia,
and the remainder by hemorrhage. Some
hemorrhages develop inside areas of ischemia
("hemorrhagic transformation"). It is unknown
how many hemorrhages actually start as
ischemic stroke.
 
  
M

 



  
 

 



 

6

 In an ischemic stroke, blood supply to part of the
brain is decreased, leading to dysfunction of the brain
tissue in that area. Mhere are four reasons why this
might happenî
m M

 (obstruction of a blood vessel by a
blood clot forming locally)
m 
 (obstruction due to an embolus from
elsewhere in the body, see below),
m   
  (general decrease in
blood supply, e.g. in shock)
m Ã

.

  
0     
^ À  
^  

^    
0 Symptoms may progress in the first 72 hours
as infarction & cerebral edema increase

 M 
  

0 M

  
0 
 
 Ôumen of the blood vessels narrow ² then
becomes occluded ² infarction
 Associated with HMN and Diabetes Mellitus
>60% of strokes
50% are preceded by MIA
Ô î development of cavity in
place of infarcted brain tissue ² results in
considerable deficits ² motor hemiplegia,
contralateral loss of sensation or motor
ability.
 Embolus lodges in and occludes a cerebral artery
 Àesults in infarction & cerebral edema of the area
supplied by the vessel
 Second most common cause of stroke ² 24%
 Emboli originate in endocardial layer of the heart ²
atrial fibrillation, MI, infective endocarditis,
rheumatic heart disease, valvular prostheses
 Àapid occurrence with severe symptoms ² body does
not have time to develop collateral circulation
 Any age group
 Àecurrence common if underlying cause not treated
 Memporary focal loss of neurologic function

 Caused by ischemia of one of the vascular territories

of the brain
 Microemboli with temporary blockage of blood flow

 Ôasts less than 24 hrs ² often less than 15 mins

 Most resolve within 3 hours

 Warning sign of progressive cerebrovascular disease

 Diagnosisî
 CM without contrast
Confirm that MIA is not related to brain lesions
 Cardiac Evaluation
Àule out cardiac mural thrombi

 Mreatmentî
 Medications that prevent platelet aggregation
ASA, Plavix
 Oral anticoagulants
m Intracranial hemorrhage is the accumulation of blood
anywhere within the skull vault.
m A distinction is made between intra-axial
hemorrhage (blood inside the brain) and extra-axial
hemorrhage (blood inside the skull but outside the
brain).
m Intra-axial hemorrhage is due to intraparenchymal
hemorrhage or intraventricular hemorrhage (blood in
the ventricular system).
m Mhe main types of extra-axial hemorrhage are epidural
hematoma (bleeding between the dura mater and the
skull), subdural hematoma (in the subdural space)
and subarachnoid hemorrhage (between the arachnoid
mater and pia mater).
m Most of the hemorrhagic stroke syndromes have specific
symptoms (e.g. headache, previous head injury).
 15% of all strokes
 Àesult from bleeding into the
brain tissue itself
Intracerebral
Subarachnoid
 Àupture of a vessel
 Hypertension ² most important cause
 Othersî vascular malformations, coagulation
disorders, anticoagulation, trauma, brain
tumor, ruptured aneurysms
 Sudden onset of symptoms with progression
 Neurological deficits, headache, nausea,
vomiting, decreased ÔOC, and hypertension
 Prognosisî poor ² 50% die within weeks
 20% functionally independent at 6 months.
 Intracranial bleeding into the cerebrospinal
fluid-filled space between the arachnoid and
pia mater membranes on the surface of the
brain
 Commonly caused by rupture of cerebral
aneurysm (congenital or acquired)

² few to 20-30 mm in size
Majority occur in the Circle of Willis
 Other causesî Arteriovenous malformation
(AVM), trauma, illicit drug abuse
 Incidenceî 6-16/100,000
 Increases with age and more common in
women
 Warning Symptomsî sudden onset of a severe
headache ² ´worst headache of one·s lifeµ

 Change of ÔOC, Neurological deficits, nausea,

vomiting, seizures, stiff neck

 Despite improvements in surgical techniques, many

patients die or left with significant cognitive
difficulties