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Cerebrovascular Accident

Cerebrovascular Accident. Aka: Stroke Brain Attack. http://www.strokecenter.org/ education/index.html. In this Session. Brain structure and function Cerebral circulation Haemorrhagic stroke TIA Ischaemic stroke Manifestations Diagnosis and management Long term disabilities.

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Cerebrovascular Accident

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  1. Cerebrovascular Accident Aka: Stroke Brain Attack

  2. http://www.strokecenter.org/education/index.html

  3. In this Session • Brain structure and function • Cerebral circulation • Haemorrhagic stroke • TIA • Ischaemic stroke • Manifestations • Diagnosis and management • Long term disabilities

  4. Review of Brain Structure & Function

  5. Cerebral Cortex • Divided into Hemispheres • Functions • Motor - Controlling voluntary movements • Sensory - Registers and processing sensations • Association - Higher mental functions • Language - Comprehension and Production

  6. Cerebral Hemispheres: Lobes • Frontal • Temporal • Parietal • Occipital

  7. Other Brain Structures • Brainstem • Medulla • Reticular formation

  8. Other Brain Structures • Thalamus

  9. Other Brain Structures • Cerebellum

  10. Other Brain Structures • Hypothalamus

  11. Language • Wernicke’s Area • Temporal lobe • Recognition of spoken & written language • Composition of spoken and written language

  12. Language • Broca’s Area • Frontal lobe • Speech motor function

  13. Coordination of Language in the Brain - How do we read aloud?

  14. Vision

  15. Cerebral Circulation

  16. Arteries supplying the Brain • Aortic Arch  Common Carotid Artery (left & right)  internal carotid artery (Left & Right)  Circle of Willis • Aortic Arch  Subclavian Arteries Vertebral Arteries (Left & Right)  Merge to form Basilar Artery  Circle of Willis • Circle of Willis  left & right: Anterior, Middle & Posterior Cerebral Arteries

  17. Definition of Stroke • Acute focal neurological deficit as a result of vascular disorder

  18. Epidemiology • Third leading cause of death • Over 70% strokes in people aged > 65 yr • Ave. age males 68 yr, female 74 yr • 1998 Age-standardised stroke mortality (per 100,000 pop) is 43 male, 42 female • A leading cause of Disability

  19. Risk Factors for Stroke • Advanced age • Systolic hypertension • Diabetes mellitus • Hypercholesterolemia • Carotid artery stenosis • TIAs • CIGARETTE SMOKING • Lack of exercise • CV disease especially atrial fibrillation • Increased weight

  20. Non-Modifiable Risk Factors • Age • Risk doubles for each decade after 55 years of age • Gender • Men slightly higher than women • Race • Heredity

  21. AGE and STROKE

  22. Modifiable Risk Factors HypertensionRR 4.0 DiabetesRR 1.8 SmokingRR 1.7 Coronary diseaseRR 2.2 TIARR 3.9 Atrial fibrillationRR 2.6-4.5 HyperlipidemiaRR 1.8-2.6

  23. Modifiable Risk Factors For ischaemic stroke: • Being overweight increases risk by 22% • Being obese increases risk by 64%

  24. Diet and Stroke • Fish: 3 servings a day associated with a 6% lower risk of stroke • Fruits and vegetables: >5 servings a day associated with a 26% lower risk of stroke • Meat: Each daily serving associated with a 24% increased risk of stroke • Reduced-fat milk: associated with a lower risk of stroke vs full-fat milk • Chocolate: High consumption associated with a 29% lower risk of stroke

  25. Diet and Stroke • Coffee: 3 to 4 cups per day associated with a 17% lower risk of stroke • Tea: ≥3 cups per day associated with a 21% lower risk of stroke • Sugar-sweetened beverages: high intake associated with increased obesity, diabetes, metabolic syndrome, and coronary heart disease • Whole grains: high intake associated with a 21% lower incidence of cardiovascular events • Rice: intake not associated with risk of stroke

  26. Types of Stroke • Haemorrhagic • AND • Ischaemic

  27. Haemorrhagic Stroke • 15% of strokes • Release of blood into the extravascular space • Caused by: • Hypertension • Aneurysms • Head Injury

  28. Berry Aneurysm • Cause unknown • Usually around Circle of Willis

  29. Haemorrhagic Stroke • Rupture of blood vessel causes: • Haemorrhage • Oedema • Compression • Death is common

  30. Haemorrhage • Intracerebral haemorrhage • Subarachnoid haemorrhage

  31. Transient Ischaemic Attack(TIA) • Ministroke or Brain angina • Fleeting attack of paralysis, numbness, tingling, aphasia, unilateral blindness or dizziness • Zone of penumbra without central infarction • Last less than 24 hours

  32. TIA’s • Warning • First month after a TIA, carries a 4-8% risk of stroke • First year, 12-13%; 24-29% over 5 years • Note: Do not have associated pain (rare), so people may ignore them • Person should seek immediate medical attention

  33. Ischaemic Penumbra • Prolonged hypoperfusion (<10 ml/100 gm/min) leads to Cell death • Ischaemic penumbra is a zone of dysfunctional but not dead brain tissue surrounding an infarct • Dysfunctional tissue may infarct • “Brain is Time”- need treatment within 3 hours

  34. Ischaemic Stroke • 85% of all strokes • Ischaemic: lack of blood flow • Caused by • Emboli • Thrombosis • Types are Thrombotic Stroke, Cardiogenic Embolic Stroke, Lacunar Stroke

  35. Thrombotic Stroke • Most common • Common sites are the origins of internal carotid, vertebral arteries and junctions of basilar and vertebral arteries • Normally a single cerebral artery is affected

  36. Cardiogenic Emboli Stroke • Caused by a moving blood clot • Most common site is middle cerebral artery • Most emboli originate in the left heart • Atrial fibrillation and other heart disease predisposes to embolus formation

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