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Ischemic Stroke

Ischemic Stroke. Peng Bin Department of Neurology,Peking Union Medical College Hospital. What do we need to know……. Definition and classification Vascular anatomy Mechanism Clinical features Diagnosis and differentiate diagnosis Treatment. Definition. Stroke:

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Ischemic Stroke

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  1. Ischemic Stroke Peng Bin Department of Neurology,Peking Union Medical College Hospital

  2. What do we need to know…… • Definition and classification • Vascular anatomy • Mechanism • Clinical features • Diagnosis and differentiate diagnosis • Treatment

  3. Definition • Stroke: World Health Organization (WHO) has defined stroke as “rapidly developing clinical signs of focal (at times global) disturbance of cerebral function, lasting more than 24 hours or leading to death with no apparent cause other than that of vascular origin.” • Ischemic stroke: deprivation of blood flow to an area of the brain, generally as a result of thrombosis, embolism, or reduced blood pressure.

  4. ---Onset : Rapidly ---Symptom: Focal or global cerebral dysfunction ---Duration: More than 24 hours ---Vascular origin:

  5. Classification of Ischemic Stroke • Atherothrombotic cerebral infarction • Cerebral embolism • Lacunar infarction • Cerebral watershed infarction

  6. Vascular Anatomy • The brain is perfused by the carotid and vertebral arteries ---Anterior circulation : carotid artery ,etc ---Posterior circulation: vertebrobasilar artery.

  7. How does it happen?

  8. Clinical manifestations • Ischemic syndromes of specific vessels depend on ----- the site of the occlusion ----- the presence of previous brain damage ----- collateral circulation

  9. ACA MCA PCA

  10. Example • Internal carotid artery occlusion(MCA+ACA) * Symptomatic --Contralateral hemiparesis --Hemianesthesia --Hemianopia *Asymptomatic ACA MCA

  11. Asymptomatic

  12. Diagnosis • Onset • Causes or risk factors • Clinical features ---Stroke syndromes • Tests ---Brain CT scan ---Brain MRI ---TCD,CTA or DSA

  13. Differentiate Diagnosis • Intracerebral hemorrhage

  14. General Management • Standard frequency of observations and monitored parameters • Deep vein thrombosis (DVT) prophylaxis • Treatment of increased blood sugar levels (BSL) • Treatment of increased temperature • Treatment of increased blood pressure (BP)

  15. Specific treatment • Thrombolytic therapy --Intravenous thrombolytic therapy with rt-PA --Intraarterial thrombolytic therapy

  16. Inclusion Criteria --Patient or family are able to indicate consent --Age > 18 --Onset of stroke symptoms defined, and within 4.5 hours of commencement of infusion --Moderate to severe neurological deficit (NIHSS > 7 and < 25) • Exclusion Criteria --Time of onset unknown, patient awoke with deficit

  17. Antiplatelet therapy • Anticoagulation --Indications :Atrial fibrillation (chronic or paroxysmal) --Contraindications • Secondary Prevention

  18. Specific Interventions • Carotid endarterectomy • Angioplasty/stenting : Extracranial (carotid) and intracranial

  19. Rehabilitation

  20. After class • Definition and vascular anantomy • Diagnosis and treatment • Suggested readings ---Cerebralvascular disease 4th editon ---Merrit’s Handbook of Neurology

  21. Thanks!

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