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Brain Attacks

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Brain Attacks

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  1. To insert your company logo on this slide • From the Insert Menu • Select “Picture” • Locate your logo file • Click OK • To resize the logo • Click anywhere inside the logo. The boxes that appear outside the logo are known as “resize handles.” • Use these to resize the object. • If you hold down the shift key before using the resize handles, you will maintain the proportions of the object you wish to resize. Brain Attacks CVA Add CorporateLogoHere

  2. Cerebral Vascular Accidents • Now referred to as strokes or brain attacks • Acute and treatable condition • Third leading cause of death • Leading cause of disability

  3. CVA • Mortality • 1. Heart disease 33.2% • Cancer 23.7% • CVD 6.6%

  4. CVA • Basic information • Males have more strokes • Females>Males over age 85

  5. CVA • Mortality by Race • Age adjusted • White 22.5 per 10,000 • Black 48.9 per 10,000 • Morbidity • Prevalence 2.9 million in 1991 • Cost $30 billion per year

  6. CVA • Mechanisms • Anoxia • CA+ influx • Excitatory amino acids • Free radicals

  7. CVA • Morphology • Penumbra develops • Region of encapsulated cells, alive but not well

  8. CVA • Some treatment methods • Surgical clinical trials - carotid ectomy • Woman’s Estrogen Trials (WEST) • Prevention by aspirin • Neuron salvage agent

  9. Carotid Arteries

  10. CVA • Long term results • Revascularization • local factors increase blood levels • Neural plasticity and regeneration • Recurrent strokes

  11. CVA • Ischemic cell damage (Choi) • Cells are stimulated to death • Glutamate neurotoxicity • Cycle of hypoxia, hypoglycemia, ischemia

  12. CVA • Glutamate neurotoxicity • Energy depletion • Glu increase • Uptake of glu • Toxic glu exposure • Cell death • Glu release

  13. CVA • Glutamate cell death • Cellular swelling • Cell death in under 5 minutes

  14. CVA • Other Mechanism • High rates of Ca+ entry into cell • AMPA yields Na+ • MMDA yields Ca+, Na+ • AMPA toxicity after 3+ hours • Yields 70% cell death • 24 hours yields 100% cell death

  15. CVA • Process • Induction • Amplification • Expression

  16. CVA • Hypoxic injury to brain • Bulbous swelling of the dendrites • Swelling of the cell body • MK801 (Ca+ blocker) greatly slows cell death • MMDA antagonistic

  17. CVA • Cardiac Arrest Victims • “Window of Opportunity” • Histopathology • Heart attack - the entire brain becomes ischemic

  18. Neurohistopathology

  19. CVA • Decreasing order of vulnerability to ischemia • Neurons • Support cells • Astrocytes • Endothelial cells

  20. CVA • Vulnerable regions • Decreasing order of sensitivity • 1. Hippocampus • 2. Cerebellum • 3. Stratum • 4. Neocortex

  21. CVA • Vulnerable regions • Hippocampal cells may live 24-72 hours • CA1 > CA3 resistant to anoxia • CA1 24-48 hours

  22. CVA • Syndromes • Transitant Ischemic Attack (TIA) • Resolving Ischemic Neurological Deficits (RIND) • Stroke

  23. CVA • Common patterns • 1. Middle cerebral artery occlusion • Redundancy in the neurovascular system • Circle of Willis

  24. Circle of Willis

  25. CVA • Some principles • “Time is brain” • Focal symptoms • “Fit” • Migraine • “Swoon”

  26. CVA • Some principles • Non-Focal symptoms • syncope • hypoglycemic • “Toxic”

  27. CVA • Types of CVA • Hemorrhage • Subarachnoid (vomiting, back of head, blood in CSF) • Intracerebral (focal onset, gradual increase in signs)

  28. CVA • Types of CVA • Ischemic • Thrombosis • Embolism • Systemic hypertension

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