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Stroke

Overview of the Etiology, Pathology, and Epidemiology of Cerebral Vascular Accident
by

Carolyn Stewart

on 28 October 2014

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Transcript of Stroke

Stroke
Cerebral Vascular Accident
By: Carolyn Stewart
Background
Stroke
= loss of brain function due to a disturbance in blood supply to the brain
History
The effects of stroke were first described as early as the 2nd millennium BC.
Hippocrates described early cases of stroke as apoplexy, meaning, "struck down with violence."
1599- "Stroke" and "apoplexy" used interchangeably
1658- Jacob Wepfer discovers that patients dying of apoplexy also have bleeding in the brain.
In the mid-nineteenth century, Rudolph Virchow described the mechanism of thromboembolism.
1927- "Cerebral Vascular Accident"
1990- "Brain Attack"
1970s- WHO
"Neurological deficit of cerebrovascular cause that persists beyond 24 hours, or is interrupted by death within 24 hours."
Epidemiology
Stroke kills nearly 130,000 Americans each year, accounting for 1 out of every 19 deaths in the U.S.
In America...
795,000 strokes occur each year.
Stokes kill one person every 4 minutes.
Worldwide...
WHO estimates that
15,000,000
strokes occur each year.
Of these, 5 million result in death and another 5 million result in permanent disability.
Stroke incidence has decreased in developed countries and increased in developing countries.
Classification
Ischemic
Hemorrhagic
Decreased blood flow to the brain, caused by:
Thrombosis
Cerebral Hypoperfusion
Embolism
Bleeding of the brain's blood vessels:
Parenchyma
Subarachnoid Space
Clinical
Etiology
Prognosis
TREATMENT
A
N
A
G
E
M
M
E
N
T
PREVENTION
RESEARCH
Silent Stroke
Does not have any outward symptoms.
Thrombotic Stroke
The thrombus (blood clot) usually forms around atherosclerotic plaques.
Embolic Stroke
A particle or debris, originating from elsewhere in the body, travels through the bloodstream and lodges in an artery of the brain.
Cerebral Hypoperfusion
Reduction of global bloodflow; all parts of the brain may be affected.
Intracerebral Hemorrhage
Hematoma enlarges until pressure from surrounding tissues limit its growth, or until it decompresses by emptying into the ventricular system, cerebrospinal fluid, or the pial system.
Blockage of the involved artery develops gradually.
Onset of symptoms is relatively slow.
Large or small vessels may be affected.
Sickle-cell Anemia
Blockage develops rapidly.
Onset of symptoms occurs very quickly.
Atrial Fibrillation
Watershed Effect
Most commonly due to heart failure, cardiac arrest, arrhythmias, or reduced cardiac output.
Hypertension, vascular malformations, trauma, bleeding disorders, and illicit drug use.
Mortality Rate:
44% after 30 days
Patients are typically unaware that they have suffered a stroke.
Higher risk of Ischemic or major strokes in the future.
Silent strokes occur 5x more often than symptomatic strokes.
Cryptogenic
Stroke
Presentation
FAST
ACE
Facial Drooping
RM
Arm Drift
PEECH
Speech Difficulties
IME
Time is of the Essence
Cincinatti Prehospital Stroke Scale
Los Angeles Prehospital Stroke Screen
Symptoms
Typically Unilateral
Dependent on which area of the brain is affected:
Central Nervous System Pathways
Spinothalmic Tract
Corticospinal Tract
Dorsal Column
Brainstem
12 Cranial Nerves
Cerebral Cortex
Cerebrum
Loss of Consciousness
Headache
Vomiting
Hemorrhagic Stroke
75% of stroke survivors experience long-term disability.
30%

20%

10%
Depression
Emotional
Lability
Seizures
"Time is Brain!"
3
Hours
Thrombolysis
Thrombectomy
Hemicraniectomy
Risk Factors
Hypertension
Atrial Fibrillation
Blood Cholesterol Levels
Alcohol Consumption
Diabetes
Smoking
Poor Diet
Illicit Drug Use
Gender
Anticoagulants
Previous prevention has centered around the use of anticoagulant drugs such as Aspirin and Warfarin.
Current Research
Secondary Prevention
Atrial Fibrillation
Multi-Disciplinary
Rehabilitation
PT
OT
Psych.
Speech
Language
Therapy
O&P
Angioplasty and Stenting
Mechanical Thrombectomy
Neuroprotection Drugs
References
World Health Organisation (1978). Cerebrovascular Disorders (Offset Publications). Geneva: World Health Organization. ISBN 92-4-170043-2. OCLC 4757533
"Brain Basics: Preventing Stroke". National Institute of Neurological Disorders and Stroke. Retrieved 2014-10-24.
Guercini F, Acciarresi M, Agnelli G, Paciaroni M (April 2008). "Cryptogenic stroke: time to determine aetiology". Journal of Thrombosis and Haemostasis 6 (4): 549–54. doi:10.1111/j.1538-7836.2008.02903.x. PMID 18208534.
Harbison J, Massey A, Barnett L, Hodge D, Ford GA (June 1999). "Rapid ambulance protocol for acute stroke". Lancet 353 (9168): 1935. doi:10.1016/S0140-6736(99)00966-6. PMID 10371574.
Kidwell CS, Saver JL, Schubert GB, Eckstein M, Starkman S (1998). "Design and retrospective analysis of the Los Angeles Prehospital Stroke Screen (LAPSS)". Prehospital Emergency Care 2 (4): 267–73. doi:10.1080/10903129808958878. PMID 9799012
Kothari RU, Pancioli A, Liu T, Brott T, Broderick J (April 1999). "Cincinnati Prehospital Stroke Scale: reproducibility and validity". Annals of Emergency Medicine 33 (4): 373–8. doi:10.1016/S0196-0644(99)70299-4. PMID 10092713.
Kernan WN, Ovbiagele B, Black HR, Bravata DM, Chimowitz MI, Ezekowitz MD, Fang MC, Fisher M, Furie KL, Heck DV, Johnston SC, Kasner SE, Kittner SJ, Mitchell PH, Rich MW, Richardson D, Schwamm LH, Wilson JA (May 1, 2014). "Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association.". Stroke; a journal of cerebral circulation 45 (7): 2160–236. doi:10.1161/STR.0000000000000024. PMID 24788967
Saver JL (2006). "Time is brain - quantified". Stroke 37 (1): 263–6. doi:10.1161/01.STR.0000196957.55928.ab. PMID 16339467
Ward, J, Sugar, T, Standeven, J, Engsberg, J. "Stroke Survivor Gait Adaptation and Performance After Training on a Powered Ankle Foot Orthosis". 2010 IEEE International Conference on Robotics and Automation Anchorage Convention District May 3-8, 2010, Anchorage, Alaska, USA. Retrieved 2014-9-2014.
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