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Stroke

cerebrovascular Stroke
by

Stefania Moreno

on 9 June 2014

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Transcript of Stroke

STROKE
Definition
A stroke is when blood flow to a part of your brain is stopped either by a blockage or a rupture of a blood vessel.
ISCHEMIC
Is triggered by blockage of cerebral blood flow.
The isquemic Stroke is divided into:
Thrombotic isquemic stroke origin
Embolic isquemic stroke origin

HEMORRHAGIC
Occurs when a blood vessel ruptures, or hemorrhages, which then prevents blood from getting to part of the brain. The hemorrhage may occur in a blood vessel in the brain, or in the membrane that surrounds the brain.
PATHOPHYSIOLOGY
Cerebral blood flow (CBF ) is normally 50ml / 100g of brain / min
When CBF decreased to 20 to 25 ml/100g/min , neurons located in the ischemic area remain depolarized but are still viable.
When CBF decreased to 10 ml/100g brain / min this process is irreversible, leading to neuronal death.

Universidad de ciencias Aplicadas
y ambientales
Presented by:
Natalia Bermeo
Edward Rojas
Stefania Moreno
Embolic ischemic stroke origin
The emboli of arterial origin occurs as a consequence of morphologic change present on the luminal surface of a critical artery
Etiology
atheromatous plaque.
cardiac sources
INTRAPARENCHYMAL HEMORRHAGE
ETIOLOGY
Hypertension, trauma, and cerebral amyloid angiopathy
cause the majority of these hemorrhages.

Risk factors

Advanced age and heavy alcohol consumption increase the risk, and cocaine use.

Hypertensive Intraparenchymal Hemorrhage:
Usually results from spontaneous rupture of a small penetrating artery deep in the brain.
The most common sites are the basal ganglia, deep cerebellum, and pons.
The hemorrhage may be small or a large clot may form and compress adjacent tissue, causing herniation and death.
If the patient survives, the clot liquefies, is absorbed, and leaves only a small residual cleft.

PATHOPHYSIOLOGY
SUBARACHNOID HEMORRHAGE
SUBDURAL AND EPIDURAL HEMORRHAGE

Injury or trauma




ETIOLOGY
The most common causes are :
rupture of a saccular aneurysm, bleeding from a vascular anomaly and extension into the subarachnoid space from a primary intracerebral hemorrhage and idiopathic

ETIOLOGY
Clinical Manifestations
Aneurysm develops, it typically forms a neck with a dome.

The length of the neck and the size of the dome vary greatly

The arterial internal elastic lamina disappears at the base of the neck. The media thins, and connective tissue replaces smooth-muscle cells.

At the site of rupture (most often the dome) the wall thins, and the tear that allows bleeding is often no more than 0.5 mm long.

Data suggest that most ruptured aneurysms are>7 mm in diameter.
PATHOPHYSIOLOGY
The subdural hematoma is caused by bleeding from bridging veins between the brain surface and the venous sinuses or is the bleeding of the cortical vessels.
  The epidural hematoma is caused by injury of the blood vessels particularly dural artery middle meningeal.

PATHOPHYSIOLOGY
Depends on the speed of hematoma formation, besides the lesion on the cerebral cortex. It may present as loss of consciousness, as well as intracranial hypertension data also may have cranial nerve injury such as third nerve disturbance anisocoria pupil diameter with up to 50% by the mydriasis hematic collection side, 6  nerve paresis in 5% of cases hemiparesis and 50%. The epidural hematoma symptoms are often quickly progressive.

Clinical Manifestations

INTRACRANIAL HEMORRHAGE

PATHOPHYSIOLOGY
Epidemiology
In the United States approximately 70% of all cases of stroke are ischemic and 30% are hemorrhagic. Cases of ischemic stroke can be subclassified into thrombotic 50%, embolic 30% and undetermined causes 20%.

Definition
Thrombotic ischemic stroke origin
The clot travels released until a distal occluded vessel, interrupting the distal cerebral blood flow.
Atherosclerosis
Atrial Fibrillation
Heart Attack
ETIOLOGY
Obstruction of the anterior circulation
Obstruction of the posterior circulation
Infract small vessel or “lacunar”
Manifestations
Bibliography
Clinical Manifestations: Pseudobulbar syndrome: characterized by emotional incontinence, dysarthria, spasticity, and dysphagia.

https://apps.who.int/infobase/CountryProfiles.aspx
Diagnosis
http://3.bp.blogspot.com/_SYXRr644EAA/TF_afeg0yXI/AAAAAAAAD_Q/42yJ40FnINM/s400/miocardiop.+fig+5
www.neurowikia.es/sites/default/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/Hallazgosprecoces2.jp
Toro,J.Yepes,M.Palacios, E. (2010) Neurologia.Ed Manual Moderno. Colombia, 159 -197.
Fauci As, Braunwald E, Kasper DL, Hauser SL, Longo DL, Jameson JL, et al., editors.Harrison's principies of internal medicine. 17th ed. New york: McGraw Hill;2008.
Arias J,Aller Maria A,Arias I,Aldamendi I.Enfermeria medico-quirurgica II.1 ED.España.Tebar.2000
J V Nixon.The AHA Clinical Cardiac Consult.3ED.Richmond, Virginia. Lippincott Williams & Wilkins.2010
Scott K, Brillman J.Neurolgy.1ED. Richmond, Virginia. Lippincott Williams & Wilkins.2005
the reason why the brain is affected in its normal processes are two:
1. oxygen deficiency and glucose that are necessary for brain metabolic activity.
2. alterations in cellular metabolism secondary to ischemia, most notably decreased energy production, which cause cellular necrosis.
paradoxical embolism.
cardiac arrhythmias.
valvular heart disease


www.neurowikia.es/sites/default/files/imagecache/wysiwyg_imageupload_lightbox_preset/wysiwyg_imageupload/Oclusionvascular.jp
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