Cerebrovascular disorders for MBBS students

This is basic learner s information regarding stroke

1. Cerebrovascular Diseases Dr Akhilesh Shroti MBBS, MD (Medicine), DM (Neurology-NIMHANS, Bengaluru) FNB (Neurovascular intervention-NBEMS, New Delhi)

2. Outline of discussion Introduction Relevant anatomy Pathophysiology Clinical features Investigations Management

3. Introduction Cerebrovascular diseases include disorders affecting blood vessels of brain such as Ischemic stroke and hemorrhagic stroke Among the most common and devastating disorders Second leading cause of death worldwide (HPIM, 20th edition) Leading cause of disability worldwide

4. Introduction

5. Introduction

6. Relevant anatomy

7. Relevant anatomy

8. Relevant anatomy

9. Relevant anatomy

10. Pathophysiology-Ischemic stroke Stroke or cerebrovascular accident- Abrupt onset of neurological deficit that is attributable to a focal vascular cause Extent of brain damage depends on various factors, such as degree of reduction in blood flow, duration of reduced blood flow etc Transient ischemic attack (TIA)- All neurological signs and symptoms resolve within 24 hours without evidence of brain infarction on brain imaging Ischemic penumbra- Ischemic but reversibly dysfunctional tissue surrounding a core of infarction

11. Pathophysiology-Ischemic stroke

12. Pathophysiology-Ischemic stroke

13. Pathophysiology-Ischemic stroke

14. Pathophysiology-Ischemic stroke

15. Pathophysiology-Ischemic stroke

16. Pathophysiology- hemorrhagic stroke

17. Pathophysiology- hemorrhagic stroke

18. Clinical features

19. Clinical features Complete MCA syndrome Contralateral hemiparesis/hemiplegia Contralateral hemianesthesia Contralateral homonymous hemianopia Gaze preference to ipsilateral side Aphasia, hemineglect, Apraxia, Anosognosia

20. Clinical features

21. Clinical features

22. Clinical features

23. Clinical features

24. Clinical features

25. Clinical features

26. Clinical features

27. Clinical features

28. Clinical features

29. Clinical features- Intraparanchymal hemorrhage Headache, vomiting Focal deficit- Hemiparesis, sensory loss, dysarthria, ataxia Loss of consciousness Most common sites of intraparanchymal hemorrhage- Lentiform nucleus (Putamen and globus pallidus), thalamus, pons, cerebellum

30. Clinical features- Subarachnoid hemorrhage Severe headache- Worst headache of life Neck pain, neck stiffness Vomiting Loss of consciousness

31. Clinical features- Subarachnoid hemorrhage

32. Management Evaluation tool CT scan MRI Colour Doppler of neck vessels DSA (Digital substraction angiography) Echocardiography ECG, Holter monitoring

33. Management Ischemic stroke Antiplatelet agents Lipid lowering agents (statins) Management of DM, hypertension Antiedema measures Thrombolytic agents- Alteplase, Tenecteplase Endovascular management Rehabilitation

34. Management Hemorrhagic stroke Hypertension management Antiedema measures Prevention of vasospasm - Nimodipine, milrinone Surgical procedures- EVD (external ventricular drainage), Aneurysm clipping Endovascular management- Aneurysm coiling

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