MANAGEMENT OF CEREBROVASCULAR ACCIDENT.pptx

OPERATED CASE OF HEMORRHAGIC BRAIN STROKE

1. DR FAKIR MOHAN SAHU MBBS, MS, MCh . (AIIMS ), DrNB CONSULTANT NEUROSURGERY Call: 8895513340 [email protected] MANAGEMENT OF CEREBROVASCULAR ACCIDENT

2. Learning Objectives Definition, types Patho -physiology Management Prognosis

3. Clinical vignette A 63 Yr/M, Retd . Insurance officer, Thunderclap Headache HTN , PR60/min. BP 210/100 mmHg 3 hr acute onset left hemi- plegia 8hr GCS – E3V3M5 (11/15) E1V1M5 (7/15)

4. INTRACEREBRAL HEMORRHAGE (ICH) Focal collection of blood within the brain parenchyma or ventricular system , that is not the results of trauma . Also called: Spontaneous ICH Non-traumatic Primary ICH STROKE : 2013, : 44, 6235

5. F

6. Etiology

7. Clinical vignette A 63 Yr/M, Retd . Insurance officer, Thunderclap Headache HTN , PR68/min. BP 210/100 mmHg 3 hr acute onset left hemi- plegia 8hr GCS – E3V3M5 (11/15) E1V1M5 (7/15)

8. ICH SCORE Mortality- 72% Functional disability in survivors- 40-60 % ICH SCORE PROGNOSIS

9. Patho -physiology 3 STAGES Hematoma extension and stabilization Mass stage ( Peri -hematoma Edema ) Resolution and Retraction

10. Monro -Kellie doctrine Cerebral Auto regulation

11. Clinical vignette A 63 Yr/M, Retd . Insurance officer, Thunderclap Headache HTN , PR68/min. BP 210/100 mmHg 3 hr acute onset left hemi- plegia 8hr GCS – E3V3M5 (11/15) E1V1M5 (7/15)

12. Medical Management Intubated ; (E1V1M5) AntiHTN - Labetalol infusion (target- 140/90) Tranexamic acid Anti edema - Mannitol , hypertonic saline Anti-epileptics Nimodipine

13. Clinical vignette A 63 Yr/M, Retd . Insurance officer, Thunderclap Headache HTN , PR68/min. BP 210/100 mmHg 3 hr acute onset left hemi- plegia 8hr GCS – E3V3M5 (11/15) E1V1M5 (7/15)

14. Position & Marking

15. Dural closure

16. Bone flap fixation

17. Closure

18. Operation Team

19. Post-op Pre-op

20. NEURO-REHABILITATION

21. ISCHEMIC CVA

22. Take Home Message GCS CT scan Golden Time Anti HTN Neuro -Rehab.

23. Thank you MOB. NO 8895513340 9337531759