Stroke is a medical condition in which poor blood flow to a part of the brain causes cell death

Stroke is a medical condition in which poor blood flow to a part of the brain causes cell death. There are two main types of stroke: ischemic, due to lack of blood flow, and hemorrhagic, due to bleeding.

1. STROKE

2. DEFINITION Stroke or cerebrovascular accident is defined as an abrupt onset of focal neurologic deficit due to disturbance in cerebral circulation . Persists more than 24 hours. It can result from either ischemia and haemorrhage .

3. All neurologic signs and symptoms that resolve within 24 hours without evidence of brain infarction on brain imaging .

4. T ypes Ischemic stroke : Caused by blockage of a blood vessel . Hemorrhagic stroke : Caused by rupture of blood vessel .

5. Risk factors Modifiable Age Gender (Male>Female) Race (Asian>European) Heredity Previous vascular events like MI, peripheral embolism High fibrinogen Non -Modifiable High blood pressure Heart disease( atrial fibrillation, heart failure, endocarditis ) Diabetes mellitus Hyperlipidemia Smoking Excess alcohol consumption Oral contraceptives Obesity , sedentary lifestyle

6. Ischemic stroke Accounts for 85% of all stroke. Common causes include thrombotic and embolic occlusion . Often associated with atherosclerosis or cardiac conditions like atrial fibrillation .

7. Hemorrhagic stroke Represents 15% of strokes, but has higher mortality . Includes: Intracerebral and Subarachnoid hemorrhage . Causes include HTN, aneurysms , anticoagulant therapy , intracranial vascular malformations and trauma

8. Clinical presentations History Time of onset Prior TIA symptoms Inquire about cardiac arrythmia and atherosclerotic risk factors SAH may present with severe headache

9. Investigations Aims to confirm: Vascular nature of lesion Distinguish cerebral infarction from haemorrhage Identify the underlying vascular disease and risk factors

10. 1. Neuroimaging CT or MRI should be performed in all patients Mri d

11. Investigation of a patient with an acute stroke is it a vascular lesion ? Is it ischaemic or haemorrhagic ? is there any cardiac source of embolism? what is the underlying vascular disease? What are the risk factors ? CT/MRI CT/MRI ECG , Echocardiogram Duplex usg of carotids, MRA, CT Angiography Lipid profile, blood sugar , coagulaion profile and other baseline investigation

12. Management Management is aimed at: Minimising the volume of brain that is irreversibly damaged . Preventing complications . Reducing disability through rehabilitation . Reducing the risk of recurrent episodes

13. Supportive care Airway , breathing , circulation Hydration Nutrition Blood pressure Blood glucose Temperature Pressure areas Incontinence Mobilization

14. Early specific management of ischemic stroke Intravenous thrombolysis : recombinant tissue plasminogen activator( rTPA ) within 3 hours of onset of symptoms (time window: 3-4.5 hrs) Endovascular mechanical thrombectomy Antithrombotic therapy and statins : if patient present after 3 hours of stroke onset, ASPIRIN is best Neuroprotection : PREVENT “5H” Hypotension,Hypoxemia,Hypoglycemia,Hyperglycemia Hyperthermia

15. Early specific management of hemorrhagic stroke A: Medical management Blood pressure : treat if SBP>180 Manage increased ICP : head elevation, osmotic therapy( mannitol ) , hyperventilation Others : Control seizures Ensure neuroprotection Maintain fluid, electrolyte and nutrition DVT prophylaxis, early rehabilitation and bedsore precaution