cva tbi

stroke

Sudden onset of focal neurologic deficit lasting more than 24 hours due to an underlying vascular pathology. Loss of motor control, altered sensation, cognitive or language impairment and disequilibrium or coma caused by non-traumatic brain injury resulting from occlusion or rupture of cerebral blood vessels

cerebrovascular disease

Designates any abnormality of the brain resulting from a pathologic process of the blood vessels

cerebrovascular accident

Implies a nihilistic view suggesting that acute outcome cannot be modified by treatment

Least used term - “Confused Vascular Assessment”

reversible ischemic neurologic deficit or RIND.

A cerebral infarct that lasts longer than 24 hours, but less than 72 hours is termed a

infarct

dead tissue necrosis

transient ischemic attack

Often colloquially referred to as “mini stroke”) Caused by the changes in the blood supply to a particular area of the brain, resulting in brief neurologic dysfunction. Persists, by definition, for less than 24 hours; Followed by complete functional recovery. If symptoms persist then it is categorized as a stroke

amaurosis fugax

Transient monocular blindness. Due to episodic retinal ischemia, usually associated with ipsilateral carotid artery stenosis or embolism of the retinal arteries resulting in a sudden, and frequently complete, transient loss of vision in one eye

monocular blindness

loss of vision in one eye

completed stroke

Stroke syndrome with a persisting neurological deficit suggesting cerebral infarction; the ensuing neurological defect can last days,weeks, or permanently; even after maximal recovery, at least minimal neurological difficulties often remain

focal or restricted distribution

neurologic deficits begin in

1. has the patient had a stroke

2. where is the lesion and what is the blood supply

3. what is the lesion

4. what is the pathogenesis

making the diagnosis - the 4 things to ask

temporal profile

may differentiate between TIAs, progressing stroke, and minor and severe completed stroke

pathogenesis

it will guide acute and chronic therapy

tumours, abscesses, subdural hematoma, demyelination, focal encephalitis, (herpes simplex)

other focal lesions

Bell's Palsy, plexopathies, mononeuropath

LMN lesions

15 million suffer

5 million die

5 million disabled

how many people suffer from stroke

how many dies

how many are permanently disabled

40

Stroke is uncommon in people under

sickle cell disease

Stroke also occurs in about 8% of children with

sickle cell disease

abnormal blood wherein the hemoglobin is stiff

ischemic

hemorrhagic

major types of stroke

ischemic stroke

Mechanisms include embolism,from heart or proximal arteries, small vessel thrombosis, or hemodynamic from a drop in the local perfusion pressure.

hemorrhagic stroke

Abrupt onset with focal neurological deficits, due to spontaneous (non-traumatic) bleeding into the brain. Includes Intracerebral Bleeding and Subarachnoid Bleeding

subdural and extradural hemorrhages

are not usually classified as strokes as they are associated with trauma

Age – likelihood is twice when age is > 55 years

Heredity/family history

African Americans > Caucasians

Prior TIA or stroke - Increases risk to 10x

non modifiable risk factors for hemorrhagic stroke

hypertension

smoking

oral contraceptives pills

diabetes mellitus

modifiable factors of hemorrhagic stroke

hypertension

leading cause and most important of hemorrhagic

Carotid Artery Disease

Peripheral Artery Disease

Atrial Fibrillation

Congenital heart disease, dilated cardiomypathy

Sickle Cell Disease

Hypercholesterolemia

Poor Diet

Rich in saturated fat

Obesity

Increased BMI and waist hip ratio correlates well

Physical inactivity

Sedentary lifestyle

other risk factors of hemorrhagic stroke

geographic loc

• southern us

socioeconomic

alcohol abuse

drug abuse

less documented risk factors

basilar artery

oenetrating arteries

posterior and anterior inferior cerebellar artery

superior cerebellar artery

pontine and internal auditory artery

vertebro-basilar territory

vascular territories

vertebrobasilar territory

carotid territory

cortical supply

internal carotid artery

ophthalmic artery

anterior communicating artery

anterior choroidal

carotid territory

middle cerebral artery

anterior cerebral artery

posterior cerebral artery

cortical supply

middle cerebral artery

supplies the lateral aspect of the brain

anterior cerebral

supplies anterior frontal lobe and medial aspect of the brain

posterior cerebral artery

suppkies the occipital lobe, choroid plexus, 3rd and lateral vent, lower surface of teporal lobe

thrombosis

Due to atherosclerotic plaque. Involves the common carotid and vertebrobasilar

embolism

Mural thrombi within the LV after AMI. Emboli of cardiac origin (structural or mechanica damage), Atrial fibrillation – poor atrial motility and stasis

lacnar infarct

Small circumscribed lesions that measure < 1.5 cm in diameter. Located in subcortical regions of BG, internal capsule, pons and cerebellum

intracerebral hemorrhage

subarachnoid hemorrhage

types of hemorrhagic stroke

intracerebral hemorrhage

Rupture of deep perforating arteries. Dissects through tissue planes unlike lacunes. Mostly within the putamen and cerebral white matter. Charcot Bouchard aneurysm

subarachnoid hemorrhage

Bleeding within the dural space and fills the basal cisterns. Due to rapture of saccular aneurysm or Arterio-venous malformation (AVM)

Motor control and Strength

Motor coordination and balance

Spasticity

Sensation

Language and communication

Apraxia

Neglect Syndrome

Dysphagia

Uninhibited bladder and bowel

anatomic basis of stroke syndromes

middle cerebral artery

anterior cerebral artery

posterior cerebral artery

vertebro-basilar artery

clinical stroke syndromes

main stem

upper division

lower division

middle cerebral artery stroke kinds

MCA stroke main stem

Contralateral hemiplegia

Contralateral hemianesthesia

Contralateral hemianopia

Head or eye turning toward lesion

Dysphagia

Uninhibited neurogenic bladders

Dominant Hemisphere - Global aphasia, Apraxia

Non-dominant Hemisphere - Aprosody and affective agnosia, Visuospatial deficit, Neglect syndrome

MCA stroke upper division

Contralateral hemiplegia, (leg spared than hand and face)

Contralateral hemianesthesia

Contralateral hemianopia

Head or eye turning toward lesion

Dysphagia

Uninhibited neurogenic bladders

Dominant Hemisphere- Global aphasia, Apraxia

Non-dominant Hemisphere - Aprosody and affective agnosia, Visuospatial deficit, Neglect syndrome

MCA stroke lower division

Contralateral homonymous hemianopia

Dominant Hemisphere - Wernicke aphasia

Non-dominant Hemisphere - Affective agnosia

anterior cerevral artery stroke

Contralateral hemiplegia *(hand relatively more spared than arm or leg)

Contralateral hemianesthesia

Head or eye turning toward lesion

Grasp reflex- groping

Paratonia

Disconnection apraxia

Akinetic mutism (abulia)

paratonia

involuntary resistance to passive movement

abulia

lack of motivation

posterior cerebral artery stroke

Hemisensory deficit

Visual impairment

Visual agnosia

Prosopagnosia

Alexia with agraphia

Memory deficits

prosopagnosia

cant recognize familiar faces

lateral syndromes

medial syndromes

vertebrobasilar syndromes