Stroke • Damrongsak Bulyalert, M.D., Ph.D. • db@chiangmai.edu • www.metadon.net What is a Stroke? Interruption of blood flow to an area of the brain due to • narrowing of blood vessels • blockage by clots • rupture of blood vessel 2 types of stroke • Ischemia: thrombosis and embolism • Hemorrhage (intracranial): – intracerebral – subarachnoid – etc. Pathology • Ischemia or hemorrhage leads to dysfunction of the affected brain tissue. Symptoms and Signs • Cerebral function – impaired consciousness – language dysfunction – headache • Cranial dysfunction – – – – – blurred vision diplopia facial weakness swallowing difficulty difficulty of speaking – – – – difficulty of maintaining posture nausea, vomiting dizziness, vertigo etc. – – – – weakness impaired sensation ataxia abnormal gait/posture/tone/reflexes • Spinal symptoms • etc. Why Do People have Stroke? • Non-modifiable risks: – age – sex Why Do People have Stroke? • Modifiable risks – – – – – – – heart disease hypertension diabetes hypercholesterolemia physical inactivity alcohol abuse etc. • Potential risks – – – – – – migraine contraceptive use drug abuse (pseudoephedrine) polycythemia leukemia etc. Spectrum of Stroke • Transient ischemic attack (TIA) – 5 minutes to hours (<24 hours) • Reversible ischemic neurological deficit (RIND) – 24 hours to 1 month • Stroke – permanent deficit – paralysis = อัมพาต (อามะพาด) – paresis = อัมพฤกษ์ (อามะพรึก) Differential Diagnoses • • • • seizure systemic infection brain tumor toxic-metabolic encephalopathy Others • • • • • • positional vertigo cardiac events syncope trauma subdural hematoma herpes simplex viral encephalitis • transient global amnesia • dementia • demyelinating disease • C-spine fracture • myasthenia gravis • parkinsonism • hypertensive encephalopathy • conversion disorder Investigation • Imaging – CT – MRI Treatment • Goals of treatment of stroke – reduction of brain tissue injury – rehabilitation of the brain – prevention of future stroke Rx • TIA – Manage the risk factors • Progressive stroke – thrombolytic agent • Completed stroke – thrombolytic agent • Embolic stroke – anticoagulant • Intracranial hemorrhage – surgery when indicated Aspirin • Antiplatelet activity • Indicated in thrombotic process • 25% reduction of stroke in general population • Good for other neoplasms