Acute Stroke Principles of Modern Management.ppt

Acute Stroke: Principles of Modern Management A program of the American Academy of Neurology The AAN Acute Stroke Management courses are supported in part by unrestricted educational grants from Abbott Laboratories, Genentech, Inc., Janssen Pharmaceutical, and Wyeth-Ayerst Pharmaceutica. Overview of the Course GOALS OF THE COURSE Review management of patients with acute stroke. Diagnosis Treatment of ischemic stroke Treatment of hemorrhagic stroke Review in-hospital management. Review management to prevent stroke or recurrent stroke. STROKE FACTS Third leading cause of death in the United States Common cause of disability and long-term institutionalized care Economic consequences more than $40 billion annually Affects not only the patient but the entire family STROKE AS A PUBLIC HEALTH PROBLEM WHO – increased importance of stroke during next 50 years Developing countries Industrial societies including U.S. Decline in stroke incidence to be reversed Increase due to aging of population People who survive severe heart disease at high risk STROKE EPIDEMIOLOGY Advancing age is the premier predictor of stroke Stroke is an important cause of death in children Strokes are relatively common in young adults More women die from stroke than do men More women die from stroke than from cancer of breast Stroke accounts for 10% of maternal deaths during pregnancy or the peripartum period Under the age of 45, more women die from stroke than from heart attack Approximately 60% of patients with SAH are women Atrial fibrillation is an important risk factor for stroke among women older than 75 SUBTYPES OF STROKE HEMORRHAGIC STROKE – 20% of cases Subarachnoid hemorrhage Intracerebral hemorrhage ISCHEMIC STROKE – 80% of cases Large artery atherosclerosis Cardioembolism Small artery occlusion (lacunes) Non-atherosclerotic vasculopathies Hypercoagulable state CURRENT STRATEGIESMANAGEMENT OF CEREBROVASCLAR DISEASE Treatment of risk factors in large populations Treatment of hig