Stroke and Company.ppt

Stroke and Company Clinical Clerk Consolidation Rounds 2005-2006 Academic Year Outline Basic introduction Epidemiology Pathogenesis Examination Stroke syndromes TIA Cerebral infarcts Cerebellar infarcts Brain stem infarcts Lacunar strokes Hemorrhagic strokes (in brief) Management and treatment Cases This session will NOT cover… Subarachnoid hemorrhage Spinal cord infarcts Stroke in the young Stroke genetics Cerebral vascular anatomy Advanced assessment modalities (NIH stroke scale, ASPECTS score, perfusion studies, intracranial doppler etc….) Introduction Key Concepts Strokes are sudden neurologic deficits that result from ischemia/infarction (80%) or hemorrhage (20%) Because of the fragile nature of the brain, the deficit quickly becomes irreversible This rule is broken via neuroplasticity, which occurs especially in young, robust brains Stroke is a disease of the old Regardless the etiology, treatment depends on prompt response, and an understanding of the neural substrate affected Some Definitions Stroke - deficits 24 hours TIA - deficits 24 hours RIND - deficits 24 hours but 3 weeks (the notion of RINDs is of little clinical value, but may be on your exam) “Brain attack” is a term used in attempt to galvanize public awareness against the counter-revolutionary threat of the stroke enemy Basic Pathogenesis Strokes arise from: Emboli Lipo-hyalinosis Watershed/global hypoperfusion Metabolic failure Source of embolic fragments: Heart Heart Heart Vessels Carotids Vetebrobasilar Circle of Willis and branches thereof Aortic arch (suspect this in vasculopaths) Shunting via a PFO Introduction (a. fib) A. fib ? stroke source (though it often does) CHADS: Introduction (differential) Also consider… Infection (sinus thrombosis, parasites) Inflammation (CNS vasculitis) Neoplasm (gliomas, mets, bleeding into either) Metabolic (hyper or hypoglycemia) Medication (narcotics, EtOH) Seizure Migraine You will often be asked to assess patients with decreased level of conscio