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STROKE
What should we know?
Dr. Gourav Goyal
MD, DM (Neurology)
Fellowship in stroke & Neuro-intervention
Assistant Professor, Department of Neurology, MGMCH
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STROKE - INTRODUCTION • Stroke remains one of the major public health problems in
India and worldwide accounting for 3rd highest mortality rates
• Also previously called cerebrovascular accident (CVA) or stroke syndrome, causes include thrombosis, embolism, and hemorrhage.
• WHO explains stroke, a cerebro-vascular event as “the interruption of the blood supply to the brain, usually because a blood vessel bursts or is blocked by a clot.
• This cuts off the supply of oxygen and nutrients, causing damage to the brain tissue”
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Perceptions of Stroke Myth – Stroke:
Is not preventable
Cannot be treated
Only strikes the elderly
Happens in the heart
Reality :
Up to 80 percent of strokes are preventable
Stroke requires emergency treatment
Anyone can have a stroke
Stroke is a “Brain Attack”
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THREE STROKE TYPES
Ischemic
Stroke
Clot occluding
artery
Intracerebral
Hemorrhage
Bleeding
into brain
Subarachnoid
Hemorrhage
Bleeding
around brain
Focal Brain Dysfunction
Diffuse Brain Dysfunction
85% 10% 5%
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STROKE – CEREBROVASCULAR ACCIDENT
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CEREBROVASCULAR DISEASE:
PATHOGENESIS Ischemic Stroke (83%) Hemorrhagic Stroke (17%)
Atherothrombotic
Cerebrovascular
Disease (20%)
Embolism (20%) Lacunar (25%)
Small vessel disease
Cryptogenic (30%)
Intracerebral
Hemorrhage (59%)
Subarachnoid Hemorrhage (41%)
Albers GW, et al. Chest. 1998;114:683S-698S.
Rosamond WD, et al. Stroke. 1999;30:736-743. All copy rights reserved with Docconsult Seveces
WHAT ARE THE EFFECTS
OF STROKE? • Left Brain
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WHAT ARE THE EFFECTS
OF STROKE? • Right Brain
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ISCHEMIC CEREBROVASCULAR BED
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WEAKENED BLOOD VESSELS
IN A HYPERTENSIVE BLEED
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AUTOPSY OF INTRACEREBRAL HEMORRHAGE
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SMALL HEMORRHAGIC STROKE
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LARGE HEMORRHAGIC STROKE
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HOW DO WE RECOGNIZE A
STROKE?
Stroke Strikes FAST
• F = FACE: Ask the person to smile.
• A = ARM: Ask the person to raise both arms.
• S = SPEECH: Ask the person to speak a
simple sentence.
• T = TIME
“If you observe any of these signs, call emergency
immediately”
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People Don’t Respond to Symptoms
Don’t recognize symptoms
Denial
Think nothing can be done
Worry about cost
Think symptoms will go away
Fear or don’t trust hospitals
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Acute Stroke Treatments
Ischemic stroke (brain clot) – Clot busting medication: tPA (tissue
plasminogen activator) – Clot-removing devices Hemorrhagic stroke (brain bleed) – Medical management – Surgical
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“Time is brain”
Estimated Pace of Neural Circuitry Loss In Typical Large-Vessel Supratentorial Acute
Ischaemic Stroke
Neurons Lost Synapses Lost Myelinated Fibres Lost Accelerated Aging
Per Stroke 1.2 billion 8.3 trillion 7140 km 36 y
Per Hour 120 million 830 billion 714 km 3.6 y
Per Minute 1.9 million 14 billion 12 km 3.1 wk
Per Second 32,000 230 million 200 m 8.7 h
Minutes Hours Days
Inflammation Peri-infarct
depolarisations
Excitotoxicity
Imp
act
Apoptosis
Time
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Potential to Reverse Neurologic
Impairment With Thrombolytic Reperfusion
An untreated patient loses
approximately 1.9 million
neurons every minute in the
ischaemic area
Reperfusion offers the
potential to reduce the extent
of ischaemic injury
Ischaemic core
(brain tissue
destined to die)
Penumbra
(salvageable
brain area)
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Thrombolysis
Alteplase rTPA
0.9mg /Kg
10% of total dose –Bolus 2-3 mins
90% of total dose –Infuse over 60
mins
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Intra-arterial thrombectomy
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Intra-arterial thrombectomy
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Onset
Infarct
Ischaemic
penumbra
Cerebral infarct - onset
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6 Hours
Infarct
Ischaemic
penumbra
Cerebral infarct – 6 hours
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Cerebral infarct – 24 hours
24 Hours
Infarct
Ischaemic
penumbra
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Without thrombolysis
2hrs
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Stroke Prevention
• Know your blood pressure. Have it
checked at least annually. If it is elevated,
work with your healthcare professional to
control it.
• Find out if you have atrial fibrillation (Afib)
– a type of irregular heartbeat. If you have
it, work with your doctor to manage it.
• If you smoke, stop All copy rights reserved with Docconsult Seveces
Stroke Prevention
• If you drink alcohol, do so in moderation.
• Know your cholesterol number. If it is high, work with your doctor to control it.
• If you are diabetic, follow your doctor’s recommendations carefully to control your diabetes.
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Stroke Prevention
• Include exercise in your daily routine
• Enjoy a lower sodium (salt) and lower fat diet
• If you have circulation problems, work with your doctor to improve your circulation.
• If you experience any stroke symptoms, call emergency immediately.
Every minute matters!
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Why prevention is important?
Stroke Recovery 10 percent of stroke survivors recover
almost completely 25 percent recover with minor impairments 40 percent experience moderate to severe
impairments requiring special care 10 percent require care within either a
skilled-care or other long-term care facility 15 percent die shortly after the stroke 15 percent die shortly after the stroke
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‘Time is Brain’
Thank you….
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