Beruflich Dokumente
Kultur Dokumente
Faculty of Medicine
Pelita Harapan University
Anatomy
Stroke
60%
Intracerebral or subarachnoid
hypertension, aneurysm, AVM
Atheroma
important factor in embolic & thrombotic
stroke
Commonly rises at the junctions of arteries
ex.carotis bifurcation
Risk factors: Hypertension, Diabetes,
smoking, family history,Cholesterol, excess
alcohol intake
Cardioemboli
AF
AUTOREGULATION
Normally : CPP 70 100 mmHg (CPP=MAP ICP) ; CBF =
CPP/CVR
To maintaine CBF 50 ml/100mg/menit needs CPP 40 - 140
mm Hg
ISCHEMIC CORE
the lowest CBF ,Neuron degeneration, blood
vessel dilatated , High lactic acid , low Po2
nekrosis
PENUMBRA around ischemic core higher CBF
loss cell function , saveable
Around penumbrahyperemia & edema.
Dilatated blood vessel high CBFhyper
perfusion
ANEURYSM
HYPERTENSION
History taking
Physical & neurologic examination
Supportive examination
Treatment
Stroke
Stroke like
No
Yes
Location
-Brain : hemiphere , brain stem
-Vascular system : Carotid
Vertebrobasilar
Etiopathology
Ischemi, infarct :
- trombosis
- emboli
Hemorrhagic : - intracranial
- Subarachnoid
(SAH)
Stadium
Stroke in evolution
Completed stroke
TIA : < 24 hours
RIND : < 2 weeks
MRI
DIFFUSION
RADIOIAMAGING: CT SCAN
Ischemic stroke
Hemorrhagic stroke
MULTISLICES CT SCAN : CT
Angiography
Thrombolytic therapy
Antithrombotic therapy
Anticoagulation
Stroke cardioembolic
If source of embolism can be demonstrated, consider early
anticoagulation with IV heparin or low
molecular-weight heparin (LMWH)
or
Aspirin 160-325 mg/day (if anticoagulation is not possible
or contraindicated)
Neuroprotection
Neuroprotective Interventions: The 5
H
Principle
Avoid hypotension, hypoxemia,
hyperglycemia or hypoglycemia and
hyperthermia (fever) during acute
stroke in an effort to "salvage the
ischemic penumbra
Neuroprotectans
Protect against excitotoxins and prolong
neuronal survival
Block the release of glutamate, free
radicals, inflammatory cytokines, and the
accumulation of intracellular calcium
cations.
CITICHOLINE / CDPcholine
helps increase phosphatidylcholine synthesis and inhibition
of
phospholipase A2 within the injured brain during ischemia
Non-surgical candidates
Patients with small hemorrhages
(<10 mL) or minimal neurological
deficits
Patients with GCS<5 except those
who have cerebellar hemorrhage and
brainstem compression
Patients with hematoma volume >
85 mL
3. Anisocoria
4. Headache, vomit
Grade 0
No symptoms at all
Grade 1
No significant disability despite
symptoms: able to carry out usual duties and
activities
Grade 2
Slight disability: unable to carry
out all previous activities but able to look
after own affairs without assistance
Grade 3
Moderate disability: requiring
some help, but able to walk without
assistance
Grade 4
Moderate severe disability:
unable to walk without assistance, and
unable to attend to own bodily needs
Grade 5
Severe disability: bedridden,
incontinent, and requiring constant nursing
care and attention
Grade 6
Deceased
Long-term
monitoring
Consider CT angiography, MRA,or 4vessel
angiography in suspected cases of
aneurysm, AV malformation or
vasculitis
THANK YOU