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STROKE What should we know?

Learn about stroke, its types, effects, recognition, and treatment options. Discover the importance of stroke prevention and the potential for stroke recovery.

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STROKE What should we know?

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  1. STROKE What should we know? Dr. Gourav Goyal MD, DM (Neurology) Fellowship in stroke & Neuro-intervention Assistant Professor, Department of Neurology, MGMCH

  2. 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”

  3. 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”

  4. THREE STROKE TYPES Focal Brain Dysfunction Intracerebral Hemorrhage Bleeding into brain Subarachnoid Hemorrhage Bleeding around brain Ischemic Stroke Clot occluding artery 85% 10% 5% Diffuse Brain Dysfunction

  5. STROKE – CEREBROVASCULAR ACCIDENT

  6. CEREBROVASCULAR DISEASE: PATHOGENESIS Ischemic Stroke (83%) Hemorrhagic Stroke (17%) Atherothrombotic Cerebrovascular Disease (20%) Intracerebral Hemorrhage (59%) Cryptogenic (30%) Subarachnoid Hemorrhage (41%) Lacunar (25%) Small vessel disease Embolism (20%) Albers GW, et al. Chest. 1998;114:683S-698S. Rosamond WD, et al. Stroke. 1999;30:736-743.

  7. WHAT ARE THE EFFECTS OF STROKE? • Left Brain

  8. WHAT ARE THE EFFECTS OF STROKE? • Right Brain

  9. ISCHEMIC CEREBROVASCULAR BED

  10. WEAKENED BLOOD VESSELS IN A HYPERTENSIVE BLEED

  11. AUTOPSY OF INTRACEREBRAL HEMORRHAGE

  12. SMALL HEMORRHAGIC STROKE

  13. LARGE HEMORRHAGIC STROKE

  14. 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”

  15. 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

  16. Acute Stroke Treatments • Ischemic stroke (brain clot) – Clot busting medication: tPA (tissue plasminogen activator) – Clot-removing devices • Hemorrhagic stroke (brain bleed) – Medical management – Surgical

  17. “Time is brain” Excitotoxicity Peri-infarct depolarisations Inflammation Impact Apoptosis Days Hours Minutes Time

  18. Potential to Reverse Neurologic Impairment With Thrombolytic Reperfusion Ischaemic core (brain tissue destined to die) Penumbra (salvageable brain area) 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

  19. Thrombolysis Alteplase rTPA 0.9mg /Kg 10% of total dose –Bolus 2-3 mins 90% of total dose –Infuse over 60 mins

  20. Intra-arterial thrombectomy

  21. Intra-arterial thrombectomy

  22. Cerebral infarct - onset Onset Infarct Ischaemic penumbra

  23. Cerebral infarct – 6 hours 6 Hours Infarct Ischaemic penumbra

  24. Cerebral infarct – 24 hours 24 Hours Infarct Ischaemic penumbra

  25. Without thrombolysis 2hrs

  26. 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

  27. 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.

  28. 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!

  29. 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

  30. ‘Time is Brain’ Thank you….

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