STROKE

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STROKE

• The third leading cause of death in the United
  States
• Killed 157,991 people in 1995accounted for 1 of
  every 15 deaths
• On the averageone stoke every minuteone death
  from stroke every 3.4 min

N Eng J Med. 19953331392-4000
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Pathophysiologic Mechanisms in cerebral ischemia
and infarction

• Atheroembolic stroke (15)
• Cardioembolic stroke (20)
• Cryptogenic strokes (30)
• Atherothrombotic stroke (1-5)
• Lacunar stroke (20-25)

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Pathophysiologic Mechanisms in cerebral ischemia
and infarction

• Atheroembolic stroke (15) A common form with
  atherosclerotic damage to the aortic arch,
  carotid bifurcation or intracranial vessels that
  produces local thrombosis and distal embolism
• Cardioembolic stroke (20) Embolism from a
  cardiac source usually arise from atria and is
  termed

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Pathophysiologic Mechanisms in cerebral ischemia
and infarction

• Cryptogenic strokes (30) sudden occlusion of a
  large intracranial vessel and with no apparent
  cause despite extensive evaluation
• Atherothrombotic stroke (1-5)thrombosis of
  large (0.5-3mm) intracranial vessels in situ from
  atherosclerosis
• Lacunar stroke (20-25) Thrombosis of smaller
  intracranial vessels (30-100mcm) in contrast to
  larger vessels

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STROKE

• The leading cause of adult disability
• Risk greatest among the elderly, men, and blacks
• Signs, symptoms or risk factors unknown to most
  people
• Death rate 10 higher in the southeastern states
  (stroke belt)

Medicine 199635-41
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The Stroke Belt

• 12 states and the District of Columbia have stoke
  death rates more than 10 higher than the rest of
  the country
• higher than average black population
• higher than average elderly population
• dietary factors

National Stroke Association
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Carotid Stenosis

• Atherosclerotic carotid artery disease is
  responsible for 10 of ischemic stokes
• for patients with recent symptomatic carotic
  stenosis of gt 70, carotid endarterectomy can
  reduce the rate of subsequent strokes

Stroke 198819547-54
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NASCET Trial

• Atherosclerotic carotid artery disease is
  responsible for 10 of ischemic stokes
• for patients with recent symptomatic carotic
  stenosis of gt 70, carotid endarterectomy can
  reduce the rate of subsequent strokes

N Engl J Med. 1991325445-53