CEREBROVASCULAR DISORDERS

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CEREBROVASCULAR DISORDERS

• PRESENTED BY
• DR.SUJA PILLAI
• II MD REPERTORY
• GHMC.CALICUT

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INTRODUCTION

• Cerebrovascular diseases include
• ischemic stroke, hemorrhagic stroke
• and cerebrovascular anomalies such
• as intracranial aneurysms and
• arteriovenous malformations.
• Third major cause of death in the developed world.

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DEFINITION

• Stroke is defined as sudden neurological deficit
  due to ischaemia or bleeding involving one or
  more cerebral blood vessels.

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CLASSIFICATION
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RISK FACTORS
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CAUSES OF ISCHAEMIC STROKE
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PATHOGENESIS

• Normal blood flow to brain is 50ml\100g of brain
  tissue per minute.
• Fall of blood flow to 30ml\mt-pt becomes
  stuporose and focal neurological defecit may
  occur.
• Fall of blood flow to 20ml\min-neurological
  defecits worsen.
• Fall of blood flow to 10ml\min-irreversible brain
  damage.

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TRANSIENT ISCHAEMIC ATTACK

• Focal neurological deficits developing suddenly
  and disappearing completely within 24 hrs,without
  any residual abnormality.
• If disability persists beyond 24hrs and upto
  72hrs-RIND
• If disability persists beyond 72hrs but still
  recovers completely-PIND

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• Stroke in
• evolution
• Completed
• stroke

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CLINICAL FEATURES ACCORDING TO ARTERIAL OCCLUSION

• Internal carotid artery-
• Contralateral paralysis of limbs and face.
• Contralateral hemisensory loss
• Aphasia
• Ipsilateral monocular blindness

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• Middle cerebral artery
• Fasio brachial paralysis
• Absence of monocular blindness

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• Anterior cerebral artery
• Weakness of contralateral lower limb and upper
  limb
• Face is spared

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• Posterior cerebral artery
• Severe sensory loss and mild hemiparesis
  contralaterally
• Hyperpathia

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• Vertebral artery
• Wallenberg Syndrome-sensory impairment over the
  face,Horners syndrome,ataxia on ipsilateral side
  and impaired pain and temperature sensatiom on
  contralateral side.

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• Basilar Artery
• Coma
• Death

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LACUNAR INFARCTION

• The term lacunar infarction refers to infarction
  following atherothrombotic or lipohyalinotic
  occlusion of a small artery (30300 m) in the
  brain.
• Small-vessel strokes account for 20 of all
  strokes
• Hypertension and age are the principal risk
  factors.

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CLINICAL MANIFESATIONS

• (1) Pure motor hemiparesis , the face, arm, and
  leg are almost always involved
• (2) pure sensory stroke
• (3) ataxic hemiparesis
• (4) dysarthria and a clumsy hand
• or arm.

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INVESTIGATIONS

• CT SCANS

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MRI
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CEREBRAL ANGIOGRAPHY
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• PET
• SPECT

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MANAGEMENT

• (1) medical support
• (2) intravenous thrombolysis
• (3) endovascular techniques
• (4) antithrombotic treatment
• (5) neuroprotection
• (6) stroke centers and rehabilitation.

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THANK YOU