Cerebrovascular Diseases 1

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Cerebrovascular Diseases:

Cerebrovascular Diseases Dr Rahul Chakor ,MD.,DM Assoc Prof Dept of Neurology T. N. Medical College B. Y. L. Nair Hospital Mumbai

Objectives:

Objectives CVD Pathology - Infarction, Hemorrhage Definition - Stroke, TIA Ischemic Stroke – Mechanism (Thrombosis, embolism) Vascular pathology – Large vessel, small vessel, atherosclerosis, dissection, vasospasm)

CVD:

Any disease of the brain due to abnormality of cerebral blood supply Disorders of > Cerebral Blood vessels > Heart systemic blood vessels > Blood CVD

CVD - Classification:

CVD - Classification Pathology – Infarction or hemorrhage Cause – Infarction, Hemorrhage, SAH Risk factors – Diabetes, HT, Hypercholesterolemia, smoking, sickle cell disease etc Vascular pathology – Atherothrombosis or embolism, dissection Vascular territory- Anterior circulation, posterior circulation, lacunar Vessel anatomy – Large or small vessels

Classification:

Classification Severity Duration of symptoms Asymptomatic Symptomatic – TIA or stroke Functional outcome

Stroke:

Stroke Acute neurological deficit resulting from focal cerebrovascular disease that lasts > 24hrs Focal neurodeficit – aphasia, hemiparesis, hemianopia, ataxia etc Venous infarcts Subarachnoid hemorrhage

Stroke:

Stroke Two opposing pathological processes Of blood vessels Thrombosis and Hemorrhage

TIA:

TIA Acute neurodeficit from focal cerebrovascular disease with full recovery within 24 hrs – a mini-stroke Most TIAs last < 30 minutes Deficits lasting > 60 minutes usually are irreversible Diffusion MRI abnormalities in irreversible deficits

Stroke:

Stroke Anatomical Classification Large vessel - Carotid or Vertebrobasilar Small vessel - Lacunar

Stroke :

Stroke Causes Infarction (85%) Intracerebral Hemorrhage (10%) Subarachnoid hemorrhage (5%)

Stroke:

Stroke Mechanism and etiology: Infarction Hemorrhage

Infarction:

Thrombosis a common link between three subtypes of ischemic stroke, each having a different etiology. Infarction

Causes of Infarction :

Causes of Infarction Cardioembolism -24% Large artery atherothromboembolism- 35% Arterial Thrombosis (ICA, MCA, VA, BA) Small vessel occlusion (lacunar stroke) – 18% Unknown – 18% Rare – 5%

Slide 14:

Cardiac Embolism IHD Cardiomyopathy CCF AF PFO Valvular Heart disease Atherothrombosis Atherosclerosis Vasculitis Dissection Hypercoagulable state Sickle cell disease

Risk factors for stroke:

Risk factors for stroke Age Gender DM HT Smoking IHD PVD AF Hypercholesterolemia Obesity Elevated Hematocrit TIA Family history of stroke Lack of exercise

Causes of Intracranial Hemorrhage:

Causes of Intracranial Hemorrhage Intracerebral hemorrhage – HT, AVM, Cavernous angioma, amyloid angiopathy, tumors, Anticoagulation SAH – saccular aneurysm, AVM, bleeding disorders

Stroke and TIA mimics:

Stroke and TIA mimics Hypoglycemia Seizure Migraine SDH SOL – Tumor, abscess MS Bells palsy

Evaluation:

Evaluation Is it a stroke Where is the lesion Hemorrhage or infarction Pathological process Risk factors

Ischemic Stroke:

Ischemic Stroke Focal – Involvement of a localized part of brain Does the pattern of neurodeficit fit in an arterial territory Localization – Cerebral arterial distribution

Slide 20:

Circle of Willis

Slide 21:

Cerebral Vascular Territories MCA ACA PCA BA VA LSA AChA PICA AICA SCA

Common presentations:

Common presentations Hemiparesis Hemiplegia Hemisensory loss Aphasia – Global, Broca’s, Wernicke’s Hemiataxia Hemianopsia

Slide 23:

Left arm drift Plantar extensor – Babinski’s sign

Slide 24:

Insular ribbon sign, MCA dot, Hyperdense MCA Diffusion MRI ACA territory stroke

Slide 25:

PCA Infarct PICA Infarct

Slide 26:

Thalamic Lacunes

Slide 27:

Thank You