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An overview of the approach to a patient presenting with symptoms suggestive of a CVA
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Approach to a patient with stroke
1.
Ashwin Haridas Asem
Ali Ashraf Adam Ebrahim
2.
3.
4.
5.
6.
Anterior Circulation Posterior
Circulation
7.
Middle Cerebral Artery
8.
Anterior Cerebral Artery
9.
Posterior Cerebral Artery
10.
11.
12.
13.
14.
15.
16.
Etiology of ischemic
stroke
17.
18.
19.
20.
ATP depletion Hypoperfusion
Failure of Na + /K + ATPase membrane ionic pump Calcium entry Glutamate release Activation of lipid peroxidases, proteases & NO synthase Destruction of intracellular organelles, cell membrane & release of free radicals Free fatty acid release Activation of pro-coagulant pathways Liquefactive necrosis Thrombus/embolus Membrane depolarization & cytotoxic cellular edema
21.
22.
23.
24.
25.
CLINICAL FEATURES
26.
27.
28.
29.
30.
31.
‘ HAND OF
GOD’
32.
CLINICAL CLASSIFICATION
33.
34.
35.
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37.
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40.
41.
42.
43.
44.
45.
46.
47.
48.
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50.
51.
52.
53.
54.
55.
56.
PATHOLOGICAL TYPES
STROKE HAEMORRHAGIC ISCHAEMIC
57.
58.
59.
ISCHAEMIC LESION
60.
CT SCAN/MRI VASCULAR
NATURE CONFIRMED HAEMORRHAGE ISCHAEMIA Cont’d… STROKE PATIENT
61.
SEARCH FOR SOURCE
Cont’d… SEARCH FOR SOURCE CEREBRAL ARTERIOGRAPHY MRA/CTA DOPPLER PET/SPECT
62.
63.
Carotid Artery Ultrasound
Showing a Completely Calcified Atherosclerotic Plaque
64.
65.
3-D reconstruction of
CT angiogram showing stenosis at the carotid bifurcation
66.
Intra-arterial angiography showing
arteriovenous malformation
67.
MR angiogram showing
giant aneurysm at the middle cerebral artery bifurcation
68.
HAEMORRHAGE CONFIRMED NORMAL
CT SCAN HAEMORRHAGE SUSPECTED LUMBAR PUNCTURE CSF WITH BLOOD/ XANTHOCHROMIA
69.
70.
71.
72.
73.
74.
75.
76.
77.
EARLY MANAGEMENT
78.
79.
80.
81.
82.
83.
84.
85.
86.
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92.
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