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Acute brain attack 911
- 1. ACUTE BRAIN ATTACK - 911 RUBEN T. DELA CRUZ MD, FPNA ACUTE STROKE UNIT- MANILA ADVENTIST MEDICAL CENTER
- 13. CBC, PT/ PTT, Blood sugar Plain Cranial CT EMERGENT DIAGNOSTIC EXAM SSP Guidelines for the Prevention & Management of Brain Attack, 2003 Electrocardiogram
- 21. Early signs of infarction on Cranial CT Dense Artery sign Insular Ribbon sign (loss of insular stripe) Obscuration of lentiform nuclei Effacement of sulci
- 23. CT FINDINGS in SUBACUTE / CHRONIC INFARCTION Wedge-shaped large cortical infarct Round / ovoid small subcortical infarcts
- 24. Subacute R-ICA infarct Subacute L-MCA infarct CT FINDINGS in SUBACUTE / CHRONIC INFARCTION
- 25. Hyperdense lesion in left lentiform nucleus with hypodense rim (vasogenic edema) CT FINDINGS in INTRACEREBRAL HEMORRHAGE
- 26. Common Sites of Hypertensive ICH
- 27. Common Sites of Hypertensive ICH
- 31. CT SCAN FINDINGS in SUBARACHNOID HEMORRHAGE
- 33. Early signs of infarction on MRI Slow flow (absence of normal flow void) in involved artery Parenchymal signal changes (hypointense on T1) T1 DWI: acute infarct appears bright Parenchymal signal changes (hyperintense on T2) T2
- 34. R medullary Infarction T1 T2 MAGNETIC RESONANCE IMAGING in BRAINSTEM INFARCTION R Pontine Infarction
- 36. MRI is not sensitive in detecting ACUTE HEMORRHAGE Cranial MRI Cranial CT scan Pontine Hemorrhage
- 40. Transcranial Doppler (TCD) Carotid/vertebral Duplex VASCULAR ULTRASOUND “ NEUROSONOLOGY ”
- 44. MAGNETIC RESONANCE ANGIOGRAPHY CT ANGIOGRAPHY Other Non-Invasive Neurovascular Imaging Procedures
- 45. Severe Carotid Stenosis CATHETER ANGIOGRAPHY Vertebral Artery Stenosis MCA Stenosis “ Gold standard”
- 47. CARDIAC EVALUATION Holter Monitoring 2 D Echocardiography
- 74. CIFIC TREATMENT
Notes de l'éditeur
- Worldwide at any given time 15 million stroke survivors are awaiting a second stroke. Locally 400,000 stroke victims are waiting for the next one.
- Defined as can raise arm above shoulder, clumsy hand, or can ambulate without assistance d. Like gait disturbance, unsteadiness, or clumsy hand.
- Motor strength- 0-2/5; sensory complete hypo/anesthetic; global aphasia
- The diagnosis of stroke is relatively straightforward. 80% of the diagnosis rely on clinical evaluation of the patient through the history, PE and Neurological Examination. One of the importance of a good Clinical Diagnosis of stroke is to Establish the Time of Onset of Symptoms with the anticipation of giving Thrombolysis. However, diagnostic errors based solely on clinical features still occur and the level of accuracy is insufficient to guide treatment decisions. Because clinical findings overlap, a brain imaging study is mandatory to distinguish ischemic stroke from hemorrhage or other structural brain lesions that may imitate stroke.
- Therefore the Role of the Diagnostic Exam in Stroke is to . .
- The more common stroke mimickers include . .
- The Stroke Society of the Philippines came out with a consensus regarding the likelihood of an event NOT being a stroke and includes . .
- The SSP Guidelines recommend the Emergent Diagnostic Exams to include:
- Second line diagnostic studies are done to identify etiology and stroke mechanism. This includes...
- Neuroimaging is an important part of the evaluation and treatment of acute stroke. The plain CT scan is recommended as a first line modality in suspected stroke cases. It is...
- In a CT scan performed in patients with hyperacute stroke, 60% will turn out to be normal. However, the following signs may be seen:
- The Hyperdense MCA sign is not yet indicative of infarction. The territory supplied is at risk for hypoperfusion. Whether infarction will take place depends on the collateral blood supply and recanalization. The loss of the insular stripe, obscurationof the lentiform nuclei and effacement of the sulci are indirect signs of a beginning edema from an infarction.
- In acute ischemic stroke, the CT will show infarction of brain tissue as a...
- In subacute and chronic infarctions, the area affected will have evidence of hypodensity that is hard to miss. Large cortical infarcts tend to be wedge-shaped while small subcortical infarcts are usually round and ovoid.
- CT findings in intracerebral hemorrhages are quite distinct. They are hyperdense lesions that may or may not have a hypodense rim that suggests edema.
- The most common cause of ICH is secondary to hypertension. It is important to note these common sites of ICH.
- In SAH, the CT will show hyperdensities along the subarachnoid spaces, in between the sulci. This slide shows the diffuse distribution of the subarachnoid blood specially in the Sylvian fissures.
- The MRA is another neurovascular imaging modality that is often used. It is an important non-invasive imaging of the vessels. One of its limitations however is the tendency to overestimate stenosis and is not reliable in detecting distal or branch intracranial occlusion.
- Still, the gold standard for imaging the anterior and posterior circulation is the conventional 4 vessel angiography. It is used to determine the severity of stenosis and detection of …
- AV malformations, aneurysms, venous angiomas and similar vascular abnormalities…
- The cardiac evaluation is an important part of the evaluation of a patient with a stroke.