Stroke Education

STROKE

What should we know?

Dr. Gourav Goyal

MD, DM (Neurology)

Fellowship in stroke & Neuro-intervention

Assistant Professor, Department of Neurology, MGMCH

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STROKE - INTRODUCTION • Stroke remains one of the major public health problems in

India and worldwide accounting for 3rd highest mortality rates

• Also previously called cerebrovascular accident (CVA) or stroke syndrome, causes include thrombosis, embolism, and hemorrhage.

• WHO explains stroke, a cerebro-vascular event as “the interruption of the blood supply to the brain, usually because a blood vessel bursts or is blocked by a clot.

• This cuts off the supply of oxygen and nutrients, causing damage to the brain tissue”



Perceptions of Stroke Myth – Stroke:

Is not preventable

Cannot be treated

Only strikes the elderly

Happens in the heart

Reality :

Up to 80 percent of strokes are preventable

Stroke requires emergency treatment

Anyone can have a stroke

Stroke is a “Brain Attack”


THREE STROKE TYPES

Ischemic

Stroke

Clot occluding

artery

Intracerebral

Hemorrhage

Bleeding

into brain

Subarachnoid

Hemorrhage

Bleeding

around brain

Focal Brain Dysfunction

Diffuse Brain Dysfunction

85% 10% 5%


STROKE – CEREBROVASCULAR ACCIDENT


CEREBROVASCULAR DISEASE:

PATHOGENESIS Ischemic Stroke (83%) Hemorrhagic Stroke (17%)

Atherothrombotic

Cerebrovascular

Disease (20%)

Embolism (20%) Lacunar (25%)

Small vessel disease

Cryptogenic (30%)

Intracerebral

Hemorrhage (59%)

Subarachnoid Hemorrhage (41%)

Albers GW, et al. Chest. 1998;114:683S-698S.

Rosamond WD, et al. Stroke. 1999;30:736-743. All copy rights reserved with Docconsult Seveces

WHAT ARE THE EFFECTS

OF STROKE? • Left Brain


WHAT ARE THE EFFECTS

OF STROKE? • Right Brain


ISCHEMIC CEREBROVASCULAR BED


WEAKENED BLOOD VESSELS

IN A HYPERTENSIVE BLEED


AUTOPSY OF INTRACEREBRAL HEMORRHAGE


SMALL HEMORRHAGIC STROKE


LARGE HEMORRHAGIC STROKE


HOW DO WE RECOGNIZE A

STROKE?

Stroke Strikes FAST

• F = FACE: Ask the person to smile.

• A = ARM: Ask the person to raise both arms.

• S = SPEECH: Ask the person to speak a

simple sentence.

• T = TIME

“If you observe any of these signs, call emergency

immediately”



People Don’t Respond to Symptoms

Don’t recognize symptoms

Denial

Think nothing can be done

Worry about cost

Think symptoms will go away

Fear or don’t trust hospitals


Acute Stroke Treatments

Ischemic stroke (brain clot) – Clot busting medication: tPA (tissue

plasminogen activator) – Clot-removing devices Hemorrhagic stroke (brain bleed) – Medical management – Surgical


“Time is brain”

Estimated Pace of Neural Circuitry Loss In Typical Large-Vessel Supratentorial Acute

Ischaemic Stroke

Neurons Lost Synapses Lost Myelinated Fibres Lost Accelerated Aging

Per Stroke 1.2 billion 8.3 trillion 7140 km 36 y

Per Hour 120 million 830 billion 714 km 3.6 y

Per Minute 1.9 million 14 billion 12 km 3.1 wk

Per Second 32,000 230 million 200 m 8.7 h

Minutes Hours Days

Inflammation Peri-infarct

depolarisations

Excitotoxicity

Imp

act

Apoptosis

Time


Potential to Reverse Neurologic

Impairment With Thrombolytic Reperfusion

An untreated patient loses

approximately 1.9 million

neurons every minute in the

ischaemic area

Reperfusion offers the

potential to reduce the extent

of ischaemic injury

Ischaemic core

(brain tissue

destined to die)

Penumbra

(salvageable

brain area)


Thrombolysis

Alteplase rTPA

0.9mg /Kg

10% of total dose –Bolus 2-3 mins

90% of total dose –Infuse over 60

mins


Intra-arterial thrombectomy


Intra-arterial thrombectomy


Onset

Infarct

Ischaemic

penumbra

Cerebral infarct - onset


6 Hours

Infarct

Ischaemic

penumbra

Cerebral infarct – 6 hours


Cerebral infarct – 24 hours

24 Hours

Infarct

Ischaemic

penumbra


Without thrombolysis

2hrs


Stroke Prevention

• Know your blood pressure. Have it

checked at least annually. If it is elevated,

work with your healthcare professional to

control it.

• Find out if you have atrial fibrillation (Afib)

– a type of irregular heartbeat. If you have

it, work with your doctor to manage it.

• If you smoke, stop All copy rights reserved with Docconsult Seveces

Stroke Prevention

• If you drink alcohol, do so in moderation.

• Know your cholesterol number. If it is high, work with your doctor to control it.

• If you are diabetic, follow your doctor’s recommendations carefully to control your diabetes.


Stroke Prevention

• Include exercise in your daily routine

• Enjoy a lower sodium (salt) and lower fat diet

• If you have circulation problems, work with your doctor to improve your circulation.

• If you experience any stroke symptoms, call emergency immediately.

Every minute matters!

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Why prevention is important?

Stroke Recovery 10 percent of stroke survivors recover

almost completely 25 percent recover with minor impairments 40 percent experience moderate to severe

impairments requiring special care 10 percent require care within either a

skilled-care or other long-term care facility 15 percent die shortly after the stroke 15 percent die shortly after the stroke


‘Time is Brain’

Thank you….


Health & Medicine

Stroke Education