Ischemic Stroke
Peng BinPeng Bin
Department of Department of
Neurology,Peking Union Neurology,Peking Union
Medical College HospitalMedical College Hospital
What do we need to know……
Definition and classificationDefinition and classification
Vascular anatomyVascular anatomy
MechanismMechanism
Clinical featuresClinical features
Diagnosis and differentiate diagnosisDiagnosis and differentiate diagnosis
TreatmentTreatment
Definition
Stroke:Stroke:
World Health Organization (WHO) has defined stroke World Health Organization (WHO) has defined stroke
as “rapidly developing clinical signs of focal (at times as “rapidly developing clinical signs of focal (at times
global) disturbance of cerebral function, lasting more than global) disturbance of cerebral function, lasting more than
24 hours or leading to death with no apparent cause other 24 hours or leading to death with no apparent cause other
than that of vascular origin.” than that of vascular origin.”
Ischemic stroke:Ischemic stroke:
deprivation of blood flow to an area of the brain, generalldeprivation of blood flow to an area of the brain, generally as a result of thrombosis, embolism, or reduced blood pressure.y as a result of thrombosis, embolism, or reduced blood pressure.
------OnsetOnset : Rapidly : Rapidly
------SymptomSymptom: Focal or global : Focal or global
cerebral dysfunctioncerebral dysfunction
------DurationDuration: More than 24 hours: More than 24 hours
------Vascular originVascular origin: :
Classification of Ischemic Stroke
Atherothrombotic cerebral infarctionAtherothrombotic cerebral infarction
Cerebral embolismCerebral embolism
Lacunar infarctionLacunar infarction
Cerebral watershed infarctionCerebral watershed infarction
Vascular Anatomy
The brain is perfused by the carotid The brain is perfused by the carotid
and vertebral arteriesand vertebral arteries
---Anterior circulation : carotid ---Anterior circulation : carotid
artery ,etcartery ,etc
---Posterior circulation: vertebrobasilar ---Posterior circulation: vertebrobasilar
artery.artery.
Clinical manifestations
Ischemic syndromes of specific Ischemic syndromes of specific
vessels depend onvessels depend on
----- the site of the occlusion ----- the site of the occlusion
----- the presence of previous brain ----- the presence of previous brain
damagedamage
----- collateral circulation----- collateral circulation
Example
Internal carotid artery Internal carotid artery
occlusion(MCA+ACA)occlusion(MCA+ACA)
* * SymptomaticSymptomatic
--Contralateral hemiparesis--Contralateral hemiparesis
--Hemianesthesia --Hemianesthesia
--Hemianopia --Hemianopia
**AsymptomaticAsymptomaticMCA
ACA
Diagnosis
Onset Onset
Causes or risk factorsCauses or risk factors
Clinical featuresClinical features
---Stroke syndromes---Stroke syndromes
TestsTests
---Brain CT scan---Brain CT scan
---Brain MRI---Brain MRI
---TCD,CTA or DSA---TCD,CTA or DSA
General Management
Standard frequency of observations Standard frequency of observations
and monitored parametersand monitored parameters
Deep vein thrombosis (DVT) Deep vein thrombosis (DVT)
prophylaxisprophylaxis
Treatment of increased blood sugar Treatment of increased blood sugar
levels (BSL)levels (BSL)
Treatment of increased temperatureTreatment of increased temperature
Treatment of increased blood pressure Treatment of increased blood pressure
(BP)(BP)
Specific treatment
Thrombolytic therapy Thrombolytic therapy
--Intravenous thrombolytic --Intravenous thrombolytic
therapy with rt-PAtherapy with rt-PA
--Intraarterial thrombolytic --Intraarterial thrombolytic
therapytherapy
Inclusion CriteriaInclusion Criteria
--Patient or family are able to indicate consent--Patient or family are able to indicate consent
--Age --Age >> 18 18
--Onset of stroke symptoms defined, and --Onset of stroke symptoms defined, and
within within 4.5 hours4.5 hours of commencement of infusion of commencement of infusion
--Moderate to severe neurological deficit --Moderate to severe neurological deficit
(NIHSS (NIHSS >> 7 and < 25) 7 and < 25)
Exclusion CriteriaExclusion Criteria
----TimeTime of onset unknown, patient awoke with of onset unknown, patient awoke with
deficitdeficit
Antiplatelet therapyAntiplatelet therapy
AnticoagulationAnticoagulation
--Indications :--Indications : Atrial fibrillation Atrial fibrillation
(chronic or paroxysmal) (chronic or paroxysmal)
--Contraindications--Contraindications
Secondary PreventionSecondary Prevention
Specific Interventions
Carotid endarterectomyCarotid endarterectomy
Angioplasty/stentingAngioplasty/stenting : Extracranial : Extracranial
(carotid) and intracranial (carotid) and intracranial
After class
Definition and vascular anantomyDefinition and vascular anantomy
Diagnosis and treatmentDiagnosis and treatment
Suggested readingsSuggested readings
---Cerebralvascular disease 4---Cerebralvascular disease 4thth
editonediton
---Merrit’s Handbook of Neurology---Merrit’s Handbook of Neurology