update ischemic stroke 2016

MANAGEMENT OF ACUTE STROKE
(ISCHEMIC STROKE)

Dr. Truong Dinh Tri
Resident, general internal medicine



DEFINITION OF STROKE
A NEUROLOGICAL DEFICIT OF
 Sudden onset
 With focal rather than global dysfunction
 In which, after adequate investigations,
symptoms are presumed to be of non-traumatic
vascular origin
 and last for >24 hours



ISCHEMIC STROKE PATHOPHYSIOLOGY
The First Few Hours
“TIME IS BRAIN:
SAVE THE PENUMBRA”

Penumbra

Core

Penumbra is zone of
reversible ischemia around
core of irreversible infarction

—salvageable in first few
hours after
ischemic stroke onset
Penumbra damaged by:
• Hypoperfusion
• Hyperglycemia
• Fever
• Seizure

Clot in
Artery

The typical patient loses 1.9 million neurons
each minute in which stroke is untreated



Stroke Risk Factors Non-modifiable
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AGE
Gender -male
Race – Blacks > Asians or Hispanics> Whites
Family Hx.
Coagulation Disorders

Cardiac Disease


Stroke Risk Factors Modifiable
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Hypertension
Diabetes mellitus
Hypercholesterolemia
Elevated LDL or Low
HDL
Elevated homocystein
Smoking
Drug abuse

Alcohol Abuse
 Oral Contraceptives
 Pregnancy
 Migraine Headaches
 Obesity
 Sleep apnea
 Carotid stenosis
A combination of these

risk factors will increase
risk of stroke!
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