Tai biến mạch máu não STROKE PGS TS nguyễn đình toàn

STROKE
TAI BIẾN MẠCH MÁU NÃO
ThS Nguyễn Đình Toàn


ĐỊNH NGHĨA


Definition Of Stroke
• “Rapidly developed clinical sign of focal
disturbance of cerebral function of
presumed vascular origin and of more
than 24 hours” WHO
• TIA (Transient Ischaemic Attack)
recovery is complete within 24 hours.
10% of patients will go on to have a
stroke.


CƠ SỞ GIẢI PHẨU HỌC






DỊCH TỂ HỌC
• Stroke is the third largest killer in the
Western World.
• It accounts for up to 6% of in-patient
hospital costs in Scotland.

• Stroke is one of the major causes of
disability, particularly in the elderly.
• Stroke patients may present with a
variety of physical, cognitive and
psychosocial problems.
• Most stroke patients show signs of
recovery over time.


DỊCH TỂ HỌC
• Incidence

(WHO) 150-250/100.000 dân
Việt nam 20-35/100.000 dân
• prevalence (WHO) 500-700/100.000
dân
Việt nam 45-85/100.000 dân
Huế 61,60/100.000 dân
Mỹ: 750.000/năm
• Mortality 35-240/100.000 dân
• Chi phí điều trị > 60 tỷ dollars/năm (Mỹ)



Sub-types Of Stroke
• Ischaemic – obstruction to one of major

cerebral arteries, brainstem strokes are
less common.
• Haemorrhage – 9% are caused by

haemorrhage to the deep parts of the
brain. Patients are usually
hypertensive.


CƠ CHẾ BỆNH SINH





•Risk

Factors


•OBESIT
Y



DRUG ABUSE


• OLD AGE
• Wee Betty lived a
long and fruitfull
life, RIP Betty
(1875-1997).
That’s 122 years

don’t you know!


ALCOHOL



What are the symptoms?

If stroke effect CNS pathways, symptoms may include:
• muscle weakness (Hemiplegia)
• numbness
• reduction in sensory or vibratory sensation
If stroke effect the brainstem, symptoms may include:
• altered smell, taste, hearing, or vision (total or partial)
• drooping of eyelid and weakness of ocular muscles
• decreased reflexes: gag, swallow, pupil reactivity to light
• decreased sensation and muscle weakness of the face
• balance problems
• altered breathing and heart rate
• weakness in sternocleidomastoid muscle (SCM) with inability to turn head to one side
• weakness in tongue (inability to protrude and/or move from side to side)
If the cerebral cortex is involved, symptoms may include:
• aphasia (inability to speak or understand language from involvement of Broca's or
Wernicke's area)
• apraxia (altered voluntary movements)
• visual field cut(involvement of occipital lobe)
• memory deficits (involvement of temporal lobe)
• hemineglect (involvement of parietal lobe)
• disorganized thinking, confusion, hypersexual gestures (with involvement of frontal

lobe)
If the cerebellum is involved, symptoms may include:
• trouble walking
• altered movement coordination
• vertigo and or disequilibrium


CHẨN ĐOÁN XÁC ĐỊNH
• Dấu thần kinh khu trú
• Xảy ra đột ngột
• Không do chấn thương