Boala vasculara cerebrala

Sistemul arterial cerebral

INCIDENTA: toate tipurile de AVC

Incidenta primului AVC, orice tip, pe grupe de
varsta si sex, in Europa
45
40
35

in rates per 1000

30
25
20
15
10
5
0
55-59

60-64

65-69

70-74

75-79

80-84

85-89

90+

Age ranges
Males

Females

6 statistici, ambulatori si institutionalizati

Incidenta medie 65 - 84:
Incidenta medie 75 + :

8.72 / 1 000 ambe sexe

17.31 / 1 000 ambe sexe

Subtipuri de AVC (CT, RMN)

AVC
15%
85%

Hemoragic

. Intraparenchimatos
. Subarahnoidian

Ischemic
20%

Boala aterosclerotica
vas mare

25%

20%

Artere penetrante
( Lacunar )

Embolie
cardiogena
.
.
.
.

FIA
Valvulopatii
Trombi intraventriculari
Altele

30%

5%

AVC
criptogenic

Cauze rare
.
.
.
.
.
.

Stari protrombotice
Disectii arteriale
Arterite
Migrena/Vasospasm
Abuz droguri
Altele

Ischemia cerebrala
Accident vascular cerebral constituit
- durata peste 3 ore
- leziune teritoriu arterial superficial / profund
- invaliditate / deces

Accident vascular cerebral tranzitor

- durata sub 3 ore
- leziune nedecelabila imagistic (+/-)
- recuperare integrala

Etiopatogenie
Boala aterosclerotica
Extracerebrala: aorta
Cerebrala:
Vas mare: tromboza in situ,
embolie arterio-arteriala
Vas mic: lipohialinoza, necroza->
tromboza in situ / hemoragie

Boala cardiaca

FIA
Boala mitrala (stenoza)
Anevrism sept, ventricul
IMA

Fiziopatologie
Necroza ischemica
Central
Perfuzie < 10 ml/100g/min
Ireversibila

Penumbra

Perfuzie < 30 ml/100g/min

Recuperabila
Apoptoza
Metab

Edem vasogenic -> metab

anaerob -> edem citotoxic

Diagnostic clinic
Debut brusc
Deficit neurologic focal: motor, senzitiv,
vizual, limbaj
salt tensional asociat (compensator!)
cefalee

Diagnostic paraclinic

CT / IRM
examen ultrasonografic vascular / cardiac
profil lipidic
profil biologic
teste hematologice

Tratament

Tratamentul fazei acute

Recanalizare: tromboliza - r-TPA
antiedematos
simptomatic
profilaxia complicatiilor: edem cerebral
(HIC), TVP TEP, complicatii decubit,
aspiratie (bronhopneumonie)
decompresie terapeutica de necesitate

Profilaxia secundara
Medical:
antitrombotic: aspirina, clopidogrel, dipiridamol +
aspirina
Anticoagulant: numai AVC cardioembolice confirmate

tratamentul factorilor de risc: IEC/ sartani, statine

Chirurgical:
endarterectomie
Stent

Profilaxia primara
= Tratamentul factorilor de risc:
HTA
dislipidemie
diabet
boli cardiace
fumat, alcool, droguri