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A. Valencia, M.D.
The biology of stroke
is such that each
moment of ischemia
and tissue injury
increases the degree
of irreversible tissue
damage.
CEREBROVASCULAR ACCIDENT OR BRAIN ATTACK
Increased age
Being male
Race (e.g., African-Americans)
Diabetes mellitus
Prior stroke/transient ischemic attacks
Family history of stroke
Asymptomatic carotid bruit
Up to approximately 30% of people who suffer
transient attacks (TIAs) will develop a stroke within 5
years.
Relative Incidence of Atherothrombotic
Stroke and MI by Age and Gender
Death Rates for Stroke per 100,000 Population
Groups Defined by Race, Age, and Gender: 1993
Risk Factor For Stroke: Treatable
Major
Hypertension
Heart disease, esp. atrial fibrillation
Cigarette smoking
Transient ischemic attacks
Dyslipidemia
Physical inactivity
Obesity
Geography/climate
Socieconomic factors
The Stroke Belt
Potential Genetic Risk Factors for Stroke
Apolipoprotein E4
Factor V mutation
ATHEROSCLEROSIS AND THROMBOSIS
Functional alteration of
endothelial cell layer
Denuding of endothelium
Superficial intimal injury
Cardiogenic emboli
lodge in the middle
cerebral artery or its
branches in 80% of
cases, in the posterior
cerebral artery or its
branches 10% of the
time, and in the vertebral
artery or its branches in
the remaining 10% of
cases.
Major Blood Vessels Of The Brain
Major Blood Vessels Of The Brain
Control Centers of the Brain
Cellular Injury During Ischemia
Neuronal Function: Importance of Oxygen and Glucose
History and PE
Computed Tomography (CT) scan of the
head
12-lead EKG, chest X-ray
Complete blood count, PT, PTT
Chemistries (sodium, phosphate, glucose
abnormalities may mimic stroke)
Urine and serum toxicology (drugs and
alcohol)
Under special circumstances, the following
tests may be required:
Hypotension
Hyperglycemia
Hyperthermia
Infection
Cerebral hypoperfusion
Brain Edema
TREATMENT OF BRAIN SWELLING
Cerebral perfusion pressure =MAP-ICP