Cerebrovascular Accident Stroke PPT| Symptoms of Brain Attack| Transient Ischemic Attack| Symptoms of Brain Aneurysm| Symptoms of Transient Ischemic Attack: SlideWorld Medical PPT Search Engine

Cerebrovascular Accident Stroke, Brain Attack

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Slide 1 :

1 Cerebrovascular Accident (Stroke, Brain Attack) Sudden onset of focal neurologic deficit resulting from infarction or hemorrhage within the brain 85% nonhemorrhagic 15% hemorrhagic

Slide 2 :

2 Transient Ischemic Attack (TIA) Sudden & temporary loss of motor, sensory, or visual dysfunction (< 6 hrs.) S/S: *amaurosis fugax (loss of vision), contralateral weakness, or aphasia *vertigo, diplopia, numbness or paresthesias, dysphagia, ataxia

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3 Management of TIA Medical: Anticoagulants Aspirin Tx. hypertension, diabetes Surgical: Carotid endarterectomy, stenting Angioplasty

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4 Incidence of CVA 3rd leading cause of death 730,000 strokes/year 160,000 deaths/year 2x higher in African-Americans 4,000,000 stroke survivors in U.S.

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5 Signs/Symptoms of Brain Attack Dysphagia, dysarthria Global aphasia, expressive & receptive aphasia Hemiparesis or hemiplegia of face, arm, and leg on same side

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6 Signs/Symptoms of Brain Attack Paresthesia--numbness, difficulty with proprioception Ataxia, dizziness Apraxia Visual deficits--homonymous hemianopsia, loss of peripheral vision, diplopia, loss of depth perception

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7 Signs/Symptoms of Brain Attack Sudden, severe headache Disoriented time, place, person. Unaware of neuro deficits Memory loss Quick anger, frustration

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8 Right & Left Hemisphere CVA feature left right language *aphasia *impaired sense of humor memory *deficit *disoriented

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9 Right & Left Hemisphere CVA feature left right vision *deficit right *spatial deficits visual field *neglect left visual field *problem *loss of depth reading perception behavior *slow *impulsive *cautious *euphoric

Slide 10 :

10 Risk Factors for CVA Hypertension Diabetes mellitus, hypothyroidism Heart disease Nonvalvular atrial fibrillation Prosthetic heart valve Smoking Substance abuse

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11 Risk Factors for CVA Obesity Sedentary lifestyle Family history High stress levels Previous CVA or TIA Elevated cholesterol Heavy alcohol use

Slide 12 :

12 Risk Factors for CVA Oral contraceptives Dehydration Polycythemia Carotid atherosclerosis Arterio-venous malformation Aneurysms Sickle cell anemia

Slide 13 :

13 Diagnostic Tests for CVA Carotid ultrasonography Cerebral angiography Positron Emission Tomography (PET) Magnetic Resonance Angiography Digital subtraction angiography ECG, Holter monitor EEG

Slide 14 :

14 Diagnostic Tests for CVA Echocardiogram CT scan Magnetic Resonance Imaging Functional MRI Diffusion/Perfusion MRI Noninvasive carotid studies Labs--PT, PTT, antiphospholipid antibodies, glucose, lytes, CBC, ABGs

Slide 15 :

15 Computerized Axial Tomography--CT Imaging Scans successive layers of brain tissue with x-ray beams Ischemic--hypo density is gray to black vs Hemorrhagic--high density lesion is white

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16 Ischemic Brain Attack Management Maintain airway--oxygenate Neuro assessment Treat with tPA (tissue plasminogen activator) within 3 hours

Slide 17 :

17 Ischemic Brain Attack Management Correct hypoglycemia, watch for hyperglycemia No free water IV fluids Raise serum osmolality to 310 mOs/L

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18 Ischemic Brain Attack Management Treat hypertension if > 180/100 Control seizures--diazepam, lorazepam, phenytoin Neuro protective agents--nimodipine Maintain normal ICP & CPP Anticoagulants Antiplatelets Carotid Endarterectomy

Slide 19 :

19 Treatment with tPA for Ischemic Brain Attack Administer tissue plasminogen activator (tPA) within 3 hours. Must do diagnostic CT first Determine eligibility Calculate dose: 0.9 mg./kg. Up to 90 mg. Loading dose 10% over 1 min. Remainder over next hour.

Slide 20 :

20 Hemorrhagic Brain Attack Management Interventions as with ischemic stroke except for anticoagulation Neuro assessment Manage increased ICP & CPP Monitor VS carefully, esp. controlling hypertension--danger of further bleed

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21 Prevention of Stroke Prevention of strokes caused by blood clots: Use warfarin (Coumadin) to thin blood Aspirin Plavix Ticlid Carotid endarterectomy

Slide 22 :

22 Acute Stroke Research (UCLA Stroke Center) Use multiple clot-dissolving regimens Use of neuroprotective agents--drugs that may protect brain cells against toxic molecules release by necrotic tissue Use of neuroperfusion trials--reverses blood flow through cerebral veins

Slide 23 :

23 Acute Stroke Research (UCLA & MGH) Plan to enhance vessel recanalization and patient outcome by delivering tPA through IV and intra-arterial lines

Slide 24 :

24 Acute Stroke Research (UCLA) Interventional Neuroradiology Techniques: Dr. Guglielmi developed GDC (Guglielmi detachable coil)--used in treatment of brain aneurysms. This is used as alternative or supplement to neurosurgery

Slide 25 :

25 Acute Stroke Research (UCLA Stroke Center) 1st center in randomized, controlled trial of carotid & vertebral artery angioplasty Planned angioplasty & stent procedure (1999)

Slide 26 :

26 Acute Stroke Research (University of Pittsburgh) Human nerve cell transplantation *Patient is awake *Inject neurons into damaged areas of brain *Takes few minutes to inject *Map with computer *4 patients done in 1998

Slide 27 :

27 Treatment Goals for Brain Attack--2000 Decrease to 5th leading cause of death Public call 911 within 15 minutes of warning signs Neuroprotective drugs given in ambulance In ED within 30 minutes of signs

Slide 28 :

28 Treatment Goals for Brain Attack--2000 Brain imaging to locate precise blockage site Thrombolytics administered directly to site of occlusion

Slide 29 :

29 Treatment Goals for Brain Attack--2000 Additional neuroprotective medications given Computer imaging monitors dissolving clot with arterial reperfusion measurements

appal on Jul 24, 2009 Says :

great ppt

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Tx. hypertension, diabetes . Surgical: Carotid endarterectomy, stenting. Angioplasty1st center in r more Tx. hypertension, diabetes . Surgical: Carotid endarterectomy, stenting. Angioplasty1st center in randomized, controlled trial of carotid & vertebral artery angioplasty less

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