Definition:: Ischemic

Definition:
A "neurological deficit of cerebrovascular cause that persists beyond 24 hours or is interrupted by

death within 24 hours". The 24-hour limit divides stroke from transient ischemic attack, which is a
related syndrome of stroke symptoms that resolve completely within 24 hours.
Classification:
Ischemic
In an ischemic stroke, blood supply to part of the brain is decreased, leading to dysfunction of the
brain tissue in that area. There are four reasons why this might happen:
1. Thrombosis
2. Embolism
3. Systemic hypoperfusion
4. cerebral venous sinus thrombosis
Hemorrhagic
There are two main types of hemorrhagic stroke:
 Cerebral hemorrhage due to either intraparenchymal hemorrhage or intraventricular hemorrhage

 Subarachnoid hemorrhage, which is basically bleeding that occurs outside of the brain tissue but
still within the skull.
In addition to neurological impairment, hemorrhagic strokes usually cause specific symptoms (for
instance, subarachnoid hemorrhage classically causes a severe headache).
S/S:
The symptoms depend on the area of the brain affected.
Early recognition
Sudden-onset face weakness, arm drift and abnormal speech. While these findings are not perfect
for diagnosing stroke, the fact that they can be evaluated relatively rapidly and easily make them
very valuable in the acute setting.
Subtypes
If the area of the brain affected contains one of the three prominent CNS pathways —
the spinothalamic tract, corticospinal tract, and dorsal column, symptoms may include:
 hemiplegia and muscle weakness of the face

 numbness
 reduction in sensory or vibratory sensation
 initial flaccidity, replaced by spasticity, excessive reflexes, and obligatory synergies.
In addition to the above CNS pathways, the brainstem gives rise to most of the twelve cranial
nerves. A stroke affecting the brain stem and brain, therefore, can produce symptoms relating to
deficits in these cranial nerves:
 altered smell, taste, hearing, or vision (total or partial)

 drooping of eyelid (ptosis) and weakness of ocular muscles
 decreased reflexes: gag, swallow, pupil reactivity to light
 decreased sensation and muscle weakness of the face
 balance problems and nystagmus
 altered breathing and heart rate
 weakness in sternocleidomastoid muscle with inability to turn head to one side
 weakness in tongue (inability to stick out the tongue and/or move it from side to side)
If the cerebral cortex is involved, the CNS pathways can again be affected, but also can produce the
following symptoms:
 Aphasia (Broca's (frontal lobe) or Wernicke's area (temporal and pariental lobes) typically
involved: Broca's aphasia - Loss of the ability to produce language (spoken or written).
Wernicke's aphasia -inablity to understand language (written or spoken form). They cannot use
correct words to express thoughts.
 Dysarthria
 Apraxia
 Visual field defect
If the cerebellum is involved, the patient may have the following:
 altered walking gait

 altered movement coordination
 vertigo and or disequilibrium
Causes:
Thrombotic stroke
In thrombotic stroke a thrombus usually forms around atherosclerotic plaques. Since blockage of the
artery is gradual, onset of symptomatic thrombotic strokes is slower than that of a hemorrhagic
stroke.
Embolic stroke
IE
htn
A Fib
DVT
RHD
Artificial heart valves
Recent MI
Cerebral hypoperfusion
Venous thrombosis
Cerebral venous sinus thrombosis leads to stroke due to locally increased venous pressure, which
exceeds the pressure generated by the arteries.
Intracerebral hemorrhage
Diagnosis:
Clinically, CT brain, MRI
Prevention:
Risk factors
The most important modifiable risk factors for stroke are high blood pressure and atrial fibrillation.
Other modifiable risk factors include high blood cholesterol levels, diabetes mellitus, cigarette
smoking, heavy alcohol consumption and drug use, lack of physical activity, obesity, processed red
meat consumption and unhealthy diet. Drugs, most commonly amphetamines and cocaine, can
induce stroke through damage to the blood vessels in the brain and/or acute hypertension.
Management:
Ischemic stroke
Aspirin reduces the overall risk of recurrence by 13% with greater benefit early on. Definitive therapy
within the first few hours is aimed at removing the blockage by breaking the clot down
(thrombolysis), or by removing it mechanically (thrombectomy).
Thrombolysis
Thrombolysis, such as with recombinant tissue plasminogen activator (rtPA), in acute ischemic
stroke, when given within three hours of symptom onset results in an overall benefit of 10% with
respect to living without disability.
Surgery
Thrombectomy may improve outcomes if done early in those with an anterior circulation large artery
clot.
Hemorrhagic stroke
People with intracerebral hemorrhage require supportive care, including blood pressure control if
required. People are monitored for changes in the level of consciousness, and their blood sugar and
oxygenation are kept at optimum levels. A proportion may benefit from neurosurgical intervention to
remove the blood and treat the underlying cause.
Stroke unit
Ideally, people who have had a stroke are admitted to a "stroke unit", a ward or dedicated area in a
hospital staffed by nurses and therapists with experience in stroke treatment.
Rehabilitation
Stroke rehabilitation is the process by which those with disabling strokes undergo treatment to help
them return to normal life as much as possible by regaining and relearning the skills of everyday
living. It also aims to help the survivor understand and adapt to difficulties, prevent secondary
complications and educate family members to play a supporting role.

Definition:: Ischemic

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Definition:: Ischemic

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Definition:

A "neurological deficit of cerebrovascular cause that persists beyond 24 hours or is interrupted by

 Cerebral hemorrhage due to either intraparenchymal hemorrhage or intraventricular hemorrhage

 hemiplegia and muscle weakness of the face

 altered smell, taste, hearing, or vision (total or partial)

If the cerebellum is involved, the patient may have the following:

 altered walking gait

Artificial heart valves

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