11/2/2016. Stroke. Carl F. McComas, M.D. November 3, Disclosures. None (of any kind)

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1 Stroke Carl F. McComas, M.D. November 3, 2016 None (of any kind) Disclosures 1

2 HYPERTENSION Stroke The seat of apoplexy seems to be within the same portion of the of the brain.... Both affects, the imagination, and common sense, though in far differing degree affected, viz. in the latter the irradiation of the spirits is wont... to be interrupted with little clouds, as it were, scattered here and there, but in the former, the same is forthwith wholly darkened and undergoes total eclipse. The apoplexy, according to the import of the word, denotes a striking, and, by a reason of the stupendous nature of the affect, as though it contained something divine; it is called a sideration; those who are seized with it, as though they were planet struck, or smitten by an invisible Diety, fall on the ground on a sudden being deprived of sense and motion. Willis T: Instructions and prescripts for curing the apoplexy, in Pordage S (ed): The London Practice of Physic or the Whole Practical Part of Physic Dring T, Harper C, Leigh J, Martyn S,

3 Transient Ischemic Attack Etiology Its practical causes are like, as in most other affects of the brain, the blood is in fault, that either engendering of itself are taking from elsewhere extraneous particles and such as are very averse to the texture or reconstitution of the animal spirit and, as it were... sends them to the brain. If, after the first seizure of a speechlessness being well over, the diseased afterward becomes more drowsy and dull, is affected with a scotoma, and a frequent vertigo, it is a sign that he will be obnoxious to other accesses of the apoplexy. Willis T: Instructions and prescripts for curing the apoplexy, in Pordage S (ed): The London Practice of Physic or the Whole Practical Part of Physic Dring T, Harper C, Leigh J, Martyn S, Stroke Definition Sudden neurologic symptoms due to occlusion or rupture of a cerebral blood vessel-artery, arteriole, or vein 3

4 Stroke Scope of Problem Approximately 795,000 strokes per year 5 th leading cause of death Leading cause of disability Leading cause of preventable disability Hypertension Diabetes mellitus Family history Stroke Risk Factors Co-existent heart disease Atrial fibrillation Hyperlipidemia Smoking 4

5 The Bacon Belt The Bible Belt The Stroke Belt, CDC Cerebrovascular Anatomy 5

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7 Anterior Cerebral Artery, Lateral View Anterior Cerebral Artery, Medial View 7

8 Middle Cerebral Artery, Lateral View Middle Cerebral Artery, Medial View 8

9 Middle Cerebral Artery Posterior Cerebral Artery, Lateral View 9

10 Posterior Cerebral Artery, Medial View Territories of Arteries 10

11 Correlative Neuroanatomy Types of Stroke Thrombotic Embolic Hemorrhagic-Primary or Secondary Vasculitic Ruptured Aneurysm Ruptured Vascular Malformation 11

12 Thrombotic Cerebral Infarctions Thrombosis of large vessel Thrombosis of small vessel Hypercoagulable state Lacunar Infarctions Definition: small cavity as result of deep cerebral infarct Due to primary end arteriolar disease Majority are 0.2 to 15 mm in size 12

13 Lacunar Infarctions Pathology of small end arterioles Location: internal capsule, basal ganglia, cerebellum Cerebral Emboli Sources Heart Atrial fibrillation Mural thrombus Endocarditis Prosthetic valve thrombus Atrial myxoma Paradoxical 13

14 Cerebral Emboli Sources Aorta Extracranial vessels Intracranial vessels Fat emboli (from trauma) Air emboli (from surgery/cath study) 14

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IV. Cerebrovascular diseases

IV. Cerebrovascular diseases - Cerebrovascular disease denotes brain disorders caused by pathologic processes involving the blood vessels. - The three main pathogenic mechanisms are: 1. Thrombotic occlusion