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    Stroke is a clinical syndrome caused by disrupted cerebral blood flow. It is classified as ischemic (80%) due to blockage or hemorrhagic (20%) due to vessel rupture. Risk factors include hypertension, smoking, diabetes, hypercholesterolemia, and atrial fibrillation. Presentation depends on the affected brain region and can include weakness, sensory changes, language problems, or visual issues. Complications include malnutrition, DVT, falls, epilepsy, spasticity, pneumonia, and bedsores. Prognosis varies by type but many survivors require long-term care.

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    Stroke is a clinical syndrome caused by disrupted cerebral blood flow. It is classified as ischemic (80%) due to blockage or hemorrhagic (20%) due to vessel rupture. Risk factors include hypertension, smoking, diabetes, hypercholesterolemia, and atrial fibrillation. Presentation depends on the affected brain region and can include weakness, sensory changes, language problems, or visual issues. Complications include malnutrition, DVT, falls, epilepsy, spasticity, pneumonia, and bedsores. Prognosis varies by type but many survivors require long-term care.

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    65 views40 pages

    Clinical Presentation and Complications of Stroke

    Uploaded by

    1569874
    Stroke is a clinical syndrome caused by disrupted cerebral blood flow. It is classified as ischemic (80%) due to blockage or hemorrhagic (20%) due to vessel rupture. Risk factors include hypertension, smoking, diabetes, hypercholesterolemia, and atrial fibrillation. Presentation depends on the affected brain region and can include weakness, sensory changes, language problems, or visual issues. Complications include malnutrition, DVT, falls, epilepsy, spasticity, pneumonia, and bedsores. Prognosis varies by type but many survivors require long-term care.

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    of 40

    Stroke: Clinical Features &

    Complications
    Dr A Sinha
    ST2 Clinical Pharmacology
    St George’s Hospital
    [email protected]
    Learning Objectives
    Definition of stroke and classification
    Prevalence and Importance
    Natural History and Clinical Presentation of Stroke
    Differential Diagnosis
    Management
    Complications
    Definitions
    Stroke or cerebrovascular accident (CVA): A clinical
    syndrome, characterised by disruption of cerebral
    vascularity, typified by rapidly developing signs of
    focal or global cerebral dysfunction lasting more than
    24 hours or leading to death.

    Transient Ischaemic Attack (TIA): A clinical


    syndrome, of presumed vascular origin, typified by
    rapidly developing signs of focal or global cerebral
    dysfunction resolving within 24 hours
    Stroke Classification
    (1) Ischaemic- thrombotic or embolic event causing
    blockage of the blood supply to the cerebrum (80%)
    (2) Haemorrhagic- rupture of a cerebral blood vessel
    leading to extravasation of blood into the cerebrum
    and its surrounding tissue compromising neural
    perfusion (20%)
    Relevance
    Stroke is the neurological disease of modern times
    In one year 3 people in every 2000 will have a stroke
    For those over the age of 75 this rises to 20 people in
    every 2000 every year
    After heart disease and cancer it remains the third most
    common cause of death after heart disease and cancer
    Natural History and Risk Factors
    Ischaemic Strokes: Underlying pathology is (usually)
    atherothromboemolism
    Haemorrhagic Strokes: Underlying pathology is
    vascular rupture
    Ischaemic Stroke
    Risk Factors for Thrombosis and
    Embolism
    High blood pressure
    Smoking
    Diabetes
    Elevated Cholesterol
    Atrial Fibrillation
    Structural heart lesions (e.g.. post-MI mural thrombus,
    endocarditis, patent foramen ovale with DVT)
    Thrombophillic States and Vasculitic States
    Haemorrhagic Stroke
    Risk Factors for Vascular Rupture
    Hypertension
    Arterio-Venous Malformations
    Trauma
    Clinical Presentation
    Variable!
    Presentation often depends on the area of the brain that
    has been damaged
    Anatomy of the brain
    Brain consists of two cerebral hemispheres (dominant
    and non-dominant), the cerebellum and the brain stem.
    The brain stem contains autonomic centres and houses
    the nuclei of the cranial nerves
    The cerebellum is involved with balance and planning
    of movements
    The cerebrum is involved with higher functions
    (speech, spatial awareness etc)
    Anatomy of the Brain
    Neuroanatomy
    Frontal Lobe

    Parietal Lobe

    Temporal Lobe

    Occipital Lobe
    Neuroanatomy
    Frontal Lobe

    Parietal Lobe

    Temporal Lobe

    Occipital Lobe
    Vascular Anatomy
    Three main cerebral arterial territories:
    Anterior Cerebral Artery
    Middle Cerebral Artery
    Posterior Cerebral Artery
    Penetrating Arteries extend into the brain tissue itself
    Verterobasilar Circulation supplies the brain stem
    Vascular Anatomy
    Linking Function to Structure
    Frontal Lobe- Higher intellectual function (mood,
    personality, frontal eye fields, language)
    Parietal Lobe- Language (reading, writing) calculation,
    Visuo-spatial function, Higher sensory function, visual
    pathways
    Temporal Lobe- Memory, language, visual pathways
    Occipital Lobe- Visual cortex and association areas
    Specialist Areas
    Specialist Areas
    Specialist Areas
    Clinical Presentation
    Global Dysfunction
    Stupor or Coma
    Confusion or agitation/memory loss
    Seizures
    Delirium
    Clinical Presentation
    Focal Dysfunction
    Aphasia (incoherent speech or difficulty understanding
    speech)
    Facial weakness or asymmetry
    Incoordination, weakness, paralysis, or sensory loss of
    one or more limbs
    Ataxia (poor balance, clumsiness, or difficulty
    walking)
    Visual loss (Monocular or binocular; May be partial
    loss of the field)  
    Differential Diagnosis
    Trauma: Extradural haematoma, Subdural
    haematoma
    Infection: Meningitis/encephalitis
    Intracranial mass: Tumour, Abscess
    Inflammation: SLE
    Migraine with persistent neurological signs
    Metabolic causes : Hyperglycaemia, Hypoglycaemia,
    Narcotic abuse, Alcohol abuse, Hypothyroidism
    Patterns of deficit
    Total Anterior Circulation Infarct (TACI). Significant
    Damage of both Anterior and Middle Cerebral
    Arteries:
    Hemiplegia
    Hemianopia
    Cortical Deficit (dysphasia, visuo-spatial loss)
    Partial Anterior Circulation Infarct (PACI). Partial
    Damage of both Anterior and Middle Cerebral
    Arteries: Two of the above
    Patterns of Deficit
    Posterior Circulation Infarct. Damage to the posterior
    cerebral artery and Vertebrobasilar circulation:
    Limb or gait ataxia
    Dysarthria
    Dysconjugate gaze
    Nystagmus
    Amnesia
    Bilateral visual field defects  
    Patterns of Deficit
    Lacunar Infarct: Damage to small penetrating vessels:
    Decreased sensation of face and limbs on one side of
    the body without abnormalities of higher brain
    function, motor function, or vision
    Investigations and Diagnosis
    Aim is to establish the cause and prevent recurrence
    Full blood count, ESR, U and Es, glucose, lipids,
    clotting
    Chest radiograph and ECG
    CT scan
    Management
    Ischaemic Strokes- Aspirin 300mg and Simvastatin
    40mg and compression stockings if not contra-
    indicated
    Admission to acute stroke ward, assessment of
    swallow reflex, intensive nursing, early physiotherapy,
    occupational therapy and social services need to be
    instigated
    Complications
    Wide ranging!
    Complications
    Complications
    Complications
    Complications
    Complications
    Complications
    Complications
    Complications
    At 1900 At 2000
    Complications
    Malnutrition and aspiration
    DVT and PE
    Falls and fracture
    Epilepsy
    Spasticity
    Pneumonia
    Bedsores
    Prognosis
    TACS: 60% dead at one year. 20% living
    independently
    PACS: 15% dead at one year. 50% living
    independently
    Lacunar: 10% dead at one year. 70% living
    independently
    POCS: 20% dead at one year. 60% living
    independently

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