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STROKE - types +management - Coggle Diagram
STROKE - types +management
Cerebral arterial system
Brain supplied by:
2 vertebral arteries (goes through vertebrae in C spine
Pass up through foramina in transverse process of Cx vertebrae and join in front of the brainstem -->
Basilar Artery
Upper brainstem, Basilar Artery divides -->
2 posterior cerebral arteries
--> connect to back of
Circle of Willis
by 2 small
posterior communicating arteries
2 internal carotid arteries
Internal carotids pass in front of neck +
divide
to form
anterior
and
middle Cerebral Arteries
(ACAs)
ACAs join anterior via
Anterior Communicating Artery
--> front section of
Circle of Willis
Circle of Willis
Occlusion of one internal carotid does not necessarily result in a stroke
Brain may be protected from bilateral carotid occlusion through basilar supply.
End arteries (no connections)
ACA
MCA
PCA
only takes a few minutes for brain death if blood supply cut off
Which arteries supply parts of brain
Middle Cerebral Artery (MCA)
Most of outer surface
Sensorimotor cortex
Basal ganglia
Internal capsule
Broca's area (left)
Anterior Cerebral Artery (ACA)
Frontal lobe - thought and memory can be affected
Medial part of sensorimotor cortex
Posterior Cerebral Artery
Occipital lobe
Medial aspect of temporal lobe
Thalamus - sensory relay station - sensation is affected
Basilar Artery
All of brainstem
Cerebellum - ataxic movement - balance and coordination
Nuclei of cranial nerves - facial nerve palsy - mimics stroke. Vagus nerve - heart function, autonomic function + homeostasis
Classification of stroke
Rapidly developing clinical signs of focal/global loss of cerebral function - lasting more than 24 hours/ leads to death - with a vascular cause
TIA - part of brain not getting enough blood - small but leads to risk of serious stroke - use to be considered >24 hours but lasts 1-2
Haemorrhage
Subarachnoid Haemorrhage
bleeding into subarachnoid space (where all the capillaries are)
due to rupture of congenital aneurysm, arteriovenous malformation (AVM) or trauma
associated with sudden intense headache vomiting, neck stiffness + loss of consciousness
approx 10% die within 2hours, 40% will die within 2weeks
Intracerebral Haemorrhage
bleeding into deeper parts of the brain
associated with hypertention
arterial walls weaken? micro-aneurysms develop? rupture and bleed
severe headache and vomiting
Subdural Haemorrhage
bleeding into subdural space
usually caused by trauma
may be an interval between injury and symptoms
headache, drowsiness, stupor, hemiparesis, coma
Extradural Haemorrhage
bleeding into extradural space
caused by severe trauma - tearing of meningeal artery
Ischemia (clots) 80%
Classified based on area and size of lesion
TACS: Total Anterior Circulation Stroke - large cortical stroke in middle/anterior cerebral artery - has
Unilateral weakness /sensory deficit of face, arm or leg
Homonymous hemianopia - only see out of half visual field
Higher Cerebral dysfunction (dysphasia, visuospatial disorder
PACS: Partial Anterior Circulation Stroke - cortical areas in middle/anterior cerebral artery areas - has 2
Unilateral weakness /sensory deficit of face, arm or leg
Homonymous hemianopia - only see out of half visual field
Higher Cerebral dysfunction (dysphasia, visuospatial disorder
POCS: Posterior Circulation Syndrome
Cerebellar or brainstem syndromes
Loss of consciousness
Isolated homonymous hemianopia
LACS: Lacunar Syndrome - Subcortical stroke due to small blood vessel disease - no evidence of higher cerebral dysfunction
Unilateral weakness/ sensory deficit of face and arm/arm and leg - or all
pure sensory stroke
Ataxic hemiparesis
due to occlusion
Atheroma of cerebral artery
blood clot in brain or neck -
thrombosis
blood clot from somewhere else that has moved and now blocks blood vessel in brain or neck -
embolism
Most common vessel -
MCA
> PCA > ACA
Brain stem strokes less common - more serious
Embolic Stroke
Completed stroke -
sudden onset
Transient Ischaemic Attack - repeated small emboli - no infarction occurs
Thrombotic stroke
Completed stroke - usually develops overnight
Developing stroke - develops over several days
Transient Ischaemic Attack - sudden? full recovery - 20% risk of full CVA within 1-4 weeks
Medical management
Ischemia
treat as emergency
MRI/CT scan within 5 hours
Ischaemic stroke (80%) - aspirin, anticoagulants, thrombolysis
TIA - aspirin, prevention work
also blood tests, angiography, echocardiology
surgery - thrombectomy, carotid endarterectomy
Haemorrhage
Treat as emergency - brain attack
MRI/CT scan
SAH - surgery or endoplastic procedures
SDH/EDH/ICH - treat hypertension
also blood tests, angiography, echocardiology
other medication - osmotic agents to get rid of fluid