1. ISCHEMIC STROKE

2. A 62 year old female presents to the ED with right sided weakness and severe aphasia.
No history of similar symptoms in past, no known risk factors, no recent illness. No
trauma or syncope.
The patient appeared slightly sonnolent and was able to slowly respond to simple
comands and verbal stimuli
BP 116/63, pulse oximetry showed 99% saturation
The physical examination showed: The patient was
approximate GCS=13
Right mouth droop
Right hemiparesis NIHSS=18
Positive babinski sign
Lost vision on the right
Ischemic Stroke?

3. Background
The ischemic stroke is the rapid loss of
cerebral functions due to the blockage of
blood supply to the brain

4. Causes

5. Epidemiology
Stroke is one of the most common cause of disability and
third leading cause of death in USA
More than 700,000 persons per year suffer a first-time stroke in United States, with
20% of these individuals dying within the first year after the stroke
62.8 cases per 100,000
59 cases per 100,000
Risk of stroke increases in patient
older than 64 years

6. Anatomy
The ACA supplies the medial
frontal and parietal lobes
The MCA supplies the The PCA supplies the thalami,
lateral frontal, parietal and occipital and inferior temporal
anterior temporal lobes lobes

7. Pathophysiology
The loss of blood flow cause an ischemic cascade
Because of the activation of several
degradative molecules, such as free radicals,
arachidonic acid and NO, the cell membrane
and other essential neuronal structures are
destroyied

8. Symptoms
• Hemiparesis
• Hemisensory loss
• Complete or partial
hemianopsia, monocular or
binocular visual loss,
diplopia
• Aphasia
• Ataxia
• Sudden loss of
consciousness

9. Laboratory Evaluation
• Complete Blood Cell Count
• Basic Chemistry Panel
• Coagulation Studies
• Cardiac Biomarkers
• Toxicology Screening
• Arterial Blood Gas Analysis

10. Imaging in Stroke
757547515451428
MRI CT scanning

11. • Conventional Angiography
It’s the Gold Standard

12. Medical Treatment
Establishing the time at which stroke symptoms
first occurred is of paramount importance when
considering patients for possible thrombolytic
therapy
The central goal of therapy in acute ischemic stroke is
to limit the severity of ischemic injury and to reduct
the duration of ischemia
Recanalization strategies include rt-PA and intrarterial approaches

13. Thrombolytic Therapy restore the cerebral blood flow
and may lead to improvement or resolution of
neurologic deficits
Unfortunately thrombolytics can cause symptomatic
intracranial hemorrage
The most common used antiplatelet
agent is the aspirin which reduces the
risk of early stroke recurrence
Neuroprotective factors are under investigation
Many studies demonstrate the usefulness of
hypothermia

14. Carotid endarterectomy
Is the removal of material on
the inside of the artery

15. Carotid Stenting
It consists in treding a catheter
through the femoral artery, up to
the aorta then inflating a balloon
to dilatate the carotid artery

16. Decompressive Craniectomy
is a neurosurgical procedure in which part of the
skull is removed to allow a swelling brain to expand
The removed part is called “bone flap”

17. Bypass

18. Prognosis
The prognosis after acute ischemic stroke depends on:
• Severity of the stroke
• Patient’s premorbid condition
• Age
• Poststroke Complications
In USA 20% of individuals die within the first year after
a first-time stroke

19. Patient Education
The american Stroke
Association advices the public
to be aware of the symptoms
of stroke that are easily
recognized and call 911

20. Conclusions
Stroke is a very common disease which need an
immediate menagement
The indication for surgical treatment is when the
theraphy had not success
In february 2011 AHA/ASA guidelines for the
primary prevention of the stroke were published
The guideline emphasizes the importance of lifestyle
changes to reduce modifiable risk factors

21. Thank You