1. Diagnosis and management of
Ischemic cerebrovascular disease
ISMAIL.I SURCHI
GENERAL MEDICINE

2. CEREBROVASCULAR
DISEASE
 Refers to a variety of conditions that affect the supply of
blood to the brain.
 Stroke General term for a brain dysfunction caused by an
abnormality of the cerebral blood supply.
 A stroke is an interruption of the blood supply to any part
of the brain. A stroke is sometimes called a "brain
attack.“
 Alternative names: Stroke CVA, Cerebral infarction,
Cerebral hemorrhage.
 Globally, cerebrovascular disease specially stroke is the
second leading cause of death

3.  This is the most common type of stroke.
 Usually this type of stroke results from clogged arteries, a
condition called atherosclerosis.
 Fatty deposits and blood platelets collect on the wall of the
arteries, forming a sticky substance called plaque.
 Over time, the plaque builds up. Often, the plaque causes the
blood to flow abnormally, which can cause the blood to clot.
There are two types of clots:
 A clot that stays in place in the brain is called a cerebral
thrombus.
ISCHEMIC STROKE

4.  A clot that breaks loose and moves through the
bloodstream to the brain is called an cerebral embolism.
 Another important cause of cerebral embolisms is a type
of arrhythmia called atrial fibrillation.
 Other causes of ischemic stroke include endocarditis and
the use of a mechanical heart valve.

5. Classification
Ischemic Stroke — three subtypes:
•
•
Thrombosis :obstruction of an artery.
Embolism : Particles of debris originating elsewhere that
block arterial access to a particular brain region.
• Systemic hypoperfusion : More general circulatory problem,
manifesting itself in the brain and perhaps other organs.
Hemorrhagic Stroke due to intracerebral hemorrhage or
subarachnoid hemorrhage
Data show that strokes due to ischemia, intracerebral
hemorrhage and subarachnoid hemorrhage are 87%, 10%,
and 3 %respectively.

6. Classification of ischemic
Subtypes
Classification
1. Large-artery atherosclerosis (embolus/thrombosis)
2. Cardioembolism (high-risk/medium-risk)
3. Small-vessel occlusion
4. Stroke of other determined etiology
5. Stroke of undetermined etiology

7. CAUSES, AND RISK FACTORS
A ischemic stroke can happen when:
 A blood vessel carrying blood to the brain is
blocked by a blood clot. This is called an ischemic
stroke.
 A blood vessel breaks open, causing blood to leak
into the brain. This is a hemorrhagic stroke.
 If blood flow is stopped for longer than a few
seconds, the brain cannot get blood and oxygen.
Brain cells can die, causing permanent damage.

9.  High blood pressure is the number one reason.
 The risk of stroke is also increased by age, family history of
stroke, smoking, diabetes, high cholesterol, and heart disease.
 Certain medications increase the chances of clot formation.
 Birth control pills can cause blood clots, especially in women
who smoke and who are older than 35.
 Men are prone to more strokes than women.
 Cocaine use, alcohol abuse, head injury, and bleeding disorders
increase the risk of bleeding into the brain.
Risk factors

10. SYMPTOMS
 The symptoms of stroke depend on what part of the
brain is damaged..
Usually, a SUDDEN development of one or more of the
following indicates a stroke:
 Weakness or paralysis of an arm, leg, side of the
face, or any part of the body
 Numbness, tingling, decreased sensation
 Vision changes
 Slurred speech, inability to speak or understand
speech, difficulty reading or writing

11.  Swallowing difficulties
 Loss of memory
 Loss of balance or coordination
 Drowsiness, lethargy, or loss of consciousness
 Uncontrollable eye movements or eyelid drooping

12.  In diagnosing a stroke, knowing how the
symptoms developed is important.
 The symptoms may be severe at the beginning
of the stroke, or they may progress or fluctuate
for the first day or two (stroke in evolution.
 During the exam, doctor will look for specific
neurologic, motor, and sensory deficits.
 These often correspond closely to the location
of the injury in the brain.
SIGNS AND TESTS

13.  An examination may show changes in vision or
visual fields, abnormal reflexes, abnormal eye
movements, muscle weakness, decreased
sensation, and other changes..
 There may be signs of atrial fibrillation.
 Tests are performed to determine the type,
location, and cause of the stroke and to rule out
other disorders that may be responsible for the
symptoms.

14.  Head CT or head MRI -- used to determine if the
stroke was caused by bleeding (hemorrhage) or other
lesions and to define the location and extent of the
stroke.
 ECG (electrocardiogram) -- used to diagnose
underlying heart disorders.
 Echocardiogram -- used if the cause may be an
embolus (blood clot) from the heart.
 Carotid duplex (a type of ultrasound) -- used if the
cause may be carotid artery stenosis (narrowing of the
major blood vessels supplying blood to the brain).
INVESTIGATIONS

15.  Heart monitor -- worn while in the hospital or as an
outpatient to determine if a heart arrhythmia (like
atrial fibrillation) may be responsible for stroke.
 Cerebral (head) angiography -- may be done so that
the doctor can identify the blood vessel responsible
for the stroke. Mainly used if surgery is being
considered.
 Blood work may be done to exclude immune
conditions or abnormal clotting of the blood that can
lead to clot formation.

16.  A ischemic stroke is a medical emergency.
 Physicians call it a "brain attack" to stress that getting
treatment immediately can save lives and reduce
disability.
 Treatment varies, depending on the severity and cause of
the stroke.
 For virtually all strokes, hospitalization is required,
possibly including intensive care and life support.
 The goal is to get the person to the emergency room
immediately, determine if he or she is having a bleeding
stroke or a stroke from a blood clot, and start therapy all
within 3 hours of when the stroke began.
TREATMENT

17.  Thrombolytic medicine, breaks up blood clots and can
restore blood flow to the damaged area.
 Blood thinners such as heparin and Coumadin are
used to treat strokes. Aspirin and other anti- platelet
agents may be used as well.
 Other medications may be needed to control
associated symptoms. Analgesics (pain killers) may
be needed to control severe headache. Anti-
hypertensive medication may be needed to control
high blood pressure.
IMMEDIATE TREATMENT

18.  For hemorrhagic stroke, surgery is often required to
remove pooled blood from the brain and to repair
damaged blood vessels.
 Life support and coma treatment are performed as
needed.
 Nutrients especially and fluids may and fluids may
necessary if the person has swallowing difficulties. The
nutrients and fluids may be given through an intravenous
tube (IV) or a feeding tube in the stomach (gastrostomy
tube). Swallowing difficulties may be temporary or
permanent.

19.  The goal of long-term treatment is to recover as much
function as possible and prevent future strokes.
 Depending on the symptoms, rehabilitation includes
speech therapy, occupational therapy, and physical
therapy.
 The recovery time differs from person to person.
 Certain therapies, such as repositioning and range-of-
motion exercises, are intended to prevent
complications related to stroke, like infections and
bed sores.
LONG-TERM TREATMENT

20. urinary catheterization or
control programs may be
 People should stay active within their physical
limitations.
 Sometimes, bladder/bowel necessary to control
incontinence.
 The person's safety must be considered.
 Some people with stroke appear to have no
awareness of their surroundings on the affected
side.
 Others show indifference or lack of judgment,
which increases the need for safety precautions.

21.  Problems due to loss of mobility (joint contractures,
pressure sores)
 Permanent loss of movement or sensation of a part of the
body
 Permanent loss of brain functions
 Reduced communication or social interaction
 Reduced ability to function or care for self
 Decreased life span
 Side effects of medications
 Aspiration
 Malnutrition
COMPLICATIONS

22. To help prevent a stroke :
 Get screened for high blood pressure at least every two
years, especially if family history of high blood pressure.
 Cholesterol check.
 Treat high blood pressure, diabetes, high cholesterol, and
heart disease if present.
 Follow a low-fat diet.
 Quit smoking.
 Exercise regularly.
 Lose weight if overweight.
 Avoid excessive alcohol use.
PREVENTION