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What is the % of strokes that are haemorrhagic strokes?
- 10-15% of all strokes (caucasians)
What is a haemorharrgic stroke caused by?
caused by rupture of an intracerebral artery
What parts does a haemorhagic stroke happen in?
What are some predisposing factors of haemorrhagic stroke?
- - AVM (arterial venous malformation)
- - degenerative small vessel disease- lifetime
- - amyloid angiopathy
- - HT
- - coagulation disorders- hemophillia
- - cocaine and amphetamines
- - tumour
Where is atherosclerotic plaque more likely to happen?
- - where arteries bifucate
- - where increase BP
What are the clinical effects of a supratentorial haematoma?
- - same ase classic ischemic stroke
- - sudden headache and LOC (mss effect) over 24-48 hrs
- - focal signs eg hemiparesis, hemisensory loss, homonymous hemianopia
- - usually get a splitting headache
what aree the clinical effects of cerebellar haematoma?
- - sudden onset of headache
- - cerebellar and brainstem signs and symptoms: ataxia, vertigo, vomiting, dizziness
- - CSF obstruction can lead to hydrocephalus with signs and symptoms of increase inter cranial pressure
What is a pontine haemotoma?
- - sudden loss of consciousness. Resp irregularities, pyrexia
- - quadriplegia, pin point pupils, skrewed eye movements
- - death commonly follows
ICH= intracerebral haemorrhagic stroke
- - they are dynamic
- - where blood doesnt get it suffers from hypoxia
What is a SAH?
Who gets SAH?
- - younger pop due to genetic abnormalities
- 5% of all strokes
What causes a SAH?
- - ruptured saccular aneurysm- 85%
- - arterial dissection- < 5%
- - hypertensive complex small vessel disease
WHat is the surgical management of SAH and ICH?
- - SAH- repair aneurysm to prevent rebleed
- - ICH- drain haemotoma to relieve mass effect and reduce ICP. Excise AVM if present
What is a TACI?
- - total anterior cerebral infarct (can be syndrome, haemorrhage)
- - hemiparesis or hemisensory loss
- - visual distrubances and glbal aphasia
- - aphasia is when dom hemisphere is affected if not you will have spatial neglect
WHat is a PACI?
- partial ant circulation infarct
- - 2/3 parts of TACI
- - dysphasia typically expressive or receptive
- - typically no drowsiness
What is a POCI?
- - posterior circulation infarct
- - ipsilateral cranial nerve alsies with contralateral sensory/ motor loss
- - vestibular or occular signs
- - isolated cerebellar dysfunction- ataxia/ coordination
- - isolated homonmous heminopia- loss of vision of one side on both eyes
- - visual disturbances
What is a LACI?
- - discrete symptoms
- - pure motor stroke
- - pure sensory stroke
- - ataxic hemiparesis
- - dysarthria or clumsy hand syndrome
- - isolated to face and hand
Your chances of surviving a stroke decrease with?
- - lesion size
- - prolonged unconsciousness
- - increased age
- - severe hyptertension
- - severe co-existing disease- heart disease
- TACIS and ICH = bad
What are the stroke outcomes at the end of the first year?
- - 30% dead
- - 30% another stroke
- of survivours
- 60% will need helps ADLs
- 5% are totally I
- 30% of working age will return to work
What causes death?
- - effects of ICP in ICH
- - Infection esp aspiration pneumonia
- - venous thromboembolism
- the best outcomes for stroke survivors are achieved by preventing complications
- 1st 48hrs