Cerebrovascular iseases课件.ppt

Cerebrovascular diseases Cerebrovascular diseases Vascular occlusive diseases (ischemic stroke) Intracerebral hemorrhage (hemorrhagic stroke) Incidence of stroke 150-600 new cases per 100.000 population per year 2-3rd leading cause of death 1st leading cause disability Ischemic stroke Atherosclerosis of great cerebral vessels 20-40% Stenosis of vessels Atherothromboembolism Cardiac embolism 15-30% Nonatherosclerotic vasculopaties and hematological abnormalities 10-20% Unknown 10-30% Common sites of atherosclerotic disease. Normal blood flow 55 ml/100g per min - average 80-100 ml/100g per min for gray mater 25-30 ml/100g per min for white matter 20 ml/100g - ischemic stroke Acute ischemia Transient Ischemic attack – neurological deficit that resolves during 24 hours Reversible neurological deficit (minor stroke) – deficit that resolves completely during more then 24 hours Ischemic stroke – persistent neurological deficit Clinical presentations of ischemic stroke Subacute begining (acute in cases of embosilsm) Consciousness is clear or short term lost of consiousness. Not often unconsciousness Focal neurological deficit – main in clinical picture Headaches, meningeal signs are not often History of TIAs, no history of hypertention Treatment of acute ischemia 1. Acute resuscitation 2. Reperfusion of the ischemic brain 3. Decreasing cerebral metabolic demands 4. Inhibition of the degradative ischemic cascade 1. Acute resuscitation Respiration Intubation with ventilation for patients in coma Supplementary oxygen for other patient Arterial pressure Maintaining mild hypertension (if there is no evidence of hemorrhage) or at least normal blood pressure Maintaining of adequate intravessel volume Controling heart output and arrhythmias Controlling of glucose level 2. Reperfusion of the ischemic brain Thrombolytic therapy – recombinant activator for tissue plasminogen In first 4-6 hours after onset If intracerebral hemorrhage is excluded with CT Hypervolemic H