1. This lecture was conducted during the Nephrology Unit Grand Ground by a Sub-intern under Nephrology Division, Department of Medicine in King Saud University. Nephrology Division is NOT responsible for the content of the presentation for it is intended for learning and /or education purpose only.

2. Sadeem Othman AlFraih

3. Blood supply of the brain: Circle of Willis ACA MCA PCA Lenticulostriate Arteries Stroke: -Definition -Types -Causes -Management -Prevention

4. found both on the surface of the brain and deep within it.

6. if one of the main arteries is occluded, the distal smaller arteries that it supplies can receive blood from the other arteries (collateral circulation).

7. From the internal carotid artery Supplies the frontal lobes Stroke in the anterior cerebral artery results in opposite leg weakness.

8. Largest branch of the internal carotid Supplies a portion of the frontal lobe and the lateral surface of the temporal and parietal lobes. Primary motor and sensory areas of the face, throat, hand and arm, and in the dominant hemisphere, the areas for speech.

9. Stem in most individuals from the basilar artery but sometimes originate from the ipsilateral internal carotid artery. Supply the temporal and occipital lobes. Infarction usually secondary to embolism from lower segments of the vertebral basilar system or heart. Clinical symptoms

10. Small, deep penetrating arteries branch from MCA. Lacunar strokes(About 20% of all stokes ) High incidence in patients with chronic hypertension.

11. Stroke, also called brain attack, occurs when blood flow to the brain is disrupted.

13. Risk factors: -Age -HTN -DM -Smoking -AF -In young age group??

14. Atherosclerotic CVD Penetrating artery disease Cardiogenic embolism Cryptogenic Un usual causes Classically the patient awakens from sleep with neurologic deficits -pure motor or sensory -Ataxic hemiparesis -Clumsy hand dysarhria -rapid onset & deficit maximal initially -depend on the artery

15. Diagnosis: -CT -MRI -ECG -Carotid duplex -MRA

16. Treatment: -Acute supportive -BP control -prevention

17. Intracerebral hemorrhage(ICH) Subarachnoid hemorrhage -Causes -Clinical features -Diagnosis -Treatment

18. The level of stroke severity as measured by the NIH stroke scale scoring system: 0= no stroke 1-4= minor stroke 5-15= moderate stroke 15-20= moderate/severe stroke 21-42= severe stroke The National Institute of Health (NIH) stroke scale (NIHSS) is a standardized method used by physicians and other health care professionals to measure the level of impairment caused by a stroke.

19. http://reference.medscape.com/features/slideshow/stroke http://www.thewellingtonneurosurgeryunit.com/brain-blood-supply.asp http://www.strokecenter.org/professionals/brain-anatomy/blood-vessels-of-the-brain/ http://www.urmc.rochester.edu/ http://stroke.about.com/od/glossary/f/NIH_Scale.htm