1. CEREBROVASCULAR ACCEDENT

2. CVA 3 rd cause of death 2/1000 anully Blood brain supply ( Circle of Willis ) do not open in all people

4. Types of strokes Ischemic Haemorrhagic TIA Ischemic stroke : 83% -Thrombotic -Embolic Thrombotic strokes: -large vessel thrombi cholesterol -small vessel thrombi (lacunar) high BP Embolic strokes: 80% source from heart

5. -young age -high BP -aneurysm -A-V malformation -haemorrhagic diseases Damage by 2 mechanisms: -anoxia -irritation of brain by leaked blood Location rather than amount of bld determain out come

6. Risk factors: Alternable: -diet -physical activity -smoking -substance/alcohol abuse -medical conditions: -hyperlipidemia -DM -atherosclerosis -high BP -obesity -cardiovascular dis -TIA -AV fistula &malformation

7. Unalternable -age -ethnic -heriditary -gender

8. Clinical Features Artry Supply Features ICA frontal,pariatal& contralateral hemiparesis,hemi temporal lobes anasthesia,hemianopia,aphasia ACA medial cerebrum, contralat.weakness legs >arms sup.frontal&pariat. behaviour abn. MCA lat.cerebrum,deep contralat.hemiplegia,hemianasthia, frontal&pariatal aphasia,visuospatial defect PCA occipital,inf.&lat.of contralat.hmonomus hemianopia temporal Basilar pons,midbrain& crossed hemiplegia,vertigo,atxia, cerebellum dysphagia,dysarthria,Horner

9. Investigations : - haemorrhagic or thromboembolic -site -risk factors. CT,MRI,MRA,angio,doppler. CBC,lipid, sugar. PT,PTT. ECG,Echo. sickle cell screen. ESR,ANA. CXR,cervical X-ray

10. Management -physical & rehabilitation -medical -surgical Physical : -feeding -bladder -bed sores -respiratory &limbs physio

11. Medical Antithrombotic : Risk of haem. Inclusion criteria: Inclusion criteria: -ischemic stroke -measurable deficit -no haem. on CT -within 3 hrs Exclusion criteria: Exclusion criteria: -minor stroke -stroke or head truma within 3m. -GI or urinary haem. 21d.

12. -major surgery 14d. -history of IC haem. -suspected SAH inspite of normal CT -syst.BP>185 or diastolic >110 -need aggressive ttt for BP -use of anticoagulant -PT>15sec., plat. 400mg * Dose of tPA: 0.9mg/kg 10%as bolus over 1min.,rest over 1hr

13. I.V heparin: For cardiogenic emboli Aspirin : Prophylactic Recobinant factor seven : For haem. stroke Manitol: For raised ICP ttt of risk factors ttt of risk factors

14. Surgical : -endarterctomy -clips for AVmalformation -evacuation of haematoma