PROTOCOl 24 Pregnacy,childbirth,miscarriage

by Jawad Ahmed
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Definition of Stroke
Disruption of blood flow to the brain or part of the
brain due to a blood clot or haemorrhage (internal
bleeding)

It is commonly called (CVA) Cerebrovascular accident.

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Classification of Stroke
Two major categories:

Ischemic strokes, caused when a blood vessel supplying the

brain is blocked by a clot.

Hemorrhagic strokes, caused when a cerebral artery

ruptures.

Both forms are life threatening.

But Ischemic strokes are more comman about 75% of all

stroke.

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Hemorrhagic Stroke
Hypertension is the most
common cause of
intracerebral hemorrhage.
Other causes:
Berry aneurysm which occur
in younger people bcoz of
ballooned blood vessels
which may rupture and may
cause death.
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Risk Factors for Stroke
Although some strokes occur without warning, most
stroke victims have prior risk factors.

Major strokes can be prevented in many cases, but

only if early signs and symptoms are heeded.

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Well-Documented
Well-Documented

Modifiable
Modifiable Risk
Risk Factors
Factors

Hypertension Other cardiac diseases

Smoking
Diabetes

Goldstein et al. Circulation. 2001:103:163 7

Less Well Documented

Potentially Modifiable Risk Factors

 Obesity  Oral Contraceptive Use

 Physical Inactivity

 Poor Diet/Nutrition

 Alcohol Abuse

 Drug Abuse

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Non-modifiable Risk Factors
Age (35 or above 35)
Sex (common in males)
Family History

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Stroke Diagnosis
Signs and Symptoms of Stroke

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Signs and Symptoms of Stroke
Consider in anyone
who has:

 Sudden numbness or
weakness of face, arm, or leg,
especially on one side of the
body

 Sudden confusion, trouble

speaking or understanding

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Signs and Symptoms of Stroke
 Sudden trouble seeing in one
or both eyes

 Sudden trouble walking,

dizziness, loss of balance or
coordination

 Sudden severe headache

with no known cause

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Signs and Symptoms of Stroke
THIS IS A LIFE THREATENING EMERGENCY!

Emergency healthcare providers must:

Recognize the importance of these symptoms.
Respond quickly with medical and / or surgical
interventions.

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Stroke Signs and Symptoms: Hemorrhagic Stroke
May present similar to Ischemic
stroke.

Distinguishing Features:
 Appear more seriously ill
 Severe headache
 Alteration in consciousness
 Nausea and/or vomiting
 Neck pain
 Intolerance of noise or light

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Emergency Diagnostic Studies
Anticoagulants and
fibrinolytic agents
should be withheld
until CT has ruled out
a brain hemorrhage.

Hemorrhagic Stroke

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Differential Diagnosis:
Unrecognized seizures
Confusional states
Syncope
Toxic or metabolic disorders
Hypoglycemia
Brain tumors
Subdural hematoma

Adams et al. Stroke. 2003;34:1056

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Management of Hemorrhagic Stroke
Prevention of continued bleeding.
Appropriate management of ICP.
Timely neurosurgical decompression when warranted.

Large intracerebral or cerebellar hematomas often

require surgical intervention.

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Conclusion:
The challenge with these therapies is that they
require administration within hours of stroke
onset, making the following measures
imperative:

 Education of at-risk patients

 Early recognition of stroke signs
 Prompt transport to the hospital
 Rapid hospital triage and evaluation
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