Description
This comprehensive lecture on cerebrovascular accidents, authored by Dr. Lawrence S Siamuyoba, Senior Registrar in the Department of Internal Medicine and Haemato-oncology, provides a detailed overview of stroke and transient ischaemic attacks (TIAs). The presentation begins by clearly defining key terms, differentiating between TIAs as transient deficits and strokes as lasting neurological impairments. It covers the etiology of TIAs, including cardiac emboli, carotid artery disease, and hematologic disorders, and outlines major risk factors such as hypertension, smoking, and diabetes. The lecture then details the two primary types of stroke: ischaemic (thrombotic and embolic) and haemorrhagic (subarachnoid and intracerebral). For each type, it explains the specific pathophysiology, characteristic clinical presentations—such as the gradual onset of thrombotic strokes versus the abrupt onset of embolic or haemorrhagic events—and the critical steps in diagnostic evaluation, emphasizing the role of CT imaging. Management strategies are thoroughly discussed, including acute interventions like thrombolysis for ischaemic strokes within the therapeutic window, blood pressure control, anticoagulation, antiplatelet therapy for secondary prevention, and the management of cerebral oedema. The material also addresses the specific medical and surgical approaches for subarachnoid and intracerebral haemorrhages. This resource is essential for medical students, postgraduate trainees in neurology, internal medicine, and emergency medicine, as well as practicing clinicians seeking to solidify their understanding of the rapid assessment, diagnosis, and evidence-based management of acute cerebrovascular events. It serves as a vital study and reference guide for mastering this critical area of clinical medicine. Review this detailed presentation to enhance your diagnostic and therapeutic skills in stroke care.
What's inside
Cerebrovascular Accident Dr Lawrence S Siamuyoba Senior Registrar, Department of Internal Medicine/Haemato-oncology Definitions • Cerebrovascular Accidents- – Neurologic deficits of Vascular origin • Transient Ischaemic Attacks – Sudden or rapid neurologic deficit caused by cerebral ischaemia lasting for a few minutes to 24hrs and clears without residual defects. • Stroke – Rapid onset of neurologic deficit involving a certain vascular territory and lasting more than 24hrs Transient Ischaemic Attacks • ETIOLOGY – Cardiac Emboli • Atrial fibrillation • Prosthetic valves • Mitral valve disease – Carotid or Vertebral artery disease • Arteriosclerosis • Dissection of aortic aneurysm • Vasculitis – Hematologic Disorders • Red cell disorders • Platelet disorders • mye;loproliferative Disorders • Increased viscosity • RISK FACTORS – Hypertension – Smoking – Dyslipidaemia – Advanced age – Diabetes – Elevated Homocysteine levels in elderly • INVESTIGATIONS – Good history and physical examination • Determine the vacular tree involved – Carotid or vertebral – Laboratory • FBC • Prothrombin time/INR • U/E, LFT, Creatinine • Protein C and S • CXR • ECG • Brain CT • TREATMENT – Medical Therapy • Anticoagulation with heparin or warfarin • Antipaltelets – Aspirin – Clopidogrel – Dipyridmole 200mg daily – Surgical therapy – Risk factor management • Modification of smoking • Control hypertension • Aggressive glucose control in DM • Aspirin therapy in patient with cardiomyopathy or previous MI • Dietary and pharmacologic control of hyperlipidaemia Stroke • Types – Ischaemic-85% of all strokes • Embolic • Thrombotic – Haemorrhagic • ETIOLOGY AND RISK FACTOR – Causes and risk factors are the same as those of TIA. • ISCHAEMIC STROKE – Etiology • Thrombosis • Embolism – Clinical presentation • Varies cerebral vessel involved • thrombotic – Gradual in onset – Often occurs at night while the patient is sleeping – Patients wakes up with neurologic deficit – Predisposing factors include » Hypertension » Diabetes Mellitus » Vasculitis » Atherosclerosis • Embolic – Very rapid onset – Patient is usually awake and involved in some activity – Predisposing factors include » Atrial fibrillation » Mitral valve Disease » Endocarditis » Paradoxical embolism • MANAGEMENT OF ISCHAEMIC STROKES – CT scan – Blood pressure control – Thrombolysis in patient who present within 3 hours of onset. • Tissue plasminogen activator • Streptokinase – Anticoagulation • heparin – Anti-platelets for secondary prevention • Aspirin 75mg-300mg daily • Clopidogrel 75mg daily – Ancilliary treatment • Manage cerebral oedema • Electrolyte balance • Respiratory support • HAEMORRHAGIC STROKES – This can be • Subarchnoid hemorrhage • Intracerebral hemorrhage – SUBARACHNOID HEMORRHAGE • Etiology – Raptured congenital or acquired aneurysm – AV malformation • Clinical manifestation – Abrupt onset of occipital or generalized headache – Restlessness – Projectile vomiting – Diminishing level of consciousness – Neckrigidity – Papilloedema – Cranial nerve palsy
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