HEMORRHAGIC STROKE INTRODUCTION STROKE ISCHEMIC 80 HEMORRHAGIC 20

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HEMORRHAGIC STROKE

HEMORRHAGIC STROKE

INTRODUCTION…. STROKE ISCHEMIC (80%) HEMORRHAGIC (20%) THROMBOTIC (50%) ICH (10%) EMBOLIC (30%) SAH (7%)

INTRODUCTION…. STROKE ISCHEMIC (80%) HEMORRHAGIC (20%) THROMBOTIC (50%) ICH (10%) EMBOLIC (30%) SAH (7%)

ICH. . § PATHOPHYSIOLOGY § CAUSES HTN (m. c. ) anticoagulant –warfarin TPA in

ICH. . § PATHOPHYSIOLOGY § CAUSES HTN (m. c. ) anticoagulant –warfarin TPA in ischemic stroke AV malformations amyloid angiopathy drugs coccaine, amphetamines, phenylpropalamine ic tumors § Site-putamen, thalamus, pons, cerebellum § Diagnosis –CT, MRI, ROUTINE

TREATMENT… • ABC • REVERSAL OF COAGULOPATHY • BP • ANTIPYRETICS • ANTIEPILEPTICS •

TREATMENT… • ABC • REVERSAL OF COAGULOPATHY • BP • ANTIPYRETICS • ANTIEPILEPTICS • ICP- raise head end 30 degree, analgesia , sedation • Osmotic diuretics • Controlled hyperventilation

SAH… • CAUSESANEURYSM RUPTURE ( types, a/w, treatment) AV malformation angiomas alcohol, ADPKD, HTN,

SAH… • CAUSESANEURYSM RUPTURE ( types, a/w, treatment) AV malformation angiomas alcohol, ADPKD, HTN, smoking, COA, Marfan, Ehlers Danlos 4 past stroke, trauma drugs, bld thinners

Clinical presentation • • • Thunderclap headache Subhyaloid retinal hemorrhage Activity raising d BP

Clinical presentation • • • Thunderclap headache Subhyaloid retinal hemorrhage Activity raising d BP FAST VISION, Co-ordination, ataxia Diagnosis-CT , CT angio CSF Analysis- xanthochromia, RBCS<5 X 10^6/L

Complications…. . • • Vasospasm, rebleeding, infarction Cerebral edema, hydrocephalus, Intracranial htn Fluid electrolyte

Complications…. . • • Vasospasm, rebleeding, infarction Cerebral edema, hydrocephalus, Intracranial htn Fluid electrolyte imbalance Respiratory failure MI Thromboembolism sepsis

CEREBRAL EDEMA… • CPP= MAP-ICP • TREATMENT Fluid restriction (1200 ml/day/m^2) controlled hyperventilation mannitol

CEREBRAL EDEMA… • CPP= MAP-ICP • TREATMENT Fluid restriction (1200 ml/day/m^2) controlled hyperventilation mannitol 0. 25 mg/kg IV -20 min s. osmolality 300 -320 osm/l surgery –venriculostomy, lobectomy. .

SAH SCALES

SAH SCALES

DIFFERENTIAL DIAGNOSIS… • • • OTHER IC HEMARRHAGES DRUG TOXICITY ISCHEMIC STROKE MENINGITIS ENCEPHALITIS

DIFFERENTIAL DIAGNOSIS… • • • OTHER IC HEMARRHAGES DRUG TOXICITY ISCHEMIC STROKE MENINGITIS ENCEPHALITIS IC TUMORS IC HYPOTENSION VENOUS THROMBOSIS PRI. HEADACHE SYNDROMES

HEMORRHAGIC Vs ISCHEMIC HEMORRHAGIC ISCHEMIC • Hyperacute • Severe headache • Consciousness usually impaired

HEMORRHAGIC Vs ISCHEMIC HEMORRHAGIC ISCHEMIC • Hyperacute • Severe headache • Consciousness usually impaired if large • Early signs of herniation • No obvious territory • More seriously ill, detoriate rapidly, nausea, vomitings, neck pain, noise n light intolerence • Acute or hyperacute • Moderate / no headache • Consciousness relatively preserved ( variable) • Herniation rare / late • Clear vascular territory

Treatment • • ABC MONITOR VITALS LABETALOL, NIMODIPINE ANTIEPILEPTICS FLUIDS ICP- DECOMPRESSION SURGERY PHYSIOTHERAPY,

Treatment • • ABC MONITOR VITALS LABETALOL, NIMODIPINE ANTIEPILEPTICS FLUIDS ICP- DECOMPRESSION SURGERY PHYSIOTHERAPY, FAMILY SUPPORT PREVENTION OF COMPLICATIONS

THANK YOU……. .

THANK YOU……. .