Strokes

Definition:
A focal neurological deficit that occur for more than 24 hours as aresult of a vascular lesion.
Complete strokes = Neurological deficit had reach its maximum

Classification of strokes
1)Strokes in evolution - strokes which the sign and synptoms are getting worst usually with in 24 hour time of onset
2)Minor Strokes - patient recover without any significant neurological deficit
3)Transient Ischemic Attack - focal neurological deficit that occur less than 24 hours

type Of Strokes
1) Cerebral Infarction
a) Embolic
- atheromatous plaque
- Septic emboli ( from vegitation of the I.E)
- mural thrombus ( from post myocardial infarction)
- Atrial Fibrillation

b) Thrombosis
- Atheromatous plaque in major cerebral vessel

c) Rare Condition
- Meningovascular syphilis
- Vasculitis e.g SLE
- Hypotension (BP <75mmhg)

2)Cerebral Haemorrhage
a) Hypertension
b) Microaneurysmal Rupture


Risk factor
1. Obesity
2. Smoking
3. OCP containing oestrogen
4. Diabetes Mellitus
5. Hypertension
6. Polycythemia
7. alcohol
8. Hyperlipidemia

Clinical features
1. Cerebral Hemisphere Infarction
Presented with - contralateral hemiparesis, hemiplegia, Uppermotor nueron lesion and Hemianopia
Initially, hypotonia with hyperreflexia, and hemiplegia then changes towards Hemiplegia, hyperreflexia, ang positive babinski sign (all feat of UMNL)

* Occlusion of main trunk of Middle cerebral Arteries

2. Lacunar Infarct
Small Infarct
Localize deficit of Pure Motor and Sensory Strokes

3. Brainstem Infarction
a) Ipsilateral Cranial Nerves Palsy
b) Contralateral Long tract lesion
- Hemiplegia - hyperreplexia, positive babinski sign,
- hemisensory loss