CEREBROVASULAR DISEASE:-…. The Stroke Syndrome is a condition of sudden development of focal neurologic deficit sometimes associated with unconsciousness, usually associated with cerebrovascular accident lasting longer than 24 hours.
Different states in the process of development of stroke
TIA or Transient ischaemic attack
RIND or Reversible ischaemic neurologic defect
Here the features are similar to completed stroke but the neural deficit either completely or mostly disappears within 24 to 36 hours.
Stroke in Evolution
Here the neurologic deficit starts in a focal manner but gradually involves wider area giving rise to larger neural deficits persisting for more than 24 hours. This is possible due to extension of thrombus along the involved artery. This is usually seen in the territory of middle cerebral or basilar artery. In the vertebrobasilar system it may indicate haemodynamic instability with spreading insufficiency to the critical zone of the hypoperfused area.
Here the clinical signs of stoke are persistent in major bulks
and new signs do not appear any more.
CAUSES OF STROKE
1. Atherosclerotic thrombosis (85%).
2. Hypertensive haemorrhage (12%)
3. Lacunar syndrome.
4. Cerebral embolism.
5. Hypertensive encephalopathy.
6. Subarachnoid haemorrhage.
7. Ruptured vascular malformation including aneurysm.
8. Middle meningeal artery haemorrhage.
9. Indeterminated and other causes.
Risk Factors in CVA
(i) Age: Median
(ii) Sex: M > F
(ii) High BP
(iv) Diabetes mellitus.
(vi) Marked Addiction to alcohol.
(vii) Cardiac disease.
(ix) Strong family history.
(xiii) Past history of stroke
Predisposing causes in CVA
1. Atherosclerosis in intra and extracranal arteries.
2. Long standing rheumatic heart disease with or withoutbacterial endocarditis with/without atrial fibrillation/flutter.
3. Arterio-venous malformation including aneurysm.
5. Hyperviscosity syndrome.
6. Bleeding diathesis.
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