DR Medhat MRCP

Stroke (= cerebrovascular accident) [CVA]
• Def : Rapid loss of brain function due to disturbance in the blood supply to the brain.
• Classification :
I. According to type of CVA ( ischemic or hemorrhagic stroke):
II.
Ischemic stroke: (thrombosis ,embolism,systemic shock)
Hemorrhagic stroke :
- Intracerebral (inside the brain parenchyma)
- Extracerebral (outside the brain) Epidural [bleeding() dura & skull]
Subdural (subdural space)
Subarachnoid .
According to the area affected (Oxford Community Stroke Scale)MRCP
A. TACS (total anterior circulatory stroke): combination of the 3 elements
1. Higher cerebral dysfunction.
2. Contralateral sensory/motor deficit.
3. Visual field defect.
B. PACS (partial anterior circulatory stroke): 2 of the 3 elements above, or new higher
cerebral dysfunction.
C. LACS (lacunar stroke):
1. Pure motor or pure sensory syndrome or
2. Ataxic hemiparesis or
3. Dysarthria or
4. Clumsy-hand syndrome.
D. POCS (posterior circulation syndrome):
1. Bilateral motor/sensory deficit or
2. Disorder of conjugate eye movement, or
3. Solitary visual field defect, or
4. Cerebellar dysfunction, or
5. Crossed cranial nerve& sensory/motor signs.
• Risk factors of stroke :
1. Old age.
2. High blood pressure (the most important modifiable risk factor of stroke).
3. Previous stroke or transient ischemic attack (TIA).
4. Diabetes.
5. High cholesterol.
6. Tobacco smoking .
7. Atrial fibrillation, valvular heart disease.
8. Thrombotic tendency (hypercoagulable state)
9. Cerebral aneurysms ,trauma, anticoagulation ttt,bleeding tendency [ risk of hge]
• Clinical presentation : (acute onset over sec/min , according to affected area):
52
The most common causes of stroke
in young age (