What is stroke Dr.Padma S. Gunaratne Consultant Neurologist - - PowerPoint PPT Presentation

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What is stroke Dr.Padma S. Gunaratne Consultant Neurologist - - PowerPoint PPT Presentation

Sep 26, 2023 675 likes •1.04k views

What is stroke ? What is stroke Dr.Padma S. Gunaratne Consultant Neurologist President, National Stroke Association of Sri Lanka Member, Board of Directors, World Stroke Organization & In-charge, Stroke Unit The National Hospital of Sri

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What is stroke ?

Dr.Padma S. Gunaratne Consultant Neurologist President, National Stroke Association of Sri Lanka Member, Board of Directors, World Stroke Organization & In-charge, Stroke Unit The National Hospital of Sri Lanka

What is stroke

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O2 + Glucose

Tissue

Cells

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Brain with blood supply

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Atherosclerosis

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“Brain attack” or stroke

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Aetiology

  • 80%
  • Cerebral Infarction
  • 15%
  • Cerebral Haemorrhage
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SYMPTOMS Contd….

  • Gradual loss of memory
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Management

  • CT
  • RBS, FBC, INR, ECG
  • FBC, ESR, RFT, Lipids, RBS, UFR
  • Nutrition
  • Nursing
  • Rehabilitation

– Physiotherapist – Occupational therapist – Speechtherapist

Within 4.5 hrs Thrombolysis >4.5 hrs

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Specific treatment

  • Thrombolysis with rt-PA within 3 hrs
  • Antiplatelet

– Aspirin – Clopidogrel – Dipyridamole

  • Oral anticoagulants

– For cardiac source of thrombo embolism

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Suspected stroke ETU assessment  Patient transferred to ICU or ward.  No antiplatelets or anticoagulants for 24 hours.  Patient is monitored for further 24 hours. Admission to medical casualty unit Probable Candidate for thrombolysis  Ischaemic stroke Confirmed  Criteria for thrombolysis satisfied.  MO neurology informed  CT department informed  Blood sent for RBS, APTT, FBC, INR  Patient transferred immediately for CT brain. Not a candidate for thrombolysis  Ischaemic stroke excluded  Criteria for thrombolysis not satisfied.  Consent obtained  rtPA started at CT room  NIHSS documented Acute stroke care programme (ASCaP) – NHSL Colombo FLOW CHART  Assessed by MO neurology.  SR/ consultant neurology and radiology informed.  CT arranged.

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RESULTS

Absolute benefit between 11% and 13% Relative benefit between 30% and 50% For every 100 patients treated with rtPA according to NINDS protocol, 11 more patients will achieve favourable out come

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Stroke Units

  • Multidisciplinary team of health care

professionals , providing organized in patient care, in a defined area.

  • There is a significant improvement in short

term and long term outcome measures.( death, disability, dependency and hospital stay)

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Stroke Team

  • Medical Oficer
  • Nurse
  • Physiotheapist
  • Speech theapist
  • Occupational therapist
  • Social worker
  • Counselor
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  • Secondary prevention
  • Rehabilitation
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Prognosis

  • Further stroke attribute to 25% of deaths
  • 10% die within 30 days
  • 50% remain disabled after 6 months
  • Heart disease is the commonest cause of

death

  • 30% functionally dependent at 1 year
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