Presentation on theme: "“The true measure of a man is how he treats someone who does him absolutely no good.” – Ann Landers."— Presentation transcript:
“The true measure of a man is how he treats someone who does him absolutely no good.” – Ann Landers
Pathology of Cerebro-vascular Disease (Stroke) Dr. Venkatesh M. Shashidhar Associate Professor of Pathology Fiji School of Medicine
Shashi-Apr-15 Introduction: Stroke is the third most common cause of death and the second most common cause of neurologic disability after Alzheimer's disease. Its incidence has decreased in recent decades, but the decrease appears now to have leveled off, and it remains the leading cause of institutionalization for loss of independence.
Shashi-Apr-15 Introduction: “Stroke” Cerebro Vascular accident (CVA) Acute neurological deficit ↓ blood supply. Third leading cause of death. (2/1000/y) Varying severity, location & types Global / Focal Transient Ischemia evolving & completed. Low O2 (hypoxia) / Low blood supply.
Shashi-Apr-15 Brain Blood Supply Features: High oxygen requirement. Brain 2% of body weight - 15% of cardiac output 20% of total body oxygen. Continuous oxygen requirement Few minutes of ischemia - irreversible injury. Neurons - Predominantly aerobic. Sensitive areas: Adults -Hippocampus, 3,5 th & 6 th layer of cortex, Purkinje cells. Border zone (watershed areas) Brain stem nuclei in infants.
Shashi-Apr-15 Infarct Stages: Immediate – 6 hours No Change both gross & micro Acute stage – 2 days Oedema, loss of grey/white matter border. Inflammation, Red neurons, neutrophils Intermediate stage – 2 weeks. Demarcation, soft friable tissue, cysts Macrophages, liquifactive necrosis Late stage – After 4 weeks. Fluid filled cysts with dark grey margin (gliosis) Removal of tissue by macrophages Gliosis – proliferation of glia, loss of architecture.
’Smile’ at each other, smile at your friends, smile at your partner, smile at strangers - it doesn't matter who it is – This will help you to grow up in greater love for each other. ’Smile’ at each other, smile at your friends, smile at your partner, smile at strangers - it doesn't matter who it is – This will help you to grow up in greater love for each other. Mother Teresa , Roman Catholic Missionary
“The ultimate measure of a man is not where he stands in moments of comfort, but where he stands in time of challenge and controversy” “The ultimate measure of a man is not where he stands in moments of comfort, but where he stands in time of challenge and controversy” – Martin Luther King Jr.
Anatomy – Stroke.
Shashi-Apr-15 Left (Dominant) Hemisphere Stroke: Common Pattern Aphasia Right hemiparesis Right-sided sensory loss Right visual field defect Poor right conjugate gaze Dysarthria Difficulty reading, writing, or calculating
Shashi-Apr-15 Right (Non-dominant) Hemisphere Stroke: Common Pattern Defect of left visual field Extinction of left-sided stimuli Left hemiparesis Left-sided sensory loss Left visual field defect Poor left conjugate gaze Dysarthria Spatial disorientation
Shashi-Apr-15 Brain Stem Stroke: Common Pattern Pure Motor - Weakness of face and limbs on one side of the body without abnormalities of higher brain function, sensation, or vision (MCA/ACA) Pure Sensory - Decreased sensation of face and limbs on one side of the body without abnormalities of higher brain function, motor function, or vision (PCA).
Shashi-Apr-15 Brain Stem / Cerebellum / Post Hemisp. Patterns. Motor or sensory loss in all four limbs Crossed signs Limb or gait ataxia Dysarthria Dysconjugate gaze Nystagmus Amnesia Bilateral visual field defects
Shashi-Apr-15 Investigations: CT of the brain without contrast – location/ext. Electrocardiogram - heart Chest x-ray - heart complete blood count, platelet count – hemat. PT, aPTT – coagulation. Serum electrolytes – complications. Blood glucose - DM Renal and hepatic chemical analyses – status. National Institutes of Health Scale (NIHSS) score – clinical/prognosis ?
Shashi-Apr-15 “We must all suffer from one of two pains: the pain of discipline or the pain of regret” The difference is Discipline weighs ounces.. while regret weighs ton’s..! Jim Rohn