What is a Stroke? Lumen ventricle A stroke is an injury to the brain caused by interruption of its blood flow, or by bleeding into or around the brain. It produces neurologic deficits that can have a relatively sudden onset and persist for more than 24 hours. It can also kill the patient.

Common Neurologic Deficits Produced by a Stroke Common Neurologic Deficits Produced by a Stroke Lumen ventricle Weakness or paralysis, usually on one side only Loss of sensation, usually on one side only Problems with vision Difficulty in talking or understanding what is said Difficulty with organization or perception Clumsiness or lack of balance

STROKE FACTS All data refer to the United States STROKE FACTS All data refer to the United States Lumen ventricle At least 600,000 people suffer a stroke each year Stroke is the third leading cause of death Death rate following stroke has fallen 13.9% in the past 10 years, but stroke deaths rose 6.6% (this presumably reflects an increase in the number of strokes) About 4,400,000 stroke survivors are alive today Cost of stroke-related care is over $51 billion yearly Risk of having a stroke and of dying from one increases with age, yet many strokes occur in those under 65

Two Major Mechanisms Produce Strokes Two Major Mechanisms Produce Strokes Lumen ventricle Blockage of an artery (80% of strokes) -- produces ischemia (inadequate blood flow) This deprives the brain of oxygen and glucose,and slows waste removal -- affected brain tissue functions abnormally, stops functioning, and will die if ischemia persists Rupture of an artery (20% of strokes) -- causes hemorrhage within or around the brain. This distorts, compresses, and tears surrounding tissue Both kinds of stroke can increase intracranial pressure, a serious complication that can lead to the patient’s death

What is a TIA? Lumen ventricle A Transient Ischemic Attack (TIA) is a brief episode in which neurologic deficits occur and then disappear completely Most TIAs last a few minutes to an hour However they may persist up to 24 hours No neurologic deficits remain once the attack has ended, because little or no brain tissue is permanently damaged A TIA is a warning sign that the stage is set for an ischemic stroke. Treatment of patients with TIAs can reduce their risk of stroke

TIA FACTS TIA FACTS Lumen ventricle As many as 20% of patients who have a new stroke retrospectively report on or more prior TIAs After a TIA, the annual risk of stroke is about 5% for the next five years After A TIA, the risk of a stroke, myocardial infarction, or death is about 8% annually for the next five years The risk of stroke is highest during the first month % of subsequent strokes occur during the first month, and 40-50% during the first year.

Carotid Bifurcation artherosclerotic plaque and thrombus Carotid Bifurcation artherosclerotic plaque and thrombus

Basilar Artery artherosclerotic plaque narrows lumen ( ) Basilar Artery artherosclerotic plaque narrows lumen ( )plaque

Aorta - Atherosclerosis Numerous ulcerated plaques Aorta - Atherosclerosis Numerous ulcerated plaques

Atherosclerotic Plaque Atherosclerotic Plaque Lumen Fat Elastic Lamella Broken Cholesterol crystals

Cholesterol Embolus Artery supplying cerebellum Cholesterol Embolus Artery supplying cerebellum Lumen ventricle Granule cells cells Granule cells gone Cerebellar Cortex

Lumen ventricle

Embolus Plugging Artery fragment of thrombus originating in heart Embolus Plugging Artery fragment of thrombus originating in heart Lumen ventricle

Lumen ventricle

Embolus in Basilar Artery Embolus in Basilar Artery Lumen ventricle Embolus

Lumen ventricle

Recent Ischemic Infarct brain has begun to swell - and shift Recent Ischemic Infarct brain has begun to swell - and shift

Old Ischemic Infarct Old Ischemic Infarct Lumen ventricle

Old Ischemic Infarct Old Ischemic Infarct

Small Artery-putamen Abnormal wall - degenerative changes Small Artery-putamen Abnormal wall - degenerative changes Lumen

Lacunar infarcts putamen Lacunar infarcts putamen

Saccular Aneurysm Anterior Communicating Artery Saccular Aneurysm Anterior Communicating Artery

Subarachnoid Hemorrhage Blood fills and outlines brain sulci Subarachnoid Hemorrhage Blood fills and outlines brain sulci

Small Artery-putamen Abnormal wall - degenerative changes Small Artery-putamen Abnormal wall - degenerative changes Lumen

Intracerebral Hemorrhage Lumen ventricle Clotted blood

Lumen

Pontine Hemorrhage Pontine Hemorrhage

Small Artery-cortex Abnormal wall - amyloid ( ) Small Artery-cortex Abnormal wall - amyloid ( ) Lumen

Small Arteries-cortex Histochemical stain (red) for beta-amyloid Small Arteries-cortex Histochemical stain (red) for beta-amyloid Lumen

Lobar Hemorrhage Normotensive patient age 84 Lobar Hemorrhage Normotensive patient age 84

Normal CT Scan Normal CT Scan Lateral ventricle (CSF) Gray matter White matter Pineal gland (calcified) Cistern (CSF) skull

Two Old Ischemic Infarcts CT Scan Two Old Ischemic Infarcts CT Scan Lacunar infarct (small) BIG Infarct

CT Scan -Embolic Stroke 6 days after onset of left-sided weakness CT Scan -Embolic Stroke 6 days after onset of left-sided weakness

CT Scan - basilar thrombus basilar occluded where it branches CT Scan - basilar thrombus basilar occluded where it branches Clotted blood appears bright

Arteriogram - acute stroke basilar occlusion Arteriogram - acute stroke basilar occlusion Basilar artery Normal flow Flow STOPS Thrombus Blocking vessel NoPerfusionhere No Perfusion here

CT Scan - Basilar Occlusion Nothing seen 6 hours after onset of symptoms CT Scan - Basilar Occlusion Nothing seen 6 hours after onset of symptoms Calcification in choroid plexus

CT Scan - 36 hours after basilar occlusion CT Scan - 36 hours after basilar occlusion Areas of occipital lobes supplied by basilar branches appear darker

Intracerebral Hemorrhage CT Scan - 3 Hours after onset Intracerebral Hemorrhage CT Scan - 3 Hours after onset ventricles

Intracerebral Hemorrhage Rupture of small vessel in putamen Intracerebral Hemorrhage Rupture of small vessel in putamen Blood in lateral ventricle Old infarct Recent hemorrhage