 A focal (or sometimes global) neurological defecit of sudden onset and lasting> 24h (or leading to death), and of presumed vascular origin  5-10 per 1000  more common in Asian,s Blacks, Pislands/Maoris  3 rd most common cause of death = developed

 Ischaemic – Thrombosis/Embolism (80%)  Large vessel disease  Heart – Artery Embolism  Small vessel disease/lacunar infarct (R’ -HT)  Haemorrhagic (20%)  Primary intracerebral (HT)  Secondary (neoplasm, vasculitis, bleeding disorder, prior embolic infarction, aneurysm, vascular malformation, trauma)

 Pathophys:  Artherosclerosis (50%) ▪ Thrombosis  Embolis  Systemic Hypoperfusion (following Cardiac arrest)  Rarer: Vasculitis, hypercoagulable states (pregnancy, antiphospholipid Sx), vasospasm

 In intracerebral hemorrhage (ICH), bleeding occurs directly into the brain parenchyma  Leakage from small intracerebral arteries damaged by chronic hypertension  Other - bleeding diatheses, iatrogenic anticoagulation, cerebral amyloidosis, and cocaine abuse.  Intracerebral hemorrhage has a predilection for certain sites in the brain, including the thalamus, putamen, cerebellum, and brainstem (+/- surrounding brain being damaged by pressure produced by the mass effect of hematoma).  A general increase in intracranial pressure may occur.

 Sudden hemiparesis/hemiplegia,  Numbness of the face, arm and the leg on one or both sides of the body  Aphasia/dysarthria  Dimness or loss of vision, particularly in only one eye  Unexplained dizziness, unsteadiness, or sudden falls  Sudden severe headache and/or loss of consciousness  Hemorrhagic strokes more likely to exhibit Sx of  ICP  Headache, often severe and sudden onset  Nausea and/or vomiting

Anterior Circulation (carotid circulation)Posterior Circulation (vertebrobasillar system) -Amaurosis Fugax (Sudden transient loss of vision in one eye, due to passage of emboli through the retinal arteries) -Diplopia, Vertigo, Vomiting -Aphasia-Choking, Dysarthria -Hemiparesis-Ataxia, Hemisensory Loss, Tetraparesis -Hemisensory Loss- Hemianopic Visual Loss

Stroke subtypeFeatures lacunar infarcts (LACI)pure motor or sensory stroke, sensorimotor stroke, or ataxic hemiparesis total anterior circulation infarcts (TACI) a combination of new higher cerebral dysfunction (e.g., dysphasia), homonymous visual field defect, and ipsilateral motor or sensory deficit of at least 2 areas of face, arm, and leg partial anterior circulation infarcts (PACI) only 2 of 3 components of TACI; higher cerebral dysfunction alone or with motor/sensory deficit more restricted than for LACI posterior circulation infarcts (POCI) brain stem or cerebellar dysfunction Cerebral Lesion – Dominant Hemisphere (usually Left): Aphasia/Dysphasia, Alexia, Agraphia Non dominant: Inattention/neglect, Denial Cerebellar Dysfunction – DANISH Dysdiadochokinesis (pronate/supinate), Ataxia, Nystagmus, Intentional tremor, Slurred Speech, Hypotonia+Hyporeflexia

Most common stroke is by infarction in the internal capsule following thromboembolism in a middle cerebral artery branch and internal carotid occlusion.