Pathophysiology of Stroke 11_19_12

Postmenopausal hormone therapy amphetamines alcohol

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Postmenopausal hormone therapy Amphetamines Alcohol Heroin Sympathomimetics Pseudoephedrine Ephedrine 1. Cantu C et al. Stroke Associated With Sympathomimetics Contained in Over-the Counter Cough and Cold Drugs. Stroke 2003;34:1667-72.
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Atrial Fibrillation and Stroke Risk Average annual risk of stroke in CHADS2 Score C H ypertension (+1) A ge >75 years (+1) D iabetes (+1) S troke or TIA (+ 2 ) CHADS2 Score Annual Stroke Risk (%) 0 1.9 1 2.8 2 4.0 3 5.9 4 8.5 5 12.5 6 18.2 Camm AJ et al. Guidelines for the management of atrial fibrillation. Eur Heart J 2010;31:2369-2429.
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Carotid Atherosclerosis Accumulation of lipids and inflammatory cells in artery intima + Hypertrophy of arterial smooth muscle cells Plaque formation 1. Fagan SC, Hess DC. Stroke. In: DiPiro JT, Talbert RL, Yee GC, et al., editors. Pharmacotherapy a pathophysiologic approach. 8th ed. New York: McGraw Hill Medical; 2011:353-356. 2. Image: http://vascular.surgery.ucsf.edu/conditions--procedures/carotid-artery-disease.aspx [Accessed 30 Oct 2012].
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Pathophysiology of Ischemic Stroke Shear stress may result in plaque rupture, collagen exposure, platelet aggregation, and clot formation Arterial occlusion decreases cerebral blood flow and causes ischemia distal to occlusion Local occlusion: clot remains in vessel Embolism: clot lodges downstream in a cerebral vessel Fagan SC, Hess DC. Stroke. In: DiPiro JT, Talbert RL, Yee GC, et al., editors. Pharmacotherapy a pathophysiologic approach. 8th ed. New York: McGraw Hill Medical; 2011:353-356.
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Image: Lomen-Hoerth C, Messing RO. Nervous System Disorders. In: McPhee SJ, Hammer GD, editors. Pathophysiology of Disease. 6th ed. New York: McGraw-Hill; 2010. http://accessmedicine.com/content.aspx?aID=5368376. [Accessed 02 Nov
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Cerebral Autoregulation Cerebral blood vessels dilate and constrict in response to changes in blood pressure Impaired by atherosclerosis, hypertension, and stroke 0 20 Mean Arterial Pressure (mmHg) ebral Blood Flow (mL/min/100 g) Ischemia Infarction 50 mL/min/100 g Gardner CJ, Lee K. CNS Spectr. 2007;12(1):35-42.
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Pathophysiology of Ischemic Stroke Apoptosis: occurs many hours after acute insult Begins within 2 hours after onset of ischemia May last several days 1. Fagan SC, Hess DC. Stroke. In: DiPiro JT, Talbert RL, Yee GC, et al., editors. Pharmacotherapy a pathophysiologic approach. 8th ed. New York: McGraw Hill Medical; 2011:353-356. 2. Smith WS, English JD, Johnston SC. Cerebrovascular Diseases. In: Longo DL, Fauci AS, Kasper DL, et al., eds. H arrison's Principles of Internal Medicine. 18th ed. New York: McGraw-Hill; 2012. http://www.accessmedicine.com/content.aspx?aID=9145753. [Accessed 02 Nov
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Diagnosis Location of injury determined by neurologic examination and confirmed by imaging studies Further diagnostic tests are then performed to identify the cause of the patient’s stroke Patient may not be able to reliably report the history due to cognitive or language 1.
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