Etiology it is never a primary condition disease of

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Etiology: It is never a primary condition Disease of elderly but can affect also children: intracranial hemorrhage- 40-55 years Subarachnoid hemorrhage 20-40 Ischemic stroke 60-65 Intracranial: - hypertension - Metastasis to the brain - Pheochromocytoma - Amyloid angiopathy Subarachnoid: - congenital vascular (aneurysm) - Hypertension - Head injury
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- AVM (malformations) - Intracranial vascular tumors (hemangiomas) Ischemic: - atherosclerosis( intra- precranial vessels and big vessels of body) - Embolic--- cardiac disease----- atrial fibrillation, myocardial infraction, up to 6 weeks may be secondary stroke Post MI period---- aneurysm of lef ventricle--- floating trombi endocarditis diosrders of cardiac conductivity(Morgani Adam Stokes syndrome, short ischemia, asynchronic contractions) cardiosurgical intervention placement of artificial devices(pacemaker, valve) - Endocrine disrders--- pheochromocytoma (rapid swings of blood pressure Diabetes mellitus(specially insulin dependent) after 50 disorders of microcirculation due to atherosclerosis Hypothyrosis (obesity) - Blood disorders---- anemia coagulative disorders (antiphospholipid syndrome) Polycythemia(excessive bone marrow production incr viscosity of blood, leukemias) - Rheumatic disease--- endocartis Rheumatic vasculitis (neovasculitis) Rheumatic disease of cervical spine, vertebral artery - Infectious disease- syphilis - Dependences--- smoking - Vascular diseases--- pre cerebral vessels Occluded carotid artery Compressive- vertebral a. Pathologenesis: Intracranial hemorrhage: ----formation of hematoma- disruption of vascular wall artery ----Hemorrhagic saturation- integrity of vascular wall in intact, permeability of vessel wall incr. ---- penetration of blood cells to neural tissue Ischemic stroke: Occlusion of artery--- decr. Perfusion area of brain--- release of glutamate (glutamic acid) in high amounts--- bind with calcium channels---- opening of calcium channels---- influx of Cl into intracellular space--- incr influx of water---- edema of neurons -intensification of lipid peroxidation----- destruction of neuronal membranes - incr NO--- activation of apoptotic genes 4.Ischemic stroke – clinical presentation (with special referral to vascular basins)
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.Ischemic stroke usually starts at the night time in people after 60. Stroke and symptoms develops slower. BP may be different, but usually is decreased. Patient doesn’t lose consciousness completely with few exceptions: embolism, ischemia o brainstem, basal arteries affection. There are 5 intracranial vascular bases: I. Internal carotid artery Optical pyramidal syndrome, ipsilateral blindness, contralateral hemiparesis II. Anterior cerebral artery Psychotic changes, apathy, resistance, grasp phenomenon, sunset phenomenon Speech disorders---- motor aphasia, hyperreactive relexes Contralateral hemiparesis of leg due to affection of upper 1/3 of precentral gyrus III. Middle cerebral artery Aphasia(sensory/ motor/ total)+ contralateral central hemiparesis Emotional changes Memory disorders Skill disorders--- different apraxias Hemispatial neglect-Ignoration of ½ o body Lower and middle part o precentral gyrus--- brachioascial paralysis IV. Posterior cerebral artery
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  • Winter '18
  • Jane doe

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