DIFFERENT TYPE OF CEREBROVASCULAR ACCIDENT
#Definition: abrupt onset of neurological disorder of vascular etiology.
#strokes can be hemorrhagic or ischemic.

TYPES OF HEMORRHAGIC STROKES
#Primary intracerebral hemorrhage
#Subarachnoid hemorrhage
#Primary intraventricular hemorrhage

TYPES OF ISCHEMIC STROKE
#Transient ischemic stroke
#Reversible ischemic neurological deficit(RIND)-ischemic neurological deficit lasting for 24-96 hours.
#Complete stroke
#Lacunar infarcts
#multifocal small infarcts or ischemia may result in slowly progressive neurological disorders

RISK FACTOR FOR STROKE
In patient at all ages...
High risk:
1)hypertension
2)Dm
3)atrial fibrillation with or without valvular heart disease
4)smoking
5)use of cocaine or amphetamines
6)vasculitis

Low risk:
1)migraine
2)use of ocp or alcohol
3)patent foramen ovale

Additional risk factors(more common in young patients)
1)protein c and s deficiency
2)antithrombin 3 deficiency
3)antiphospholipid syndrome
4)factor V Leiden syndrome
5)sickle cell anemia
6)hyperhomocysteinemia
7)thrombotic thombocytopenic purpura

TRANSIENT ISCHEMIC ATTACK:
#definition:abrupt onset focal neurological deficit of presumedvascular aetiology not lasting longer than 24 hours.Many episodes last for a few seconds to minute and rarely up to 24hours.

#mechanism:due to platelet thrombus get dislodgefrom an atherosclerotic plaque,to cause short lasting obstruction at a distal branch.Embolus gets broken resulting in re-establishment of perfusion with clearance of neurological deficit.

#symptom and signs:
CAROTID TERRITORY
-ipsilateral mono-ocular blindness(amaurosis fugox)
-contralateral hemiparesis
-hemianaesthesia
-dysarthria
-rarely hemianopia
-monoparesis
-isolated facial weakness
-reduced carotid pulsation
-bruit over carotid artery
-occasionally cholesterol crystal may be seen in retinal vessel on funduscopy

VERTEBROBASILAR TERRITORY
-ataxia
-dysarthria
-hemianopia
-diplopia
-sudden fall
-weakness on both sides
-paraesthesia

Diagnosis:
-focal seizurs and migraine

Investigations:
-routine test->ESR,FBC,CXR,ECG,BLOOD GLUCOSE,UREA,PROTEIN.

Treatment:
-correction of risk factors
-antiplatelet agents
-anticoagulants
-surgery;eg carotid endarterectomy