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Acute ischemic stroke can be caused by global hypoperfusion, thrombus formation, embolism, or other rare causes like vasculitis. Thrombus formation is the most common cause and can result from large vessel occlusion in the internal carotid or middle cerebral arteries, or small vessel occlusion. Risk factors for thrombus include modifiable factors like hypertension, diabetes, smoking, and hyperlipidemia as well as non-modifiable factors like older age and male sex. Embolism is also a common cause and can arise from arterial sources, cardiac sources involving the left atrium or ventricle, or paradoxical embolism through a patent foramen ovale. Diagnosis involves non-contrast CT to

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264 views3 pages

Ninja Nerd

Acute ischemic stroke can be caused by global hypoperfusion, thrombus formation, embolism, or other rare causes like vasculitis. Thrombus formation is the most common cause and can result from large vessel occlusion in the internal carotid or middle cerebral arteries, or small vessel occlusion. Risk factors for thrombus include modifiable factors like hypertension, diabetes, smoking, and hyperlipidemia as well as non-modifiable factors like older age and male sex. Embolism is also a common cause and can arise from arterial sources, cardiac sources involving the left atrium or ventricle, or paradoxical embolism through a patent foramen ovale. Diagnosis involves non-contrast CT to

Uploaded by

Salsabila HM
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOCX, PDF, TXT or read online on Scribd
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Acute Ischemic Stroke

Etiology & Patophysiology


Causes category :
1. Global hypoperfusion
2. Thrombus (blood vessel clot)
3. Embolic (clot somewhere that broke off and circulated, blocking cerebral vessel)
4. Other causes (vasculitis, dissection, hypercoagulable state)

Global hypoperfusion
Lead to watershed infarcts
Causes : significant cardiogenic shock (cardiac arrest), lack of oxygen (severe acute
respiratory failure), I.C.A stenosis & low BP (too much anti-HTN), septic shock, cardiac
surgery

Thrombus
Large Vessel Thrombus : I.C.A. (extra & intracranial), M.C.A (prox segment/M1),
Vertebral/basillar A.
Small vessel :
Come off the MCA and supply basal ganglia  lenticulostriae artery
Small pontine branches

RF of thrombus :
Modifieble :
Hypertension (m/c)
DM type 1 or 2 (hyperglycemia)
Hyperlipidemia
Smoking
Obesity

Non modifiable :
Old age (>65 yrs)
Male
Family history
Genetic hyperlipidemia

Risk factor  atherosclerotic plaque  stenosis, occlusion of cerebral vessel  with high
blood pressure, piece of covering the plaque got removed  inner cheesy material got
exposed (super thrombotic)  little platelet adhere to the cheesy material  platelet plug
formed, fibrin mesh formed  blood clot on top of thrombus  blockage of blood flow

Embolic causes (m/c of ischaemic stroke)


1)Arterial to arterial emboli : Aortic arch to I.C.A leading to infarction. Could be due to I.C.A.
plaque or aortic arch plaque  the plaque that’s on vessel wall rupture  freely circulated
in the blood vessel  infarction

2)Cardiac embolic cause


L.A. thrombus
 ineffective atrial contraction (A.Fib or AFL to some degree)
 Valve issue (mechanical valve
 Rheumatic heart disease (super prone to form clot)
 infective endocarditis (IV drug user, etc)

Stasis of BF, hypercoagula, endhotelial dysfunction  Virchow triad

L..V. thrombus
 L.V. aneurysm
 Ant/Lat. MI  stasis of blood flow ec weakend pumping function
 HF w/ reduced EF (30-35%)

Paradoxical Embolus
ASD : Patent foramen ovale (P.F.O.), atrial septal aneurysm

PFO  abnormal hole between atrial  patient w/ DVT  clot breaks off  come up via
IVC to right atrial  patient w/ PFO the emboli could go straight to left atrial and to cerebral
circulation

Embolic locations :
- M.C.A. usually proximal (M1 segment)
- P.C.A.
- Smaller segment (M2/M3)

On imaging, if theres multiple lesion  think about embolic cause

Vasculitis (autoimmune, infection)  injury to the vessel/pathogen attack the cerebral


vessel  blood clot formed

Dissection (trauma, iatrogenic, connective tissue disease like ehlers-danlos syndrome)

Hypercoagulable disorder (factor V leiden, protein C and S deficiency, anti-thrombin 3


deficiency, pro-thrombin gene mutation, anti-phospolipid syndrome, polisitemia, Heparin
Induced Thrombocytopenia)

CLINICAL FEATURES  see other vids

DIAGNOSIS
Stat Non Contrast CT-Scan  R/O hemmoragic stroke (ICH/SAH)
Hyperdense sign  hyperdense MCA/Basillar artery
Hypodensity as infark (cerebral tissue)

CT-Angiogram w/ contrast (see where contrast cant get past the clot)

MRI
DWI  hyperintense on infark (bright)
ADC  hypointense (darker on infark)

ECHO (T.E.E./T.T.E)

Point of care glucose  wanna know hypo/hyperglycemia  sometimes hypoglycemia into


a lesser degree hyperglycemia can present a stroke mimics
Patient w/ low glucose  before you give them TPA correct the glucose level first

Check INR  INR >1.7 ??


INR >1.7 + warfarin  take into consideration bcs anticoagulated + TPA  increased risk of
bleeding

PT/INR/PTT

CBC

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