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Cerebrovascular Disease - Stroke Group#: 5 Case 2, Week 3 Qussi J. Al-Rebh TUESDAY 8/9/2016

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Page 1: Cerebrovascular disease / KFU- 2.1

Cerebrovascular Disease- Stroke

Group#: 5Case 2, Week 3Qussi J. Al-Rebh

TUESDAY 8/9/2016

Page 2: Cerebrovascular disease / KFU- 2.1

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Cerebrovascular disease !• Cerebrovascular disease refers to a group of conditions that affect the circulation of blood to the brain, causing limited or no blood flow to affected areas of the brain.

Cerebrovascular Blood flow in

your brain.

Vascular which means arteries and

veins.

Cerebro large part of

the brain.

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Case scenario While giving a speech, a 62 – year – old man is suddenly unable to find the right words. He also feels slightly faint. After about 5 minutes he can speak normally again and can also understand everything that is said to him. He has never had a speech disorder like this before; however, he has had two episodes of double vision, lasting 5 and 15 minutes respectively, which disappeared spontaneously. For the past two years he has been treated with anticoagulants after the replacement of his mitral valve.

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Learning Objectives• What are these Episodes called and what is the probable cause in this patient?• How can the episodes of double vision be explained?

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Mitral valve replacement:• Cardio surgical procedure in which a patient’s

 mitral valve is replaced by a prosthetic valve.

• Performed when the: • (mitral valve stenosis)• (mitral valve regurgitation).

• Patients with these valves must take anticoagulants  for life.

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Anticoagulation drugs:• Prevent blood clots from forming and growing and reduce the risk for heart attack, stroke and blockages in the arteries and veins

• Insufficient dosage of anticoagulant makes the patient susceptible to embolic events

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Double vision (Diplopia):• A condition where a single object is seen in

duplicate when the image produced by two eyes don’t absolutely match.

• Caused by paralysis or loss of coordination of one or more muscles that control the one eye movement due to a cranial nerve palsy

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Diplopia:• Normally, eye movement controlled by :• The 3rd cranial nerve (oculomotor nerve) • The 4th cranial nerve (trochlear nerve) • The 6th cranial nerve (abducent nerve)

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Pathophysiology of diplopia :

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Aphasia:• Aphasia is an impairment of language, affecting the production or comprehension of speech and the reading or writing could be affected.

• Aphasia is always due to injury to the brain ( head trauma,  brain tumors, or infections), most commonly from a stroke

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Aphasia:• In general, the left hemisphere of the brain is responsible for language and speechand is called the "dominant" hemisphere

• Cause by Damage of Broca’s area or Wernicke's area or both.

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Aphasia:• The type of aphasia depends on the brain area affected:• Broca’s area lies in the left frontal lobe.• Blood supply : Middle Cerebral Arteries.• If this area is damaged, It called Broca's aphasia • Causes reduced speech fluency with inability to understand what he is saying. • The patient makes great efforts to initiate language, which becomes reduced to a few disjointed words with failure to construct sentences

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Aphasia:• Wernicke's area lies in the left temporal lobe . • Blood supply : Middle Cerebral Arteries• Damage to this area causes Wernicke's aphasia. • The individual may speak in long sentences that have no meaning, add unnecessary words, and even create new words. • They can make speech sounds, however they have difficulty understanding speech and are therefore unaware of their mistakes.

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Aphasia:• Global (central) aphasia:• The combination of Broca’s comprehension of Wernicke’s with loss of both language production and understanding.• aphasia and the loss of This is due to widespread damage to speech areas• And is the commonest aphasia

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Aphasia Pathophysiology:• Due to mitral valve replacement and insufficient anticoagulation, Piece of thrombus on the surface of prosthetic valve broke off•The resulting embolus probable passedreadily through the internal carotid artery Disruption blood supply in the cerebral area of speech Ischemia.•Affect speech area Aphasia

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what is TIA?•A transient ischemic attack (TIA) — also called a ministroke: A temporary decrease in blood supply to part of your brain causes TIAs, which often last less than five minutes.

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Signs and Symptoms!?•Stroke symptoms depend on the affected area of the brain.•The main symptoms are “the FAST” symptoms:

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Risk FactorsHigh bloodpressure

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TIA Treatment:

Anticlotting drug

antihypertensiv

e therapy internal carotid endarterectomy

Rehabilitation

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Complications!?

ParalysisEmotional problems

Difficulty talking

central pain syndrome

Memory loss

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summary• When the single object duplicated, we call it diplopia.• Inability to find the right words or to talk called aphasia.• Which has 3types: Broca’s aphasia, Wernicke aphasia, and global apasia.• TIA is a temporary decrease in the blood supply in the brain.• One of the main causes of TIA in the heart patients is insufficient using of anticoagulation drugs.• The signs and symptoms are “FACT symptoms”.

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References•http://www.medicalnewstoday.com/articles/184601.php•http://www.aans.org/Patient%20Information/Conditions%20and%20Treatments/Cerebrovascular%20Disease.aspx•http://www.stroke.org/site/PageServer?pagename=stroke•http://www.nhlbi.nih.gov/health/health-topics/topics/stroke/signs.html•http://www.medicinenet.com/stroke_symptoms_and_treatment/page6.htm•http://www.mayoclinic.org/diseasesconditions/stroke/basics/definition/con-20042884• http://www.uptodate.com/contents/stroke-symptoms-and-dia

gnosis-beyond-the-basics• http://www.nhsggc.org.uk/content/default.asp?page=s1418_

1_1• http://en.wikipedia.org/wiki/Hypoglycemia

• Clinical medicine chapter 22

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