Ischemic Stroke: Characteristics

by Carlo Raj, MD

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    00:01 What are the characteristics of our ischemic stroke? Well, it’s important to understand where did my stroke take place.

    00:07 We call it a cerebrovascular accident, don’t we? A CVA.

    00:11 In cerebrovascular accident, where was the location of this particular stroke? Which blood vessel was it affecting? Was it a large blood vessel? Was it a little blood vessel? What part of the brain was affected? Was it the dominant or non-dominant side? You understand that at this juncture, it would be a really good idea for you to have a firm handle of the neuroanatomy, right? Make sure you know where all the important significant blood vessels are located, what part of the brain that they are supplying and make sure you understand what – That part of the brain, what is it responsible for? What kind of activity? Is it motor or sensory? So on and so forth.

    00:53 Those kinds of questions become important for us and it’s important that you understand what part of the brain is responsible for what kind of function.

    01:01 Maximal at onset.

    01:04 Remember that husband sitting on a recliner chair, watching TV and then all of sudden, boom, it happened quickly.

    01:12 Slurring of the speech, was unable to walk, maybe blurring of the vision.

    01:18 That’s characteristic of a stroke.

    01:20 May have a step-wise progression depending on the etiology.

    01:23 Now, you’ve heard of multi-infarct dementia maybe perhaps.

    01:27 And so therefore, as you have more and more of your blood vessels being blocked and blocked and blocked.

    01:34 And then the dementia that is setting in takes a step-wise like, well, deterioration.

    01:42 Let’s talk further about risk factors.

    01:44 Hypertension being one of the most common, common risk factors for ischemic stroke.

    01:50 And if it is hypertension, then what may then happen to the blood vessel focally? Good.

    01:56 Let's talk about benign, chronic type of hypertension.

    01:59 And you know about hyaline arteriosclerosis.

    02:02 That could be a possible risk factor.

    02:05 What about diabetes itself? Diabetes, most of the time accompanied by hyperlipidemia, resulting in atherosclerosis, stroke.

    02:14 Tobacco with history of stroke or TIA.

    02:17 Now, smoking itself or tobacco is an injurious agent.

    02:21 Heart disease.

    02:22 For example, we’ve talked about atrial fibrillation.

    02:25 Well, what if there’s valvular disease or cardiomyopathy? Take a look at those conditions, please.

    02:30 All of those conditions are the perfect environment to develop a thrombi and then eventually embolize resulting in a type of focal stroke.

    02:40 A patient has hypercholesterolemia and age.

    02:43 These are common sense type of risk factors, but nonetheless important once that you want to keep in mind.

    02:49 Genetic conditions.

    02:50 Now these, you may or may not be too familiar with, but I would recommend that you would have a pretty good idea as to some of these conditions genetically.

    02:59 There’s something called a CADASIL, which is your cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy.

    03:09 And specifically, this gene is called NOTCH3 gene.

    03:13 CADASIL.

    03:14 So this patient unfortunately develops a stroke and risk factors are not present, but genetically is prone to have one and that just sucks.

    03:26 Sickle cell disease, hypercoagulable state.

    03:28 For example, cancer is almost always associated with a hypercoagulable state.

    03:34 Pregnancy.

    03:35 Remember whenever you think about the hormone, estrogen, you know your patient is in a state of, well Or at risk for? Good. Hypercoagulability.

    03:44 Hence, you want to try to avoid oral contraceptive pills that have estrogen.

    03:47 Doing hormone replacement therapy, you’re worried about estrogen.

    03:51 When you have liver disease, you’re worried about heightened levels of estrogen.

    03:54 Pregnancy, you’re worried about heightened levels of estrogen.

    03:59 Hypercoagulable states.

    04:02 What else? How about antiphospholipid syndrome? Remember this condition.

    04:07 Antiphospholipid syndrome, autoimmune disease.

    04:11 There could be a small percentage of patients that go on to develop SLE.

    04:15 You’ve heard of – When you do this test – Now, this patient who is most likely a female, she’s trying to become pregnant and when she does, she has a history of multiple, multiple, multiple miscarriages unfortunately, has these thrombi formation both in the venous and arterial side.

    04:34 It’s a hypercoagulable state, autoimmune-wise.

    04:38 And you do a particular test and you check for the coagulation of this pathology.

    04:45 And what does it do in a test tube? Oh, my goodness.

    04:48 It causes anticoagulation.

    04:50 Why? Well, we'll have to research on that.

    04:52 But at this point, we call this particular cell a lupus anticoagulant.

    04:57 But the point is, genetic or in other words, here’s an autoimmune disease, which is now putting your patient at risk for a stroke.

    05:05 Protein C deficiency.

    05:07 So think about protein C.

    05:09 Think about protein S.

    05:11 These are little proteins that come from the liver.

    05:15 And it is in the spectrum of coagulation factors.

    05:19 You’ve heard of your II, VII, IX, and X.

    05:21 And those are procoagulants, aren’t they? And then you have protein C and S.

    05:26 And protein C and S -- And if I were you I will specifically make sure that you have an understanding of protein C and S, which normally breaks down factor V.

    05:37 Yes, technically, also factor VIII, but at least know factor V.

    05:42 The reason I say that to you is because another very important and common, actually the most common hereditary type of hypercoagulable state is called factor V Leiden disease.

    05:55 Say that your patient has protein C or S deficiency, you can’t break down factor V.

    06:01 Your patient is in the state of hypercoagulable.

    06:04 We’re putting all of these together, don’t just look at this list and memorize, make sure that you know the pathogenesis for many of these conditions that I’m giving you.

    About the Lecture

    The lecture Ischemic Stroke: Characteristics by Carlo Raj, MD is from the course Stroke (Cerebrovascular Accident).

    Included Quiz Questions

    1. History of use of baby aspirin
    2. Hypercholestrolemia
    3. Diabetes
    4. Hyaline arteriolosclerosis of the arteries in the brain
    5. Sickle cell disease
    1. Hemophilia
    2. CADASIL (cerebral autosomal dominant arteropathy with subcortical infarcts and leucoencephalopathy)
    3. Protein C deficiency
    4. Sickle cell disease
    5. Protein S deficiency
    1. Notch 3 gene
    2. Rb gene
    3. P53 gene
    4. WT 1 gene
    5. ADAMTS-13 gene
    1. CADASIL
    2. Antiphospholipid syndrome
    3. Chronic use of oral contraceptive pills
    4. Multiple myeloma
    5. Pregnancy

    Author of lecture Ischemic Stroke: Characteristics

     Carlo Raj, MD

    Carlo Raj, MD

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    ischemic strokes could be focal or global
    By Neuer S. on 16. April 2017 for Ischemic Stroke: Characteristics

    very clear explanation and easy to understand great examples and easy to follow