00:01
What are the characteristics
of our ischemic stroke?
Well, it's important
to understand
where did my stroke
take place?
We call it a
Cerebral Vascular Accident,
don't we?
A CVA.
00:11
In the cerebral vascular 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 a dominant
or non-dominant side?
Do you understand
that at this juncture,
it would be a really good idea
for you have a firm handle
of the neuroanatomy, right?
Make sure you know
where all the
important significant
blood vessels are located.
00:39
What part of the brain
that they are supplying?
And make sure you understand
that part of the brain,
what is it responsible for?
What kind of activity?
Is a motor or sensory?
So on and so forth.
00:53
Those kind of questions
become important for us.
00:55
And it's important
that you understand
what part of the brain
is responsible for
what kind of function?
Maximal at onset.
01:04
Remember that
husband of sitting
on a recliner chair,
watching TV
and all of a sudden
boom...
01:11
it happen quickly.
01:12
Slurring of the speech,
was unable to walk,
maybe blurring of the vision.
01:17
That's characteristic of a stroke.
01:20
May have a stepwise progression
depending on the etiology.
01:23
Now, you've heard of
multi infarct dementia
may be perhaps.
01:27
So therefore, as you have
more and more of the blood vessels
that are being blocked
and blocked and blocked.
01:33
And then the dementia
that is setting in
takes a step wise like
well, deterioration.
01:41
Stop 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 made them happen
to the blood vessel focally?
Good.
01:56
Talking about benign,
chronic type 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...
02:08
most of the time accompanied by
hyperlipidemia,
resulting in
atherosclerosis.
02:13
Stroke.
02:14
Tobacco with history of stroke
or TIA.
02:17
Now, smoking itself or tobacco
is a injurious agent.
02:21
Heart disease.
02:22
For example, we talked about
atrial fibrillation.
02:25
What if there was
valvular disease or cardiomyopathy?
Take a look
at those conditions, please.
02:30
All those conditions
are the perfect environment
to develop a thrombus
and then eventually embolize,
resulting in a type of focal stroke.
02:40
Patient has
hypercholesterolemia and age.
02:43
These are common sense
type of risk factors,
but nonetheless, important ones
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 have
a pretty good idea,
as to some of these conditions
genetically.
02:59
There's something called
CADASIL,
which is your
Cerebral Autosomal
Dominant Arteriopathy
with subcortical infarct
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.
03:24
Sickle cell disease,
hypercoagulable state, for example,
cancer is almost always
associated with
a hypercoagulable state.
03:32
Pregnancy.
03:33
Hypercoagulable states.
03:36
What else?
How about
antiphospholipid syndrome?
Protein C deficiency.
03:41
So think about protein C.
03:43
Think about protein S.
03:45
These are little proteins
that come from the liver.