Now, with the ischemic
stroke, what we'll do
here is divide it into
focal versus your global.
What do you mean by focal?
Focal means that you have an individual
blood vessel that is undergoing
some type of compromise of
blood flow to the brain.
How did it occur?
Oh maybe, the patient had some type of
thrombi formation taking
place in the heart
secondary to, let's say,
And if you remember, atrial fibrillation
would be one of the criteria
for developing the thrombi, and
in essence, the Virchow triad.
Imagine now that you have a thrombus
formation taking place in left atrium.
What may then happen?
At some point in time if
there's, let's say, AFib,
then the thrombi will break off.
You embolize into left
ventricle and there you go.
And 10% of the time, you might
end up in the carotids.
And if you do, focally, the embolized thrombus might then become
lodged in a smaller cerebral blood vessel and occlude it.
This would create an ischemic type of stroke.
It could be.
Embolic, meaning artery to artery
or maybe the patient
started having a DVT,
maybe who's a female who's
obese and is smoking,
also taking estrogen therapy,
develops a deep vein thrombosis.
But how is that going to result in having
a stroke which is on the systemic side?
Obviously, there has to be
communication taking place
from the systemic veins
to the systemic artery.
So you begin with a deep vein
thrombosis, think of that please.
You will then embolize to the
right side of the heart.
And then, maybe, there was
an atrial septal defect.
And so, therefore, paradoxically,
will then embolize to the left
side and end up in your --
focally, a blood vessel bringing
about stroke-like symptoms.
Some more topic.
Ischemic stroke, specifically, focusing
upon one blood vessel at a time.
How did it become pathological is the
question that we're answering, aren't we?
How about thrombotic?
Once again, you have a thrombus
formation, but this time,
it's not in the deep vein of your
leg, nor is it in the left atrium,
but maybe it's actually taking place
in a blood vessel in the brain
due to, well, years have gone by and
the patient has hyperlipidemia,
and it might be atherosclerosis
decrease blood flow
profusion to the brain,
or a combination
What does that mean to you?
You know what hyaline is,
an aggregation of protein.
Oftentimes, you know that a patient
may have hypertension and diabetes
mellitus at the same time
and so therefore lipohyalinosis.
What's happening here?
There is a thrombus formation
taking place in your blood vessel,
Therefore, resulting in decrease
blood supply to the brain
and giving our patient, unfortunately, a
focal cerebral type of ischemic stroke.
Or the patient has vasculitis.
And by vasculitis we
refer to something like
temporal arteritis, you've heard it before.
Arteritis or maybe something like your
granulomatosis with polyangiitis,
formerly known as Wegener.
you get the point.
Or even something like IgA vasculopathy
formerly known as Henoch-Schönlein purpura.
All of those conditions
have one in common.
They're causing inflammation
in the blood vessel.
Then what then happens
to caliber of the lumen?
Uh-oh. It is getting
This is not good.
They result in what?
A focal type of ischemic stroke.
Are you seeing this now?
Or could it be cryptogenic.
In other words, not exactly
sure as to what the cause is.
So, on this side, it
would be focal type.
And then on this side, globally.
What may happen?
Well, global, your patient maybe
suffering from hypotension.
Globally versus focally.
So, if the entire body is
then there's going to be decrease
blood supply obviously to the brain.
Once again, causing an ischemic-type of
stroke but this is global in nature.
Keep that in mind.