An overview of the approach to a patient presenting with symptoms suggestive of a CVA

1. Ashwin Haridas Asem Ali Ashraf Adam Ebrahim

6. Anterior Circulation Posterior Circulation

7. Middle Cerebral Artery

8. Anterior Cerebral Artery

9. Posterior Cerebral Artery

16. Etiology of ischemic stroke

20. ATP depletion Hypoperfusion Failure of Na + /K + ATPase membrane ionic pump Calcium entry Glutamate release Activation of lipid peroxidases, proteases & NO synthase Destruction of intracellular organelles, cell membrane & release of free radicals Free fatty acid release Activation of pro-coagulant pathways Liquefactive necrosis Thrombus/embolus Membrane depolarization & cytotoxic cellular edema

25. CLINICAL FEATURES

31. ‘ HAND OF GOD’

32. CLINICAL CLASSIFICATION

56. PATHOLOGICAL TYPES STROKE HAEMORRHAGIC ISCHAEMIC

59. ISCHAEMIC LESION

60. CT SCAN/MRI VASCULAR NATURE CONFIRMED HAEMORRHAGE ISCHAEMIA Cont’d… STROKE PATIENT

61. SEARCH FOR SOURCE Cont’d… SEARCH FOR SOURCE CEREBRAL ARTERIOGRAPHY MRA/CTA DOPPLER PET/SPECT

63. Carotid Artery Ultrasound Showing a Completely Calcified Atherosclerotic Plaque

65. 3-D reconstruction of CT angiogram showing stenosis at the carotid bifurcation

66. Intra-arterial angiography showing arteriovenous malformation

67. MR angiogram showing giant aneurysm at the middle cerebral artery bifurcation

68. HAEMORRHAGE CONFIRMED NORMAL CT SCAN HAEMORRHAGE SUSPECTED LUMBAR PUNCTURE CSF WITH BLOOD/ XANTHOCHROMIA

77. EARLY MANAGEMENT