资源描述
Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Brain Attacks,CVA,Add CorporateLogoHere,To insert your company logo on this slide,From the Insert Menu,Select “Picture”,Locate your logo file,Click OK,To resize the logo,Click anywhere inside the logo. The boxes that appear outside the logo are known as “resize handles.”,Use these to resize the object.,If you hold down the shift key before using the resize handles, you will maintain the proportions of the object you wish to resize.,1,Cerebral Vascular Accidents,Now referred to as strokes or brain attacks,Acute and treatable condition,Third leading cause of death,Leading cause of disability,2,CVA,Mortality,1. Heart disease 33.2%,Cancer23.7%,CVD 6.6%,3,CVA,Basic information,Males have more strokes,FemalesMales over age 85,4,CVA,Mortality by Race,Age adjusted,White 22.5 per 10,000,Black48.9 per 10,000,Morbidity,Prevalence 2.9 million in 1991,Cost $30 billion per year,5,CVA,Mechanisms,Anoxia,CA+ influx,Excitatory amino acids,Free radicals,6,CVA,Morphology,Penumbra develops,Region of encapsulated cells, alive but not well,7,CVA,Some treatment methods,Surgical clinical trials - carotid ectomy,Womans Estrogen Trials (WEST),Prevention by aspirin,Neuron salvage agent,8,Carotid Arteries,9,CVA,Long term results,Revascularization,local factors increase blood levels,Neural plasticity and regeneration,Recurrent strokes,10,CVA,Ischemic cell damage (Choi),Cells are stimulated to death,Glutamate neurotoxicity,Cycle of hypoxia, hypoglycemia, ischemia,11,CVA,Glutamate neurotoxicity,Energy depletion,Glu increase,Uptake of glu,Toxic glu exposure,Cell death,Glu release,12,CVA,Glutamate cell death,Cellular swelling,Cell death in under 5 minutes,13,CVA,Other Mechanism,High rates of Ca+ entry into cell,AMPA yields Na+,MMDA yields Ca+, Na+,AMPA toxicity after 3+ hours,Yields 70% cell death,24 hours yields 100% cell death,14,CVA,Process,Induction,Amplification,Expression,15,CVA,Hypoxic injury to brain,Bulbous swelling of the dendrites,Swelling of the cell body,MK801 (Ca+ blocker) greatly slows cell death,MMDA antagonistic,16,CVA,Cardiac Arrest Victims,“Window of Opportunity”,Histopathology,Heart attack - the entire brain becomes ischemic,17,Neurohistopathology,18,CVA,Decreasing order of vulnerability to ischemia,Neurons,Support cells,Astrocytes,Endothelial cells,19,CVA,Vulnerable regions,Decreasing order of sensitivity,1. Hippocampus,2. Cerebellum,3. Stratum,4. Neocortex,20,CVA,Vulnerable regions,Hippocampal cells may live 24-72 hours,CA1 CA3 resistant to anoxia,CA1 24-48 hours,21,CVA,Syndromes,Transitant Ischemic Attack (TIA),Resolving Ischemic Neurological Deficits (RIND),Stroke,22,CVA,Common patterns,1. Middle cerebral artery occlusion,Redundancy in the neurovascular system,Circle of Willis,23,Circle of Willis,24,CVA,Some principles,“Time is brain”,Focal symptoms,“Fit”,Migraine,“Swoon”,25,CVA,Some principles,Non-Focal symptoms,syncope,hypoglycemic,“Toxic”,26,CVA,Types of CVA,Hemorrhage,Subarachnoid (vomiting, back of head, blood in CSF),Intracerebral (focal onset, gradual increase in signs),27,CVA,Types of CVA,Ischemic,Thrombosis,Embolism,Systemic hypertension,28,
展开阅读全文