STROKE -Clinical Manifestasion

CEREBROVASCULAR DISEASE :

1. Asymptomatic
2. Focal brain dysfunction

Ø  TIA ( Transient ischemic attack )

Ø  Stroke

3. Vascular dementia
4. Hypertensive encephalopathy

STROKE

Ø  Definition :

                Stroke is brain dysfunction, sadden and very rapid development of symptoms, focal or global, caused by only primary cerebrovascular disease which persistence of the neurologic deficit for longer than 24 hours or die.

Ø  Primary cerebrovascular disease is refere to the risk factors

Ø  Global brain dysfunction is refere to unconsciousness status

Ø  TIA if neurologic deficits last completelly less 24 hours

Improving stroke

Ø  Complete recovery of neurologic deficit between 24 hours to 3 weeks

Worseningstroke

Ø  Progresivity of nneurologic deficit, qualitative and quantitative, either anamnestic or follow up

Ø  50 % of cases in several minutes and hours

Ø  Divided in :

ü  Smooth worsening

ü  Steplike worsening

ü  Fluctuating worsening

CLINICAL MANIFESTATION ( cont’ )

1. Carotid system

Ø  Visual disturbances

ü  Contralateral homonymous hemiamianopsia

ü  Amaurosis fugax ( TIA )

Ø  Higher cortical dysfunction

ü  Aphasia

ü  Agnosia

CLINICAL MANIFESTATION ( cont’ )

2. Vertebrobasiler system

Ø  Visual disturbances

ü  Homonymous hemianopsia

ü  Cortical blindness ( TIA : blackout )

Ø  Others

ü  Loss of balance

ü  Vertigo

ü  Diplopia

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EPILEPSY

Definition

Abnormal and recurrent excessive synchronized discharge of cerebral neuron with clinical manifestation of epileptic seizure which are an intermittent stereotypical behavior, emotion, motor function or sensation.

Pathophysiology

•       Paroxysmal depolarization shift (PDS) of the resting membrane potential, which triggers a brief rapid   burst of action potentials terminated by a sustained after hyperpolarization

•   PDS : result of imbalance between excitatory (glutamate and aspartate) and inhibitory (GABA) neurotransmitters

•         Abnormalities of voltage controlled membrane ion channels

•        Imbalance between endogenous neuromodulators, acetylcholine favoring depolarization and dopamine enhancing neuronal membrane stability

Focal Epiloptogenesis

•          Asynchronous burst firing in some hypocampal and cortical neurons

Generalized Epiloptogenesis

·         asynchronous burst firing in abnormal thalamocortical interaction

Etiology

•          Idiopathic

•          Cryptogenic

•          Symptomatic

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