Documente Academic
Documente Profesional
Documente Cultură
Gavriliuc
Department of
Neurology,
AVC
Medical and
Pharmaceutical
Nicolae Testemitsanu
State University,
Republic of Moldova
EPILEPSIA
FACULTATEA STOMATOLOGIE, CICLUL NEUROSTOMATOLOGIE
FIZIOPATOLOGIA COMEI
PRINCIPALELE CAUZE CARE PRODUC COMA:
1. O leziune a trunchiului
cerebral sau tulburri
metabolice ce lezeaz sau
deprim Sistemul Reticular
Activator (SRA).
2. O leziune emisferic
bilateral sau o inhibiie a
activitii emisferelor.
1+2
Scala Glasgow
15
14 - 13
12 - 9
8-4
3
Informaia epidemiologic
Accidentul vascular cerebral reprezint a treia cauz de
mortalitate dup afeciunile cardiace i boala neoplazic
i prima cauz n rndul bolilor neurologice.
Incidena anual i mortalitatea prin AVC au sczut
considerabil (pe plan mondial) n ultimii ani, acest lucru
datorndu-se unui bun control al factorilor de risc.
Republica Moldova se afl printre primele tari ale
Europei la capitolul mortalitii prin boli cerebrovasculare.
Rata mortalitii pacienilor cu AVC n lume constituind
8% pentru pacienii ce au benifeciat de tratament n
unitile de STROKE i 27% - 33% pentru cei care nu a
fost posibil internarea n unitile specializate.
Factorii de risc
Nemodificabili
Vrsta
Rasa
Sexul
Greutatea ponderal mic la natere
Anamnestic familial de AVC sau AIT
Factorii de risc modificabili, bine documentai
Hipertensiune arterial
Tabagism
Diabet zaharat
Patologia carotidian
Fibrilaie atrial
Anemia falciform
Dislipidemia
Stilul alimentar
Obezitatea
Inactivitatea fizic
Terapia hormonal postmenopauzal
BOLILE CEREBRO-VASCULARE
Etiologia alteraiilor arterelor i venelor rezultnd n anormaliti
cerebrale
1. Tromboza aterosclerotic.
2. Spasme de arter cerebral (atac ischemic cerebral tranzitoriu).
3. Embolia.
4. Hemoragia hipertensiv.
5. Anevrismul sacular sau malformaia arterio-venoas cu sau fr
ruptur.
6. Arterita
1. Tromboza
aterosclerotic.
BOLILE CEREBRO-VASCULARE
Etiologia alteraiilor arterelor i venelor rezultnd n anormaliti
cerebrale
1. Tromboza aterosclerotic.
2. Spasme de arter cerebral (atac ischemic cerebral
tranzitoriu).
3. Embolia.
4. Hemoragia hipertensiv.
BOLILE CEREBRO-VASCULARE
Etiologia alteraiilor arterelor i venelor rezultnd n anormaliti
cerebrale
1. Tromboza aterosclerotic.
2. Spasme de arter cerebral (atac ischemic cerebral tranzitoriu).
3. Embolia.
4. Hemoragia hipertensiv.
5. Anevrismul sacular sau malformaia arterio-venoas cu sau fr
ruptur.
6. Arterita
3. Embolia.
BOLILE CEREBRO-VASCULARE
Etiologia alteraiilor arterelor i venelor rezultnd n anormaliti
cerebrale
1. Tromboza aterosclerotic.
2. Spasme de arter cerebral (atac ischemic cerebral tranzitoriu).
3. Embolia.
4. Hemoragia hipertensiv.
5. Anevrismul sacular sau malformaia arterio-venoas cu sau fr
ruptur.
6. Arterita
4. Hemoragia hipertensiv.
BOLILE CEREBRO-VASCULARE
Etiologia alteraiilor arterelor i venelor rezultnd n anormaliti
cerebrale
1. Tromboza aterosclerotic.
2. Spasme de arter cerebral (atac ischemic cerebral tranzitoriu).
3. Embolia.
4. Hemoragia hipertensiv.
5. Anevrismul sacular sau malformaia arterio-venoas cu sau
fr ruptur.
6. Arterita
BOLILE CEREBRO-VASCULARE
Etiologia alteraiilor arterelor i venelor rezultnd n anormaliti
cerebrale
1. Tromboza aterosclerotic.
2. Spasme de arter cerebral (atac ischemic cerebral tranzitoriu).
3. Embolia.
4. Hemoragia hipertensiv.
5. Anevrismul sacular sau malformaia arterio-venoas cu sau fr
ruptur.
6. Arterita
6. Arterita
a. Sifilisul
meningovascular,
arterita secundar
ca consecin a
meningitei
piogenice sau
tuberculoase,
infecii rare (tifos,
shistosomiasis,
malarie, micoze,
etc.).
BOLILE CEREBROVASCULARE
Etiologia alteraiilor arterelor i venelor rezultnd n anormaliti
cerebrale
7. Tromboflebita cerebral: secundar otogen, infeciei sinusurilor
paranazale, a feei, etc.; n cadrul meiningitei i empiemului subdural; stri
de slbire general a organismului, postpartum, postoperativ, insuficien
cardiac, sau de cauz nedeterminat.
7. Tromboflebita
cerebral secundar
otogen, infeciei
sinusurilor paranazale,
a feei, etc.; n cadrul
meningitei i
empiemului subdural;
stri de slbire
general a
organismului,
postpartum,
postoperativ,
insuficien cardiac,
sau de cauz
nedeterminat.
Tromboflebita sinusului
longitudinal superior cu
infarct hemorrhagic
bilateral. Femeie n vrst
de 21 ani cu cefalee,
tetraparez, i stupoare.
BOLILE CEREBROVASCULARE
Etiologia alteraiilor arterelor i venelor rezultnd n anormaliti
cerebrale
7. Tromboflebita cerebral: secundar otogen, infeciei sinusurilor
paranazale, a feei, etc.; n cadrul meiningitei i empiemului subdural; stri
de slbire general a organismului, postpartum, postoperativ, insuficien
cardiac, sau de cauz nedeterminat.
BOLILE CEREBROVASCULARE
Etiologia alteraiilor arterelor i venelor rezultnd n anormaliti
cerebrale
7. Tromboflebita cerebral: secundar otogen, infeciei sinusurilor
paranazale, a feei, etc.; n cadrul meiningitei i empiemului subdural; stri
de slbire general a organismului, postpartum, postoperativ, insuficien
cardiac, sau de cauz nedeterminat.
9. Traumatismul i
disecia arterei
carotide i bazilare.
BOLILE CEREBROVASCULARE
Etiologia alteraiilor arterelor i venelor rezultnd n anormaliti
cerebrale
7. Tromboflebita cerebral: secundar otogen, infeciei sinusurilor
paranazale, a feei, etc.; n cadrul meiningitei i empiemului subdural; stri
de slbire general a organismului, postpartum, postoperativ, insuficien
cardiac, sau de cauz nedeterminat.
BOLILE CEREBROVASCULARE
Etiologia alteraiilor arterelor i venelor rezultnd n anormaliti
cerebrale
7. Tromboflebita cerebral: secundar otogen, infeciei sinusurilor
paranazale, a feei, etc.; n cadrul meiningitei i empiemului subdural; stri
de slbire general a organismului, postpartum, postoperativ, insuficien
cardiac, sau de cauz nedeterminat.
BOLILE CEREBROVASCULARE
Etiologia alteraiilor arterelor i venelor rezultnd n anormaliti
cerebrale
7. Tromboflebita cerebral: secundar otogen, infeciei sinusurilor
paranazale, a feei, etc.; n cadrul meiningitei i empiemului subdural; stri
de slbire general a organismului, postpartum, postoperativ, insuficien
cardiac, sau de cauz nedeterminat.
BOLILE CEREBROVASCULARE
Etiologia alteraiilor arterelor i venelor rezultnd n anormaliti
cerebrale
7. Tromboflebita cerebral: secundar otogen, infeciei sinusurilor
paranazale, a feei, etc.; n cadrul meiningitei i empiemului subdural; stri
de slbire general a organismului, postpartum, postoperativ, insuficien
cardiac, sau de cauz nedeterminat.
12.
Complicaiile
arteriografiei.
BOLILE CEREBROVASCULARE
13. Migrena
cu deficit
neurologic
persistent.
BOLILE CEREBROVASCULARE
14. Angajri
(hernii) cerebrale
supratentoriale
i subtentoriale,
n gaura rupt
posterioar.
BOLILE CEREBROVASCULARE
Etiologia alteraiilor arterelor i venelor rezultnd n
anormaliti cerebrale
13. Migrena cu deficit neurologic persistent.
14. Angajri (hernii) cerebrale supratentoriale i subtentoriale, n gaura
rupt posterioar.
15. Cauze mixte: displazia fibromuscular cu disecare local de
carotid, arter cerebral medie, or arter vertebral, bazilar;
iradiere cu raye X, infarct cerebral n teritoriu a. Cerebrale
medii n cadrul traumatismului cranio-cerebral nchis,
compresie prin anevrism sacular fr ruptur, complicaii de
utilizare a contraceptivelor orale.
16. Cauze nedeterminate ale vrstei copilreti i adultului tnr: boala
moyamoya; ocluzia arterial multipl progresiv (Taveras).
BOLILE CEREBROVASCULARE
Etiologia alteraiilor arterelor i venelor rezultnd n
anormaliti cerebrale
13. Migrena cu deficit neurologic persistent.
14. Angajri (hernii) cerebrale supratentoriale i subtentoriale, n gaura
rupt posterioar.
15. Cauze mixte: displazia fibromuscular cu disecare local de carotid,
arter cerebral medie, or arter vertebral, bazilar; iradiere cu raze X,
infarct cerebral n teritoriu a. Cerebrale medii n cadrul traumatismului
cranio-cerebral nchis, compresie prin anevrism sacular fr ruptur,
CEREBROVASCULAR DISEASES
CEREBROVASCULAR DISEASES
Circle of Willis
At the base of the brain, the
carotid and vertebrobasilar
arteries form a circle of
communicating arteries
known as the circle of Willis.
From this circle other arteries -the anterior cerebral artery
(ACA), the middle cerebral
artery (MCA), the posterior
cerebral artery (PCA) - arise
and travel to all parts of the
brain.
Because the carotid and
vertebrobasilar arteries form
a circle, if one of the main
arteries is occluded, the
distal smaller arteries that it
supplies can receive blood
from the other arteries
(collateral circulation).
CEREBROVASCULAR DISEASES
More than any other organ, the brain
depends from minute to minute on an
adequate supply of oxygenated blood.
Constancy of the cerebral circulation is
assured by a series of baroreceptors
and vasomotor reflexes under the
control of centers in the lower
brainstem.
Brain tissue deprived of blood undergoes
ischemic necrosis or infarction (also
referred to as a zone of softening or
encephalomalacia). Obstruction of an
artery by thrombus or embolus is the
usual cause of focal ischemic damage,
but failure of the circulation and
hypotension from cardiac
decompensation or shock, if severe and
prolonged, can produce focal as well as
diffuse ischemic changes.
CEREBROVASCULAR DISEASES
Ischemic cascade
Free radicals, arachidonic acid, and nitric oxide are generated
by this process, leading to further neuronal damage. Within
hours to days after a stroke, specific genes are activated,
leading to the formation of cytokines and other factors that
in turn cause further inflammation and microcirculatory
compromise. Ultimately, the ischemic penumbra is
consumed by these progressive insults, coalescing with the
infarcted core, often within hours of the onset of the stroke.
The central goal of therapy in acute ischemic stroke is to
preserve the ischemic penumbra. This can be
accomplished by limiting the severity of ischemic injury (ie,
neuronal protection) or reducing the duration of ischemia
(ie, restoring blood flow to the compromised area).
day
20
50
SCOPUL TRATAMENTULUI
PACIENTULUI CU ICTUS
CEREBRAL:
1. PACIENTULUI I SE OFER O
ANS OPTIMAL DE
SUPRAVIEUIRE.
2. REDUCEREA LA MINIMUM A
CONSECINELOR ICTUSULUI
PENTRU BOLNAV I PENTRU
PERSOANELE CARE NGRIJESC
DE EL.
COMPARTIMENTELE TRATAMENTULUI
ACCIDENTULUI VASCULAR
CEREBRAL:
the thalamus,
originating from
ascending
thalmogeniculate
branches of the
posterior cerebral
artery (C);
penetrating
cortical branches
of the anterior,
middle, or
posterior cerebral
arteries (A);
and the
cerebellum,
originating from
penetrating
branches of the
posterior
inferior, anterior
inferior, or
superior cerebellar
arteries (E).
basal ganglia,
originating from
ascending
lenticulostriate
branches of the
middle cerebral
artery (B);
INTRACRANIAL HEMORRHAGE
The bleeding occurs
within brain tissue,
and rupture of
arteries lying in the
subarachnoid space
is practically
unknown apart from
aneurysm. The
extravasation forms a
roughly circular or
oval mass that
disrupts the tissue
and grows in volume
as the bleeding
continues.
An unenhanced CT scan showing the typical picture of a massive primary
(hypertensive) hemorrhage in the basal ganglia. The third ventricle and opposite
lateral ventricle are compressed and displaced by the expanding mass (12 h after
onset of stroke).
INTRACRANIAL HEMORRHAGE
INTRACRANIAL HEMORRHAGE
INTRACRANIAL HEMORRHAGE
INTRACRANIAL HEMORRHAGE
INTRACRANIAL HEMORRHAGE
INTRACRANIAL HEMORRHAGE
INTRACRANIAL HEMORRHAGE
Spontaneous Subarachnoid Hemorrhage (Ruptured Saccular Aneurysm)
INTRACRANIAL HEMORRHAGE
Spontaneous Subarachnoid Hemorrhage (Ruptured Saccular Aneurysm)
INTRACRANIAL HEMORRHAGE
Spontaneous Subarachnoid Hemorrhage (Ruptured Saccular Aneurysm)
INTRACRANIAL HEMORRHAGE
Spontaneous Subarachnoid Hemorrhage (Ruptured Saccular Aneurysm)
INTRACRANIAL HEMORRHAGE
Spontaneous Subarachnoid Hemorrhage (Ruptured Saccular Aneurysm)
INTRACRANIAL HEMORRHAGE
Spontaneous Subarachnoid Hemorrhage (Ruptured Saccular Aneurysm)
INTRACRANIAL HEMORRHAGE
Spontaneous Subarachnoid Hemorrhage (Ruptured Saccular Aneurysm)
INTRACRANIAL HEMORRHAGE
Spontaneous Subarachnoid Hemorrhage (Ruptured Saccular Aneurysm)
Treatment
The timing of surgery for grade III patients is still
controversial, but if their general medical condition allows,
they probably also benefit from the same aggressive
approach. In grade IV patients, the outcome is generally
dismal, no matter what course is taken, but we have usually
avoided early operation. The insertion of ventricular drains
into both frontal horns has occasionally raised a patient with
severe hydrocephalus to a better grade and prompted early
operation. In the hands of experienced anesthesiologists
and cerebrovascular surgeons using microdissection, the
operative mortality, even in grades III and IV patients, has
now been reduced to 2 to 3 percent.
INTRACRANIAL HEMORRHAGE
Spontaneous Subarachnoid Hemorrhage (Ruptured Saccular Aneurysm)
Treatment
The timing of surgery for grade III patients is still
controversial, but if their general medical condition allows,
they probably also benefit from the same aggressive
approach. In grade IV patients, the outcome is generally
dismal, no matter what course is taken, but we have usually
avoided early operation. The insertion of ventricular drains
into both frontal horns has occasionally raised a patient with
severe hydrocephalus to a better grade and prompted early
operation. In the hands of experienced anesthesiologists
and cerebrovascular surgeons using microdissection, the
operative mortality, even in grades III and IV patients, has
now been reduced to 2 to 3 percent.
EPILEPSIA
I.
II.
III.
IV.
Aura.
Faza convulsiilor tonice.
Faza convulsiilor clonice.
Compa postcritic care treptat se transform n
somn.
I.
II. .
III. - .
Encefalita herpetic
Investigaii complementare.
THE END
QUESTIONS ???