Documente Academic
Documente Profesional
Documente Cultură
in ra t e s p e r 1 0 0 0
35
30
25
20
15
10
5
0
55-59
60-64
65-69
70-74
75-79
80-84
85-89
90+
Age ranges
Males
Females
Hemoragic
. Intraparenchimatos
. Subarahnoidian
Ischemic
20%
25%
20%
Embolie
cardiogena
.
.
.
.
30%
5%
AVC
criptogenic
FIA
Valvulopatii
Trombi intraventriculari
Altele
Cauze rare
.
.
.
.
.
.
Stari protrombotice
Disectii arteriale
Arterite
Migrena/Vasospasm
Abuz droguri
Altele
Ischemia cerebrala
Accident vascular cerebral constituit
- durata peste 3 ore
- leziune teritoriu arterial superficial / profund
- invaliditate / deces
Etiopatogenie
Boala aterosclerotica
Extracerebrala: aorta
Cerebrala:
Vas mare: tromboza in situ,
embolie arterio-arteriala
Vas mic: lipohialinoza, necroza->
tromboza in situ / hemoragie
Boala cardiaca
FIA
Boala mitrala (stenoza)
Anevrism sept, ventricul
IMA
Mecanisme:
Aterotrombotic prin
Tromboza in situ: pe o stenoza preexistenta ->
ocluzie la aelasi nivel
Embolie arterio-arteriala: emboli migrati de la
nivelul unei placi de aterom trombozate
Fiziopatologie
Necroza ischemica
Central
Perfuzie < 10 ml/100g/min
Ireversibila
Penumbra
Diagnostic clinic
Debut brusc
Deficit neurologic focal: motor, senzitiv,
vizual, limbaj / modificare a starii de
constienta
salt tensional asociat (compensator!)
+/- cefalee
Manifestare clinica
Ocluzie vas mare
ACA: pareza crurala
controlaterala
ACM: hemipareza predominant
facio-brahiala controlaterala,
hipoestezie cl, hemianopsie
homonima cl, afazie,
ACP: hemianopsie homonima
cl
A vert: vestibular + cerebelos
A bazilara: sd altern + coma
Hemipareza ataxica
Hemihipoestezie izolata
Pareza faciala / faciobrahiala
!! Semnele se remit in 3-7
zile
Diagnostic paraclinic
CT / IRM
examen ultrasonografic vascular / cardiac
profil lipidic
profil biologic
teste hematologice
CT: hipodensitate
Diagnostic diferential
Criza epileptica / deficitul postcritic
rezidual
Proces expansiv intracerebral cu debut
clinic pseudoictal
Encefalopatii metabolice: hipoglicemica,
hepatica, uremica
Encefalite
Tratament
Profilaxia primara
= Tratamentul factorilor de risc:
HTA
dislipidemie
diabet
boli cardiace
fumat, alcool, droguri
Profilaxia secundara
Medical:
antitrombotic:
Antiagregant: aspirina, clopidogrel, dipiridamol + aspirina
Aspirina in primele 7 zile: 150 320 mg / zi
Si in AVC tranzitor urgenta majora
Proceduri:
Chirurgical: endarterectomie
Endovascular: stent