ACIDENTUL VASCULAR

CEREBRAL - STROKE
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 OBIECTIVE
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Definirea AVC
Enumerarea tipurilor de AVC
Factorii de risc
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Reabilitarea pacientului cu AVC
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 AVC- Statistica
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Este a 2-a cauza de deces
(#1 – boli cardiace, #3 – Cancer)

Mortalitatea este de 160.000 oameni/an

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Cu aproximatie 1persoana la fiecare 53
secunde sufera un AVC
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 AVC- Statistica
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La fiecare 5 min un om moare din aceasta

cauza
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Riscul creste cu varsta. Dupa 55 ani riscul

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se dubleaza
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72% din toate AVC-urile apar la persoane

peste 65 ani
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 Ce este ?
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Tesutul cerebral sufera din cauza

intreruperii bruste a fluxului
sanguin,rezultand un deficit neurologic
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Cauze :
– Obturarea unui vasul de sange
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– Sangerare din cauza rupturii vasului
Boston

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 Tipul - AVC
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 Tipul - AVC
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 Accident vascular
Ischemic (85%)

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 Accident vascular
hemoragic (15%)
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 AVC Ischemic
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AIT (Accidend Ischemic Tranzitor)-

remiterea completa a simptomelor in mai
putin de 24h
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 Aparitia semnelor clinice de afectare

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cerebrala de cauza vasculara cu durata de
>24h

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 AVC Ischemic
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Tipuri de AVC ischemic:

– Embolic
– Cheagul migreaza in vas
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– Trombotic
– Fluxul sanguin este blocat de
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cheag
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– Hipoperfuzia sistemica
• colaps circulator
• afectare multiorgan
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 Hipoperfuzia
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Socul :
– Cardiogenic, septic, hipovolemic
Simptomele sunt difuze,nesistematizate
Regiunile de granita
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– Cecitate corticala
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– deficit motor proximal

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 AVC-ul hemoragic
Apare sangerare la nivelul
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vaselor creierului. Cauza poate

fi: HTA, anevrism,

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 Accidentul Ischemic tranzitor
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Fenomene asemanatoare strok-ului, care dureaza

minute-ore. Creierul este privat de sange oxigenat
temporar.simptomele se remit dupa revenirea
fluxului normal.
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 Fara leziuni permanente

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 Este de obicei ignorat sau nediagnosticat corect

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 Atentie la simptome:
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1/3 din cei cu AIT ajung sa prezinte AVC

– 5% din toate AVC-urile apar la 1luna de la
AIT
– 12% in primul an
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– 20% in primii 2 ani

The sky
– 25% in primii 3 ani
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Boston

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 AVC-ul nu dicrimineaza
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 Strok-ul afecteaza populatia

• La orice varsta

• Orice grup etnic

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• Indiferent de antecedente

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 Cele mai multe insa, pot fi prevenite

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 Semne si simptome
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 Slabirea fortei musculare la nivelul membrelor sau

a fetei

 Confuzie brusc instalata, tulburari de vorbire sau de

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 Tulburari ale mersului, echilibrului sau de
Boston
coordonare

 Cefalee severa de cauza necunoscuta

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 Ask for a smile

Afecteaza
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partea opusa a
corpului
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 Ask for a smile

Factori de risc:

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OBEZITATEA

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–FUMATUL
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DROGURI
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 VARSTA INAINTATA
 Wee Betty ATRAIT 122 ANI

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ALCOOL
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 FACTORI DE RISC:
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 TENSIUNE ARTERIALA PESTE
140mmHg
Diabet
Valori crescute ale colesterolului
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Afectiuni cardiace
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 Factori de risc:
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Istoric familial de AVC

Lipsa acitivitatii fizice
Barbati peste 45 ani, femei peste 55 ani
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 Factori de risc
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Factori de risc pe care-I poti controla:

– DIETA
– ACTIVITATEA FIZICA
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– MEDICATIA CORECTA
– FUMATUL
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 Stroke Classification

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TACI (Total Anterior Circulation Infarct)

PACI (Partial Anterior Circulation Infarct)
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LACI (Lacunar Infarct)
POCI (Posterior Circulation Infarct)
 AVC-UL ESTE O URGENTA
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Prezenta la spital este obligatorie

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 DIAGNOSTIC
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 Evaloarea
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 Explorari
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 Aspecte CT
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 Evaloarea RMN
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 MRI
– T1/T2, DWI
– Provides immediate
evaluation of ischemia
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emergency use in
many settings
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 EKG –fibrillatia atriala

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 Carotid Ultrasound

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 Echocardiogram – cheaguri in cavitati

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 Radiografia Torace

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 Explorarea Angiografica
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 Analize de sange
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Factori de coagulare
Nivel colesterol.

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 Recunoasterea simptomelor in Stroke
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 3 Intrebari simple

– Sa zambeasca

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– Sa ridice bratele

The sky
is blue in – Pronunte o propozitie
Boston

scurta The sky

is blue
in
Boston

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 Masuri
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 Accident vascular cerebral este o urgenta

medicala.
 Fiecare minut contează atunci când cineva are un
accident vascular cerebral.
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 Fluxul de sânge este diminuat la creier, cu atât
mai mare prejudiciul.
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 Tratamentul imediat poate salva viața și de a
sporește șansele de recuperare de succes

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 TIMPUL este CREIER
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Timpul este foarte important pentru a putea

primi acest medicament

Ask for a stretch Fereastra de oportunitate tratament:

- de 3 ore – tromboliza IV
The sky
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Boston - de 6 ore tromboliza mecanica,

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 TRATAMENT
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 Tratament – tromboliza IV
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Linie intravenoasa Liza chegurilor

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tPA (Tissue Plasminogen Activator)

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 Chirurgical -Endarterectomia
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 Chirurgical - Craniotomia
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 Tratament endovascular
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 Indicatori de prognostic dificil
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Stroke anterior
Varsta inaintata
Persistenta disfuctiilor vegetative
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Deficiente de orientare vizuala spatiala
The sky
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– Conștiență la debut, severitatea paralizie, echilibru in
pozitia sezanda, nivelul de sprijin social,
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 Complicatii
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 Preventia
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 Medicatia
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Aspirina
Plavix
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Normo- tensoare
Scadere a colesterolului
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Vasodilatatoare periferice
Protectie neuronala
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 Tratamentul
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Managementul Medical
– Dietetic
– Terapie Fizica & Occupationala
– Terapiea vorbirii, comunicarii
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– Ingrijire general

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 Tratamentul In Spital
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Reabilitarea
– Consult amanuntit
– Stabilirea unui program de
reabilitare
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• Internare
• Reabilitare subacuta
The sky
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• Ingrijire la domiciliu

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 Reabilitarea
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Scop
- Funcția de restaurare ca urmare a unei boli
sau a prejudiciului, cu scopul de a
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maximiza capacitatea unei persoane de a
realiza cea mai deplină viață posibilă
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- "Retragere planificată a sprijinului“
Boston

- Echipa complexa

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 Rol
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 Obiectivele initiale ale terapiei si reabilitare
includ:
- preveni si trata probleme medicale
- maximiza independența funcțională
Ask for a stretch - să promoveze reluarea stilului de viață pre-
existente
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- pt reintegrarea în comunitate casa/comunitate
- îmbunătățesc calitatea vieții
Boston

- să faciliteze adaptarea psihologică și socială

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 Clasificarea Internationala a
Mobilitatii, Disfunctiilor si Sanatatii
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• Disfunctii: Probleme legate de miscarea
normala a unei parti a corpului: pareze,
plegii
• Limitari activitati: dificultati individuale-
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apuca o cana, mers
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• Restrictii de participare: probleme de
is blue in
Boston
implicare in situatii de viata (cumparaturi,
sport)
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 ECHIPA
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 MOMENTUL OPORTUN
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Reabilitarea începe cât mai curând posibil

după admiterea pentru ingrijirea acuta
• în mod ideal este asigurat de o echipa de ingrijire
accident vascular cerebral pe o unitate de accident
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• Dupa Stroke - 70-80% din pacienti nu pot merge
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independenti
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• Mai tarziu doar 15-20% nu sunt în măsură să
meargă în mod autonom

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 Institutia
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• Internat
• Ingrijire la domiciliu
• Vizite zilnice in centre
de recuperare
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• Programe de
reabilitare comunitare
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 Constientizarea propriei
persoane
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 Imbunatatirea mersului,
echilibrului
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 Imbunatatirea functiilor
membrelor superioare
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 Ingrijire personala
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 Redobandirea aptitudinilor
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 Imbunatatirea comunicarii dupa
stroke
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 Probleme tardive de
reabilitare
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• neadaptare psihologica
• depresie
• sexuale
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• de conducere masina
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• necesar de echipamente
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 Strategii recuperatorii
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Fizioterapie
Hidroterapia
Masaj
Ask for a stretch Stimularea electrica
Corectarea posturii - corsete
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Psihoterapie
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 Rolul fizioterapiei
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 Pentru a normaliza tonusul muscular
 Pentru a restabili funcției musculare
 Pentru a controla strategiile de compensare
 Pentru a menține o lungime musculare
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 Pentru a re-educare echilibru
 Să se recalifice mersul pe jos și de a restabili
mobilitatea
 Pentru a maximiza capacitatea functionala
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permitand in acelasi timp in curs de recuperare

neuromusculară
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 Alte probleme de considerat
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 Patologia asociata
– HTA

 Statusul Emotional
– Labilitate
– Depresie
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 Deficiente de Vorbire sau Limbaj

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– Disfazie (expressive/receptive)
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Boston – Disartrie
– Dispraxie

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