STROKE ????????????????????????????????????? ???????

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STROKE?????????????????????????????????????
???????
I. IntroductionII. CausesIII. Symptoms
signsIV. Lab investigationsV. Treatment
managementVI. RehabilitationVII.
PreventionVIII. Questions answers
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I. Introduction
Stroke CVA cerebrovascular
accident ????? ???????????? ???????????????????
? Symptoms signs ?????????????????????????
????????????...???... ???? deep coma
????????????...?? ???????? Thrombolysis-rtpa
??????????????????????????? ??????? ?????
window time period ????? 3-4 ???????
??????? ??????????????????????????????? 100
????????? 100... stroke unit fast
tract???????? Anticoagulant - antiplatelet
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I. Introduction
?????????? ?????????????????? ???????????????????
?????????????????? ?????????????????????????????
?????????? ?????????? stroke ???????????????????
??????????? ???????????? Prevention is much
much better than cure
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II. Courses

• Hypertension heart diseasesAF, valvular
• Diabetes mellitus
• Dyslipidemia
• Overweight
• Lack of exercises
• Cigarette smoking
• Alcohol consumptionruptured
• Arteriovenous malformation, Berry
  neurysmcongenital
• Arteritis syphilitic arteritis, tuberculous
  arteritis, SLE
• Ageing

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III. Symptoms signs
??????????????????????
? Anatomical locationvery much variable
- cerebralhemisphereR L - dominant
speech - non-dominantdressing apraxia -
???????????????????? - anteriorposterior
middle - brainstempons,medulla, midbrain,
thalamus R L
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III. Symptoms signs
??????????????????????
? Size or arterial lumen - lacune2-3 mm
---gt 1.0 lt 1.5 cm - middle large artery
carotid, or middle cerebral artery whole
cerebral hemisphere infarct .????????????????????
??? massive brain edema ? Nature
ischemic VS hemorrhagic ? Brain edema ?
increased intracranial pressure ExampleHemiplegi
a with aphasia, hemiparesis with dysphasia
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V. Treatment Management
Acute ? Medical - thrombolysis
anticoagulant - control of hypertension
glucose, temperature, others ? Surgical -
indication for surgical intervention -
timing Chroniclong term management?
Psychological support
maintenance - ???????????? ???????????
?????? ?????????????????????????????????????????
???? - ???????? ????????????????? ?????????????
????????????????????? ??????? stroke ??????
?????? ?????? ?????????????...????????????
??????...????????????????...???????????????????
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I.V. Lab investigations

• Basic CBC, urinalysis, VDRL
• LFT BUN, Cr, electrolyte
• CT brain scanindication timing when
• MRI-MRA brain scanindication
• Ultrasound Doppler
• Chest x-ray
• EKG
• Echo condiagram
• Others

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VI. Rehabilitation

• Passive movement when to start how
• Active movement when to starthow
• - Sitting balance
• - Standing balance
• - Assisted ambulation
• - Unassisted walk
• - Gait stability training

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VII. Prevention

• Primary prevention ?????????????? ???? DM,
  HT, HD, dyslipilemia
• ???????????????? stroke ??????
• Secondary ???? stroke ????????????????????????
  ?????????????????
• 2,3 ??????????? ????????????????????????
  ??????????????
• ??????????????...???????????????????????????
  ????????? 2,3
• ???????????????????????????

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VIII. Questions answers

• BP control drugs
• - thiazide
• - ACEI inhibitorsa must for DM patient
• - ARIIB inhibitorsa must for DM patient
• - Propanolol
• - Ca-blockers
• - Etc.
• Lipid control drugs
• - Simvastatins
• - Others
• Glucose control drugs
• - Oral
• - Parenteralinsulin

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CT-Scan Brain
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