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Cerebrovascular |
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Neurosurgery Information |
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Stroke and Cerebrovascular Information |
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Peripheral Nerve |
Functional |
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Paediatric Neurosurgery |
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Cerebrovascular diseases constitute one of the most prevalent causes of neurological morbidity and mortality. These include:
1. Cerebral Infarction (lack of blood supply to brain tissue)
2. Cerebral Haemorrhage (bleeding into the brain)
3. Subarachnoid Haemorrhage (bleeding into subarachnoid space)
4. Vascular malformations (eg, Arteriovenous malformations/AVM)
5. Moya Moya disease (Japanese word for "puff of smoke")
6. Medical conditions like Encephalopathy |
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CT scan: Subarachnoid Haemorrhage (SAH) |
Anterior Communicating Artery Aneurysm |
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| Cerebral Aneuryms |
What is a Stroke? |
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Some stroke facts |
| Learn more about aneurysms |
A Stroke occurs when there is damage to the brain from an abnormality in its blood supply. It is otherwise referred to as a "Brain attack" or "Cerebrovascular accident". The 2 main types of stroke are: |
From Singapore National Stroke Association (SNSA) |
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1. Ischaemic Strokes - Due to blockage of an artery
2. Haemorrhagic Strokes - Due to bleeding from an artery |
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SNSA FAQS |
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What are the causes of an Ischaemic Stroke? |
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1. Blockage of an artery in the neck (from atherosclerosis)
2. Blockage of an artery in the brain
3. Blockage originating from the heart (cardioembolic)
4. Inflammation of the arteries
5. Clotting disorders
6. Undetermined
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Large Haemorrhagic Stroke |
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How about Haemorrhagic Strokes? |
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While this is not as common as ischaemic strokes, they are relatively more common in the east and amongst orientals and some asians. The risk factors of haemorrhagic strokes include: |
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1. Age, Males, Race - eg, orientals and blacks
2. Smoking, Alcohol
3. Drugs
4. Previous strokes
5. Liver dysfunction |
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The many causes of haemorrhagic type of brain attack include: |
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1. Hypertension (High blood pressure)
2. Progression of ischaemic strokes (Haemorrhagic conversion)
3. Aneurysms (abnormal dilatation of a blood vessel)
4. Arteriovenous malformations (abnormal communication between the arteries and the veins, AVMs)
5. Other vascular abnormalities
6. Age & degeneration (amyloid angiopathy)
7. Brain tumours
8. Brain infections
9. Trauma - delayed
10. Clotting disorders
11. Dural sinus thrombosis
12. Ecclampsia |
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How do I prevent a stroke? |
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Stroke prevention |
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A healthy and sensible lifestyle cum diet is probably the way to go! Smoking is one of your worst enemies. Controlling your blood pressure, keeping your cholesterol down at normal values and regular excercise are helpful. Statins may be necessary if your cholesterol is high while aspirin or other anti-platelet drugs are often prescribed if you have increased risk factors such as a previous stroke. If you're diabetic, control your blood sugar levels while people who drink alcohol should do so in moderation. Patients with atrial fibrillation (a condition where the atrium of the heart beats irregularly and ineffectively) may require warfarin (an anti-coagulant). If there is blockage of the carotid artery in the neck, patients will benefit from surgery (carotid endarterectomy) especially if they have symptoms. |
AHA guidelines
AAFP article
NHA recommendations
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If a stroke has occured, there is little the doctors can do. Is that true? |
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This is probably one of the greatest misconceptions. If a stroke has occured, there is little one can do to salvage whatever brain that is dead. However, very often, the brain that is under attack is not dead but vulnerable (ischaemic). Moreover, a small stroke may evolve and become more extensive. Good medical care to support the patient, thereby protecting his brain (neuroprotection) and allowing it to 'autoregulate' goes a long way in saving these vulnerable areas in the brain. In some circumstances, surgery has excellent results. For example, in a person with a large right sided stroke with brain sweling, urgent decompressive surgery to remove part of the skull allows the brain to 'swell outwards'. Not only does this reduce intracranial pressure, thereby saving the patient from certain death, the results can be be very encouraging indeed. |
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Cerebral Aneurysms. What are they? |
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An aneurysm is an abnormal dilatation of a blood vessel. They typically occur at arterial branch points where an area of weakness is present. The latter was previously thought to be due to a congenital defect. It is now believed to be related to vessel wall degeneration aggravated by haemodynamic forces of blood flow. Cerebral aneurysms therefore represent weak outpouchings of the vessel wall. If they rupture, bleeing occurs in the subarachnoid space leading to subarachnoid haemorrhage (SAH). Spontaneous SAH has a high morbidity and can lead to mortality. Approximately 20-30% of people with a rupture cerebral aneurysm die at the time of rupture; about 30% of them reach the hospital in a state of coma or paralysis while the remaining one-third of patients with SAH remain conscious but complain of a massive headache, characteristically described as "the worse headache in their lives".
Tell me more about cerebral aneurysms. Click here!!! |
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