Você está na página 1de 35

VERTEBROBASILAR ISCHEMIC

Lecturer : Prof. dr. MI Widiastuti, Sp.S(K), PAK, MSc


Presentan : Ben Asiel Padang

BACKGROUND
The

number of stroke patients in


Indonesia is the highest in Asia
Incidence rate : 8.3 /100 population
in Indonesia
There are approximately 1.7 million
stroke survivors in Indonesia
Vertebrobasilar ischemia have a
mortality rate of over 85%

Approximately

80-85% of all strokes

are ischemic
20 % are vertebrobasilar ischemic
Mortality and Morbidity
vertebrobasilar ischemic is high

DEFINITION
Stroke according to WHO criteria :
1. Suddenly
2. more than 24 hours
3. obtained focal neurological deficit and global
4. caused by vascular disorders

CLINICAL MANIFESTATION
Frequent

symptoms
Dizziness, vertigo, headache, vomiting, double
vision, loss of vision, ataxia, numbness, and
weakness involving structures on both sides of
the body.

The

most common signs


Limb weakness, gait and
oculomotor
palsies,
and
dysfunction.

limb ataxia,
oropharyngeal

TYPES OF STROKE
Based on the pathology and cause:
Ischemic Stroke
Hemorrhagic Stroke
Based on the stage / time considerations :
TIA
Stroke-in-evolution
Completed stroke
Based on the vascular system :
Carotid system
Vertebrobasilar system

DIAGNOSIS OF STROKE

The diagnosis of stroke is made by


Taking a careful history,
Performing a neurologic examination
confirming the clinical diagnosis
with an appropriate neuroimaging
study.

PHYSICAL EXAMINATION
Diagnosis can be made from careful neurological
examination
70% of patients will exhibit:

Abnormal

level of consciousness.
Hemiparesis or quadriparesis (usually
asymmetrical).

40% of patients have bulbar manifestations


Also common are pupillary and oculomotor
abnormalities

ANATOMY
Cerebral arterial circulation
I.

The carotid system

II.

The vertebrobasilar system

THE CAROTID SYSTEM


Aortic arch

Common Carotid

Internal Carotid

M.C.A

A.C.A

THE VERTEBROBASILAR SYSTEM


Aortic Arch
Subclavia

Subclavia

Vertebral

Vertebral

Basilar

P.C.A

P.C.A

PATHOPHYSIOLOGY

CEREBRAL BLOOD FLOW


- Controlled by autoregulation mechanisme
that modulates a constant rate of blood flow
through the brain.
- These mechanisms provide homeostatic
balance
- Normal
: 50-60 ml/100g/min
- Reversibel :
20 ml/100g/min
- Irreversibel :
10 ml/100g/min

Atherosclerosis : formation of multiple plaques


within the blood vessels
Embolus : an object that migrates from one part
of the body to causes blockage or occlusion to
another part of the body
Trombus : the final product of the blood
coagulation step in hemostatis.

RISK FACTORS

Risk factors for a disease are


characteristics of an individual
or of a population, associated
with an increased risk of that
disease

NON-MODIFIABLE RISK
FACTORS
Increasing

age
Male Gender
African-American race
Have family history of stroke

MODIFIABLE RISK FACTORS


TIA

Hypertension
Diabetes

Mellitus
Heart disease
Hyperlipidemia
Obesity
Cigarette Smoking

IMAGING

CT - Scan

MRI

MRA

TCD

TREATMENT OF ISCHEMIC
STROKE
Rapid

diagnosis of stroke and


initiation of treatment are
important.
Patients with an acute stroke
should be admitted to hospital.

THROMBOLYTIC THERAPY
To recanalize the occluded artery
Carries the risk of major bleeding
3 4,5 hours time window
0,9 mg / kg

ANTICOAGULAN
For cardioembolic ischemic strokes :
IV unfractionated heparin
SC low molecular weight heparin
Oral Warfarin

Neuroprotective

is to prevent or limit
damage of brain tissue
Antiplatelet therapy, aspirin is the
most frequently prescribe
antiplatelet agent.
-

COMPLICATIONS
Pneumonia
Seizures
Deep

Vein Trombosis
Emboli Paru

THANK YOU