Neurology · MU Sofia

59. Acute ischemic disorders of cerebral circulation: etiology, clinical features, pathogenesis, vascular pools, prevention, therapy

Covers acute ischaemic stroke from its definition and share of all strokes through its causes: thrombosis from atherosclerosis, embolism from atrial fibrillation and other cardiac sources, and haemodynamic hypoperfusion. It then sets out the ischaemic cascade, core versus penumbra, the vascular syndromes of the MCA, ACA, PCA and vertebrobasilar territories, diagnosis, prevention, thrombolysis and thrombectomy, and complications.

Inside: 4 sections · 1 labelled picture · 15 flashcards · 2 min

Topic 59 of 88 in the MU Sofia syllabus for Neurology (Medicine, Year 4). The free AceMed note covers it in 4 sections, about 334 words (2 min of reading), with 15 flashcards.

In this note

  1. Acute ischemic disorders of the cerebral circulation - etiology, clinical features, pathogenesis, vascuar pools, prevention, therapy
  2. Prevention
  3. Acute Therapy
  4. Complications

Acute ischemic disorders of the cerebral circulation - etiology, clinical features, pathogenesis, vascuar pools, prevention, therapy

Definition: Acute ischemic stroke is a sudden neurological deficit caused by interruption of cerebral blood flow, resulting in brain ischemia and infarction.

  • It accounts for about 80–85% of all strokes.

Etiology (Causes)

A. Thrombosis (most common): Occlusion of cerebral arteries due to atherosclerosis.

  • Risk factors: Hypertension. Diabetes mellitus. Hyperlipidemia. Smoking

B. Embolism

  • Sources: Atrial fibrillation (most important). Myocardial infarction. Valvular heart disease. Endocarditis

C. Hemodynamic (Hypoperfusion): Severe hypotension. Shock. Cardiac arrest

Pathogenesis

Ischemic Cascade: Arterial occlusion → ↓ cerebral blood flow → ↓ oxygen and glucose → ATP depletion → neuronal injury → infarction.

Important Concepts

  • Ischemic Core: Irreversibly damaged tissue
  • Ischemic Penumbra: Hypoperfused but viable tissue. Main target of acute treatment

Clinical Features

  • General Characteristics: Sudden onset. Focal neurological deficit. Symptoms depend on affected vascular territory

Vascular Syndromes (Vascular Pools)

A. Middle Cerebral Artery (MCA) Syndrome (Most Common)

  • Contralateral: Hemiparesis (face and arm > leg). Hemisensory loss
  • Additional findings: Aphasia (dominant hemisphere). Hemineglect (non-dominant hemisphere). Homonymous hemianopia

B. Anterior Cerebral Artery (ACA) Syndrome

  • Contralateral: Leg weakness > arm weakness. Leg sensory loss
  • Frontal lobe signs: Abulia (lack of initiative). Personality changes. Urinary incontinence

C. Posterior Cerebral Artery (PCA) Syndrome

  • Findings: Contralateral homonymous hemianopia. Visual agnosia. Memory impairment. Thalamic sensory syndrome

D. Vertebrobasilar (Posterior Circulation) Syndrome

  • Brainstem/Cerebellar Signs: Vertigo. Diplopia. Dysphagia. Dysarthria. Ataxia. Cranial nerve deficits

Diagnosis

  • Emergency Brain CT
  • First investigation: Excludes hemorrhage
  • MRI: More sensitive for early ischemia
  • Additional Studies: CT angiography/MR angiography. Carotid Doppler ultrasound. ECG. Echocardiography

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