HAEMORRHAGIC

STROKE
Indications of Surgery

Roll No- 11
 STROKE is defined by WHO as a ‘clinical
syndrome consisting of rapidly developing
clinical signs of focal disturbance of cerebral
function lasting more than 24 hours or
leading to death with no apparent cause
other than a vascular origin.’
TYPES OF STROKE
 HAEMORRHAGIC STROKE

INTRACEREBRAL SUB ARACHNOID

HAEMORRHAGE HAEMORRHAGE
(15%) (5%)

Caused by bleeding Caused by extravasation

within the brain tissue of blood into the sub
itself arachnoid space
INTRACEREBRAL HAEMORRHAGE

ETIOLOGY
 Ruptured saccular aneurysm
 AV malformation
 Brain trauma
 Haematological disorders
 Alcoholic disease, narcotic overdose
 PATHOPHYSIOLOGY OF ICH
Acute hydrocephaly

Increased ICP

Brain oedema

Dislocation of brain structures

Brainstem compression

Haematoma resolution occurs in 4-8 weeks, leaving a cystic cavity.

 CLINICAL PRESENTATION
 Weakness or paresis that may affect a single extremity
 Facial droop
 Monocular or binocular blindness
 Dysarthria
 Ataxia
 Aphasia
 Siezure
 Vomiting
 Increased Systolic BP
 Headache- more common in ICH
 DIAGNOSIS
 CT Scan
 MR- Angiography or Contrast Cerebral
Angiography- to identify a possible aneurysm or
arteriovenous malformation.
 Later MRI
 MANAGEMENT

 Monitoring of BP, ECG, Blood Glucose, Electrolytes.

 Prevention and treatment of complications.
 Surgical treatment- Removal of haematoma.
 Rehabilitation-Speech therapy, Physical therapy,
Cognitive therapy.
 INDICATIONS FOR SURGICAL
TREATMENT IN ICH
 Large
(>40ml) and superficial
hematoma with brain
compression signs.
 Acute hydrocephaly.
 Large hematoma in cerebellum.
 SUBARACHNOID HAEMORRHAGE

ETIOLOGY
 Saccular aneurysm
 AV malformations
 Haematological disorders
 Unknown etiology
 CLINICAL FEATURES

 Severe (THUNDERCLAP) headache

 Loss of consciousness
 Epileptic seizures
 Meningeal syndrome
 Hyperthermia, tachycardia
 DIAGNOSIS OF SAH

 CT Scan
 Lumbar Puncture
 MR angiography or Contrast cerebral angiography
 MANAGEMENT OF SAH

 Strict bed regimen

 Ca-antagonists – prevention for secondary
vasospasm
 Monitoring of BP, blood glucose, ECG, electrolytes
 Analgesics – in severe headache
 Surgical management
 SURGICAL TREATMENT
ANEURYSM CLIPPING

INDICATIONS-
 Hematoma associated with
aneurysm
 Large aneurysm
 Wide necked aneurysm
 Recurrentaneurysm after coil
embolisation
 COIL EMBOLIZATION
Endovascular treatment

INDICATIONS
 Patients with aneurysms in posterior
circulation, mainly in basilar apex
 Patients with high grade SAH
 Patients who are medically unstable
 Patients with small neck aneurysms in
posterior fossa
 Patients in whom the aneurysm lacks a
defined surgical neck
 Patients with multiple aneurysm in
different arterial territories if surgical risk
is high
THANKYOU