Stroke results from either infarction or haemorrhage.
Differentiation is important to the management and prognosis but may be difficult clinically.
>>>Cerebral infarction accounts for the majority of strokes yet is often difficult to distinguish from haemorrhage on clinical grounds.
Features suggestive of cerebral infarction include:
atrial fibrillation
history of TIAs
stuttering stroke
moderate headache
consciousness relatively unaffected
normal CSF
risk factors - atherosclerosis, age
carotid bruits
clinical evidence of internal carotid artery occlusion - facial pulses, retinal signs
Thrombosis and embolism are the main mechanisms. The precise effects depend upon the arterial territory affected.
>>>Embolic stroke::An embolic stroke is a focal neurological deficit lasting for more than 24 hours that is secondary to vascular occlusion by material carried within the blood.
Anterior, middle and posterior cerebral artery branch occlusions are more often embolic - thrombotic occlusion beyond the first main intracranial branches is unusual.
Embolic strokes are usually of sudden onset. Seizures are frequent and may persist for some time after the acute event.
Diagnosis depends upon:
identification of an embolic source
clinical picture - sudden onset; depression of consciousness if major vessel occlusion
N.B. Emboli frequently cause TIA's as well as infarction.
thrombotic stroke::The larger extracranial vessels, particularly the origin of the internal carotid artery, and the immediate branches of the circle of Willis, are usually affected by thrombosis.
The most common cause by far is atherosclerosis and it is not unusual for patients to have coexistent cerebral and peripheral vascular disease.
>>>other causes of cerebral infarction
Less commonly, cerebral infarction may result from:
cerebral vasospasm:
following subarachnoid haemorrhage
migraine
haemodynamic effects:
following a rapid fall in local perfusion pressure in severe systemic hypotension or cardiac arrest
carotid occlusion in patients with an inadequate collateral supply from the contralateral carotid artery
subclavian steal syndrome - usually causes TIA
vasculitis - a rare but important cause of cerebral infarction as immediate immunosuppressive therapy is indicated; more common causes include giant cell arteritis, polyarteritis nodosa, systemic lupus erythematosus, Takayasu's disease, radiation angiopathy
>>Cerebral hmg>>>Haemorrhagic stroke may occur during activity with no history of any previous attacks. They are most often associated with hypertension and cerebral aneurysms.
Features suggestive of haemorrhage:
sudden onset - no prodrome
recognised risk factors especially hypertension
severe headache, vomiting, early onset of coma
progression of deficit, e.g. loss of consciousness
blood in CSF
occurrence during waking hours
........Intracerebral haemorrhage is bleeding into the brain substance with the formation of a focal haematoma. It may rupture through the cortical surface to produce an associated "subarachnoid" haemorrhage. Alternatively, it may rupture into the ventricular system to produce an intraventricular haemorrhage.
ICH accounts for about 10% of all strokes. It is slightly more common among US blacks and individuals of Chinese and Japanese origin.
..>>>>>>>>Subarachnoid haemorrhage accounts for about 6% of cerebrovascular disease with an annual incidence of about 1 per 10,000. It is bleeding from intracranial vessels in the subarachnoid space. Occasionally, the arachnoid layer gives way and a subdural haematoma develops.
a very good source for stroke information , it s because of people like you that this site is running and wekeep coming back , thanks for all your efforts. by the way where can i find some good data on head injury?
Hi,
iam 50 years old. 3 years back,i was operated for teigiminal neralgia.,according to doctor,he operated for microvascular decompression, and cut a piece and sent for lab,histopath showed neuroma.
after the operation,i couldnot even walk.i lost balance.,and started severe thrombing pain like forign body,needle,in my right eye.,operation was also on right side.after 6 months,i started walking,and gained my balance.
still problem is that severe pain in right eye.eye is not red,normal tears,fundoscopy is normal.CT scan,MRI normal,numbness on right side of face still present. i tool many medicine,no effect.,including gabapentinl, neurolepties, esitalopram, analgesics.
please help me from this dying pain. thanks
I think u r referring to the condition named "Anesthesia Dolorosa"
Anesthesia dolorosa (AD) is an uncommon complication of surgical treatments for trigeminal neuralgia.
The two main symptoms of AD are facial numbness (much like the numbness from a dental anesthetic injection) and constant pain. The pain is usually burning, pulling or stabbing but can also include a sharp, stinging, shooting or electrical component. Pressure and "heaviness" can also be part of the pain symptoms. Often there is eye pain. Cold increases the feeling of numbness sometimes making the face feel frozen.
The treatment is mainly pain relief: What u can do at home is,
Even though cold air causes the neuralgia, Ice packs can be used to reduce the pain as it numbs the nerve.
you can encase icecubes in packs or the Commercial ice pack can be purchased through local pharmacy or physical therapy center.
1. Place in a pillowcase, to absorb and contain moisture. Do not use a terrycloth towel. Towels absorb too much of the cold and make the ice application less effective.
2. Expose the area for ice application. Place ice pack (in pillowcase) on bare skin of the affected area. Leave ice pack in place for at least 30 minutes with each use. Only the first 3 minutes are uncomfortable (if at all) after this time you will be numb.
3. Apply ice pack every 2 hours as needed for control of pain and discomfort, and/or swelling or spasm. You cannot overdose on ice!
Drugs like Carbamazepine(Tegretol) or Clonazepam(Klonopin) can also helpful to reduce pain but these drugs should be taken only after prescription by a registered medical practitioner. So do see ur doctor in person at the earliest.
I think u r referring to the condition named "Anesthesia Dolorosa"
Anesthesia dolorosa (AD) is an uncommon complication of surgical treatments for trigeminal neuralgia.
The two main symptoms of AD are facial numbness (much like the numbness from a dental anesthetic injection) and constant pain. The pain is usually burning, pulling or stabbing but can also include a sharp, stinging, shooting or electrical component. Pressure and "heaviness" can also be part of the pain symptoms. Often there is eye pain. Cold increases the feeling of numbness sometimes making the face feel frozen.
The treatment is mainly pain relief: What u can do at home is,
Even though cold air causes the neuralgia, Ice packs can be used to reduce the pain as it numbs the nerve.
you can encase icecubes in packs or the Commercial ice pack can be purchased through local pharmacy or physical therapy center.
1. Place in a pillowcase, to absorb and contain moisture. Do not use a terrycloth towel. Towels absorb too much of the cold and make the ice application less effective.
2. Expose the area for ice application. Place ice pack (in pillowcase) on bare skin of the affected area. Leave ice pack in place for at least 30 minutes with each use. Only the first 3 minutes are uncomfortable (if at all) after this time you will be numb.
3. Apply ice pack every 2 hours as needed for control of pain and discomfort, and/or swelling or spasm. You cannot overdose on ice!
Drugs like Carbamazepine(Tegretol) or Clonazepam(Klonopin) can also helpful to reduce pain but these drugs should be taken only after prescription by a registered medical practitioner. So do see ur doctor in person at the earliest.
You r most welcome pearl.
btw to avoid double/triple posts, when the rxpg submit reply page hangs, press the stop button in ur browser. Now wait for a couple of minutes. Even if the page hangs, the reply is sometimes posted. so just wait a few minutes, then go to rxpg front page, then "My posts" section, u can see if its posted or not.
You r most welcome pearl.
btw to avoid double/triple posts, when the rxpg submit reply page hangs, press the stop button in ur browser. Now wait for a couple of minutes. Even if the page hangs, the reply is sometimes posted. so just wait a few minutes, then go to rxpg front page, then "My posts" section, u can see if its posted or not.
i agree with you BGM , here the link to the real post was missing which is more important which forced me for a second post.
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Topic Tags: 
>>>Cerebral infarction accounts for the majority of strokes yet is often difficult to distinguish from haemorrhage on clinical grounds.
Even though cold air causes the neuralgia, Ice packs can be used to reduce the pain as it numbs the nerve.
You r most welcome pearl. 
