00:01
Now, with the ischemic
stroke, what we'll do
here is divide it into
focal versus your global.
00:06
What do you mean by focal?
Focal means that you have an individual
blood vessel that is undergoing
some type of compromise of
blood flow to the brain.
00:17
How did it occur?
Oh maybe, the patient had some type of
thrombi formation taking
place in the heart
secondary to, let's say,
atrial fibrillation.
00:29
And if you remember, atrial fibrillation
would be one of the criteria
for developing the thrombi, and
in essence, the Virchow triad.
00:38
Imagine now that you have a thrombus
formation taking place in left atrium.
00:42
What may then happen?
At some point in time if
there's, let's say, AFib,
then the thrombi will break off.
00:49
You embolize into left
ventricle and there you go.
00:52
And 10% of the time, you might
end up in the carotids.
00:56
And if you do, focally,
the embolized thrombus might then become
lodged in a smaller cerebral
blood vessel and occlude it.
This would create an ischemic type of stroke.
01:08
About thrombotic.
01:10
Once again,
you have a thrombus formation.
01:12
But this time, it's not in
the deep vein of your leg,
nor is it in the left atrium.
01:19
But maybe it's actually taking place
in a blood vessel in the brain,
due to years have gone by
and the patient has hyperlipidemia.
01:32
It's atherosclerosis,
and it might be atherosclerosis,
therefore causing decreased
blood flow perfusion to the brain,
or a combination of
lipohyalinosis.
01:44
What does that mean to you?
You know what hyaline is,
an aggregation of protein.
01:48
Oftentimes,
you know that a patient
may have hypertension and
diabetes mellitus at the same time.
01:55
And so therefore, lipohyalinosis,
what's happening here?
There is a thrombus formation
taking place in your blood vessel,
and therefore, resulting in
decreased blood supply to the brain
and giving our patient
unfortunately, a focus verbal
type of ischemic stroke,
Or the patient as vasculitis.
02:14
And by vasculitis
we refer to something like,
oh, temporal arteritis,
you've heard it before.
02:19
Arteritis,
or maybe something like your
granulomatosis with polyangiitis,
formerly known as Wegener's.
02:26
Microscopic polyangiitis,
you get the point or even,
even something like
IgA vasculopathy,
formerly known as
Henoch Schönlein purpura,
all of those conditions
have one in common.
02:39
They're causing inflammation
in the blood vessel.
02:42
Then what then happens
to the caliber of the lumen?
Oh, it's getting compromised.
This is not good.
02:48
May result in what?
Good, a focal type
of ischemic stroke.
02:52
Are you seeing this now?
Or could be cryptogenic.
02:56
In other words, not exactly sure
as to what the causes.
02:59
So on this side,
it would be focal type.
03:02
And then on this side globally,
what may happen?
Well, globally, your patient
may be suffering from hypotension.
03:09
Globally, versus focally.
03:12
So, if the entire body is
undergoing hypotension,
then there's going to be decreased
blood supply obviously to the brain.
03:20
Once again,
causing ischemic type of stroke,
but this is global in nature.
Keep that in mind.