Ischemic Stroke

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.