acv isquemico
TRANSCRIPT
![Page 1: Acv isquemico](https://reader033.vdocumento.com/reader033/viewer/2022052311/559f6f511a28ab05068b4690/html5/thumbnails/1.jpg)
![Page 2: Acv isquemico](https://reader033.vdocumento.com/reader033/viewer/2022052311/559f6f511a28ab05068b4690/html5/thumbnails/2.jpg)
Apoplejía a, Ictus, Stroke
Deficiencia neurológica repentina atribuible a una causa vascular focal
![Page 3: Acv isquemico](https://reader033.vdocumento.com/reader033/viewer/2022052311/559f6f511a28ab05068b4690/html5/thumbnails/3.jpg)
3ra causa de muerte tras las cardiopatías y el cáncer
Causa mas común de discapacidad a largo plazo ACV isquémico es el mas frecuente 85-90% Hemorrágico 10-15%
![Page 4: Acv isquemico](https://reader033.vdocumento.com/reader033/viewer/2022052311/559f6f511a28ab05068b4690/html5/thumbnails/4.jpg)
ACV isquemicos• Aterotromboticos : aterosclerosis,
diseccion de la aorta, displasia fibromuscular, sarcoidosis
• Cardioembolicos: FA, Enfermedad reumatica, trombos auriculares o ventriculares, valvulas protesicas, endocarditis
• Hipoperfusion• Estados de hipercoagubilidad
ACV hemorragicos Trombosis del seno venoso
![Page 5: Acv isquemico](https://reader033.vdocumento.com/reader033/viewer/2022052311/559f6f511a28ab05068b4690/html5/thumbnails/5.jpg)
![Page 6: Acv isquemico](https://reader033.vdocumento.com/reader033/viewer/2022052311/559f6f511a28ab05068b4690/html5/thumbnails/6.jpg)
![Page 7: Acv isquemico](https://reader033.vdocumento.com/reader033/viewer/2022052311/559f6f511a28ab05068b4690/html5/thumbnails/7.jpg)
![Page 8: Acv isquemico](https://reader033.vdocumento.com/reader033/viewer/2022052311/559f6f511a28ab05068b4690/html5/thumbnails/8.jpg)
Causa responsable Afectación de la circulación colateral Territorio vascular afectado
![Page 9: Acv isquemico](https://reader033.vdocumento.com/reader033/viewer/2022052311/559f6f511a28ab05068b4690/html5/thumbnails/9.jpg)
Hemisferio dominante
Hemisferio no dominante
Anosognosia, apraxia y negligencia contralateral
![Page 10: Acv isquemico](https://reader033.vdocumento.com/reader033/viewer/2022052311/559f6f511a28ab05068b4690/html5/thumbnails/10.jpg)
Sindrome ACP
Sme de Claude Sme de Weber
Contralateral
Segmento P1
Sme de Dejerine-Roussy
•Trastorno sensorial
Alexia : esplenio del cuerpo calloso Agnosia : prosopagnsia, corteza temporo-occipital
![Page 11: Acv isquemico](https://reader033.vdocumento.com/reader033/viewer/2022052311/559f6f511a28ab05068b4690/html5/thumbnails/11.jpg)
Sindrome de Anton: porción distal de la ACP
Sindrome de Balint: lesiones bilaterales del area de asociacion visual: ataxia optica, apraxia ocular
![Page 12: Acv isquemico](https://reader033.vdocumento.com/reader033/viewer/2022052311/559f6f511a28ab05068b4690/html5/thumbnails/12.jpg)
Sme bulbar lateral (Wallenberg): D,D,D,D, vertigo, hipoestesia facial ipsi, hipoestesia corporal contralat, horner ipsilateral
Sme bulbar Medial: hemiparesia contralateral (incompleta), paresia y desviacion de la lengua ipsilateral
![Page 13: Acv isquemico](https://reader033.vdocumento.com/reader033/viewer/2022052311/559f6f511a28ab05068b4690/html5/thumbnails/13.jpg)
![Page 14: Acv isquemico](https://reader033.vdocumento.com/reader033/viewer/2022052311/559f6f511a28ab05068b4690/html5/thumbnails/14.jpg)
![Page 15: Acv isquemico](https://reader033.vdocumento.com/reader033/viewer/2022052311/559f6f511a28ab05068b4690/html5/thumbnails/15.jpg)
Episodios de enfermedad cerebrovascular sintomática que duran poco tiempo
Definicion habitual Amaurosis fugaz tPA Terapia antiplaquetaria y anticoagulante
![Page 16: Acv isquemico](https://reader033.vdocumento.com/reader033/viewer/2022052311/559f6f511a28ab05068b4690/html5/thumbnails/16.jpg)
Examen fisico
Examen neurologico
![Page 17: Acv isquemico](https://reader033.vdocumento.com/reader033/viewer/2022052311/559f6f511a28ab05068b4690/html5/thumbnails/17.jpg)
HC, TP/IRN, TPT, electrolitos, glicemia y troponina
ESR, hemocultivos, funcion hepatica, toxicologia
EKG
![Page 18: Acv isquemico](https://reader033.vdocumento.com/reader033/viewer/2022052311/559f6f511a28ab05068b4690/html5/thumbnails/18.jpg)
![Page 19: Acv isquemico](https://reader033.vdocumento.com/reader033/viewer/2022052311/559f6f511a28ab05068b4690/html5/thumbnails/19.jpg)
Signos vitales Control de la hipertension
Perfusion cerebral 15% durante las primeras 24 h
![Page 20: Acv isquemico](https://reader033.vdocumento.com/reader033/viewer/2022052311/559f6f511a28ab05068b4690/html5/thumbnails/20.jpg)
![Page 21: Acv isquemico](https://reader033.vdocumento.com/reader033/viewer/2022052311/559f6f511a28ab05068b4690/html5/thumbnails/21.jpg)
![Page 22: Acv isquemico](https://reader033.vdocumento.com/reader033/viewer/2022052311/559f6f511a28ab05068b4690/html5/thumbnails/22.jpg)
GOLD STANDAR DActivador tisular del plasminógeno
(tPA)intravenoso(0 –4,5 horas)
![Page 23: Acv isquemico](https://reader033.vdocumento.com/reader033/viewer/2022052311/559f6f511a28ab05068b4690/html5/thumbnails/23.jpg)
![Page 24: Acv isquemico](https://reader033.vdocumento.com/reader033/viewer/2022052311/559f6f511a28ab05068b4690/html5/thumbnails/24.jpg)
AAS dosis inicial 325 mg primeras 24-48 h. Se puede reducir a 81 mg despues del periodo agudo
Antiagregantes plaquetarios (clopidogrel, AAS/dipiridamol)
Heparina de bajo peso molecular o la warfarina no se recomiendan en la fase aguda
![Page 25: Acv isquemico](https://reader033.vdocumento.com/reader033/viewer/2022052311/559f6f511a28ab05068b4690/html5/thumbnails/25.jpg)
Control de glicemia Hipotermia Oxigenoterapia Citicolina Piracetam
![Page 26: Acv isquemico](https://reader033.vdocumento.com/reader033/viewer/2022052311/559f6f511a28ab05068b4690/html5/thumbnails/26.jpg)
Harrison, Medicina Interna 17 Ed Consenso 2007 American Stroke Association
![Page 27: Acv isquemico](https://reader033.vdocumento.com/reader033/viewer/2022052311/559f6f511a28ab05068b4690/html5/thumbnails/27.jpg)