Emergencies: Acute Cerebrovascular Disease

Emergency Room · Clinical Specialties

How it begins

El encéfalo humano es un órgano metabólicamente hiperactivo y con una nula reserva energética de sustratos como el oxígeno y la glucosa. Representa aproximadamente el 2% del peso corporal total, pero consume de forma continua el 20% del oxígeno y el 25% de la glucosa corporal total. Esta extrema dependencia metabólica exige un sistema de control del Flujo Sanguíneo Cerebral (FSC) sumamente preciso y adaptativo.

What it covers

1. Cerebral Blood Flow Regulation Mechanisms
2. · 1. Myogenic Autoregulation (Bayliss Effect)
3. · 2. Metabolic Regulation (Chemical Coupling)
4. · 3. Neurovascular Coupling (Functional Hyperemia)
5. Critical Cerebral Blood Flow Thresholds
6. Concept of Ischemic Core and Ischemic Penumbra
7. Phases of the Molecular Ischemic Cascade
8. 1. Large Vessel Atherosclerosis (Macroangiopathy)
9. 2. Cardioembolism (Embolic Heart Disease)
10. 3. Small Vessel Arterial Occlusion (Microangiopathy/Lacunar Infarction)
11. 4. Stroke of Other Determined Etiology
12. 5. Stroke of Undetermined Etiology (Cryptogenic)
13. Middle Cerebral Artery (MCA) Territory
14. Territory of the Anterior Cerebral Artery (ACA)
15. Territory of the Posterior Cerebral Artery (PCA)
16. Brain Stem Syndromes (Vertebrobasilar System)
17. Prehospital Screening Scales
18. · 1. FAST Scale (Face, Arm, Speech, Time)
19. · 2. RACE Scale (Rapid Arterial Occlusion Evaluation Scale)
20. Detailed Structure of the NIHSS Scale
21. Clinical Correlation and Prognosis according to the NIHSS
22. Early Signs of Ischemia on Simple CT
23. Evaluation of the Extent of Early Damage: ASPECTS Scale
24. Perfusion CT (CTP) and advanced Magnetic Resonance (MRI)
25. Thrombolytic Agents and Emergency Dosage
26. · 1. Alteplase (rtPA - Recombinant Tissue Plasminogen Activator)
27. · 2. Tenecteplase (TNK-tPA)
28. Eligibility Criteria for Intravenous Thrombolysis (AHA/ASA Guidelines)
29. Blood Pressure Control before and during Fibrinolysis
30. Indications for Mechanical Thrombectomy in Early Window (6 hours)
31. Expansion of the Therapeutic Window up to 24 hours (Perfusion Criteria)
32. Mechanical Thrombectomy Devices
33. Evaluation of Recanalization: TICI Angiographic Scale
34. Physiopathological Classification according to Location
35. · 1. Deep Intracerebral or Supratentorial Subcortical Hemorrhage
36. · 2. Lobar Intracerebral Hemorrhage
37. · 3. Infratentorial Hemorrhage (Cerebellar and Brainstem)
38. Mechanisms of Brain Damage in ICH
39. Severity Stratification: ICH Score Scale
40. 1. Aggressive Blood Pressure Control (INTERACT-2 and ATACH-2 Trials)
41. 2. Immediate Reversal of Anticoagulation
42. 3. Emergency Surgical Indications in HIC
43. Classic Clinical Presentation: Thunder Headache
44. Clinical and Radiological Classification Scales
45. Emergency Diagnostic Route for Suspected SAH
46. 1. Urgent Exclusion of Ruptured Aneurysm (First 24 hours)
47. 2. Prevention and Management of Vasospasm and Delayed Cerebral Ischemia (DCI)
48. · Therapeutic Strategy for Active Delayed Cerebral Ischemia (DCI)
49. Key Risk Factors
50. Polymorphic Clinical Presentation
51. Diagnostic Approach by Neuroimaging
52. Short-Term Stroke Risk Stratification: ABCD² Scale
53. Dual Antiplatelet Therapy in High Risk TIA (POINT and CHANCE Trials)
54. 1. Malignant Stroke of the Middle Cerebral Artery (Massive Osmotic Cerebral Edema)
55. 2. Hemorrhagic Transformation of Ischemic Infarction
56. 3. Cerebral Reperfusion and Hyperperfusion Syndrome
57. 4. Neurogenic Cardiac Dysfunction and Sympathetic Hyperactivity
58. Systemic Metabolic Monitoring and Support Protocol
59. Epilogue and Integrative Perspective in Emergencies