ENFERMEDAD CEREBROVASCULAR: ICTUS ISQUÉMICO, HEMORRÁGICO 3/3 VILLAMEDIC 2026

Cerebrovascular disease is the second leading cause of death and the leading cause of acquired disability in adults worldwide, with thousands of new cases every day that could be prevented with timely diagnosis and early treatment. 🌍 In this video, we review the general aspects of ischemic stroke, hemorrhagic stroke, and transient ischemic attack (TIA), with a clinical and practical focus for students, residents, and emergency physicians. 📚🩺 🔬 DEFINITION AND KEY CONCEPTS ▸ Stroke or cerebrovascular accident (CVA): a sudden interruption of blood flow to the brain with acute neurological damage lasting more than 24 hours or resulting in a lesion on neuroimaging. ▸ Transient ischemic attack (TIA): a focal neurological deficit lasting less than 24 hours without a lesion on neuroimaging, but with a high risk of established stroke in the following days. ▸ Ischemic penumbra: hypoperfused but still viable brain tissue, salvageable with early reperfusion. The cornerstone of urgent treatment. ⏰ ▸ Time is brain: For every minute without treatment in ischemic stroke, approximately 1.9 million neurons are lost. 🚨 📌 CLASSIFICATION 🔴 ISCHEMIC STROKE (85% of cases) ▸ Thrombotic: formation of a thrombus on an atherosclerotic plaque in a large or small cerebral artery. ▸ Embolic: embolus originating from cardioembolism (atrial fibrillation, endocarditis, prosthetic valve, recent MI) or extracranial arteries. ▸ Lacunar: small infarct less than 15 mm due to occlusion of a perforating artery in patients with hypertension or diabetes. ▸ Cryptogenic: no identified cause after a complete workup, up to 25% of cases. ⚠️ 🟠 Hemorrhagic Stroke (15% of cases) ▸ Intracerebral hemorrhage: bleeding within the brain parenchyma, most frequently in the basal ganglia, thalamus, cerebellum, and brainstem. ▸ Causes: high blood pressure (most frequent), amyloid angiopathy, anticoagulation, arteriovenous malformation, hemorrhagic tumor. ▸ Subarachnoid hemorrhage: bleeding in the subarachnoid space; the most frequent cause is rupture of an intracranial aneurysm. ▸ Thunderclap headache: a sudden onset of severe headache, a warning sign of subarachnoid hemorrhage. 🚨🔴 🟡 TRANSIENT ISCHEMIC ATTACK (TIA) ▸ A focal neurological deficit of sudden onset with complete recovery in less than 24 hours, usually within minutes. ▸ Neurological emergency: established stroke risk of 10-15% in the first 2 days. ▸ ABCD2 score: age, blood pressure, clinical presentation, duration, and diabetes. Stratifies the risk of early stroke. ▸ All TIAs require urgent evaluation and immediate hospital admission for secondary prevention. ⚠️ 📌 RISK FACTORS 🟡 MODIFIABLE ▸ High blood pressure: the most important and prevalent risk factor, doubling the risk. ▸ Atrial fibrillation: increases the risk of cardioembolic stroke fivefold. ▸ Diabetes mellitus, dyslipidemia, smoking, obesity, sedentary lifestyle. ▸ Atherosclerotic cardiovascular disease, carotid stenosis, obstructive sleep apnea. ▸ Excessive alcohol consumption, cocaine use, and other vasoactive drugs. 🫀⚠️ 🔵 NON-MODIFIABLE RISK FACTORS ▸ Age over 55: the risk doubles with each decade. ▸ Male sex in middle age, female sex in older age. ▸ Family history of stroke or early-onset ischemic heart disease. ▸ Race: higher prevalence in African Americans and Hispanics. 📋 📌 CLINICAL PRESENTATION AND EARLY RECOGNITION 🔴 FAST SCALE ▸ Face: facial asymmetry, drooping of the corners of the mouth. ▸ Arms: Weakness or paralysis of an arm or leg (hemiparesis or hemiplegia). ▸ Speech: Difficulty speaking or understanding (aphasia or dysarthria). ▸ Time: Call emergency services immediately. ⏰🚨 🟡 SYMPTOMS ACCORDING TO VASCULAR TERRITORY ▸ Anterior carotid territory: Contralateral hemiparesis or hemiplegia, hemianesthesia, aphasia (if dominant hemisphere), neglect (if non-dominant hemisphere), homonymous hemianopsia. ▸ Posterior vertebrobasilar territory: Vertigo, diplopia, dysphagia, dysarthria, ataxia, Horner's syndrome, altered level of consciousness, bilateral cortical blindness. ▸ Lacunar stroke: pure syndromes (pure motor, pure sensory, hemiparesis-ataxia) without cortical involvement. ▸ Subarachnoid hemorrhage: thunderclap headache, neck stiffness, photophobia, nausea, loss of consciousness. 🧠 #stroke #CVA #cerebrovascularaccident #ischemicstroke #hemorrhagicstroke #TIA #thrombolysis #thrombectomy #atrialfibrillation #subarachnoidhemorrhage #ischemicpenumbra #FAST #neurology #internalmedicine #emergencymedicine #medicineinspanish #Mediesfera #strokeprevention #anticoagulation #antiplatelettherapy #statins #carotidartery #aneurysm #thunderclapheadache #healtheducation #cerebrovascularhealth #braintime