avc ischemic curs 4 continare

7/25/2019 Avc Ischemic Curs 4 Continare

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Avc ischemicAvc ischemicCurs nr.4 - continuareCurs nr.4 - continuare


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SIMPTOMATOLOGIA AVC ISIMPTOMATOLOGIA AVC I

Tabloul functie de sediul ischemiei:Tabloul functie de sediul ischemiei: ACC + ACI PROXIMA!"I#TAACC + ACI PROXIMA!"I#TA ACA!ACM:su$erf%$rof%totalACA!ACM:su$erf%$rof%total

ACoA'(&PICA&A(&ACP&AC#)ACoA'(&PICA&A(&ACP&AC#) "ef. neurolo*ic brusc sau in tre$te!$ro*resi"ef. neurolo*ic brusc sau in tre$te!$ro*resi Cefaleea $recede sau insoteste infarctulCefaleea $recede sau insoteste infarctul

cerebralcerebral Cri,e deCri,e de

e$i:$artiale!*enerali,ate!i,olate!re$etitie!re$i:$artiale!*enerali,ate!i,olate!re$etitie!rau e$ile$tic in din ca,uri ICau e$ile$tic in din ca,uri IC


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DiagnosticDiagnostic

Anamne,a!e/. *eneral si $e a$arateAnamne,a!e/. *eneral si $e a$arate 0/. neurolo*ic si neuroascular0/. neurolo*ic si neuroascular

Clinic:e/.Clinic:e/.'.e/tracraniene%ins$ectie%$al$are%asculatie%TA%1O'.e/tracraniene%ins$ectie%$al$are%asculatie%TA%1O

Paraclinic:inesti*. 2ematolo*ice siParaclinic:inesti*. 2ematolo*ice sibiochimice3metab $rot%*luc%biochimice3metab $rot%*luc%li$idic&imunolo*ic!en,ime&CR&neuroradiolo*ic:clli$idic&imunolo*ic!en,ime&CR&neuroradiolo*ic:clasice:CT%IRM%A56IO-asice:CT%IRM%A56IO-RM%electro7,iolo*ic:006%0C2O-RM%electro7,iolo*ic:006%0C2O-

"OP0R%086%2OT0R"OP0R%086%2OT0R "ia*n. eocat de debutul brutal%sistemati,area"ia*n. eocat de debutul brutal%sistemati,areaasculara!AT#!cardiacasculara!AT#!cardiac

0rori:P0IC!hemora*ie0rori:P0IC!hemora*ie


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DIAGNOSTIC DIFERENTIALDIAGNOSTIC DIFERENTIAL

AVC IAVC I MA'%#I5COPA%TCC%MI6R05A%05C01AOPATI0MA'%#I5COPA%TCC%MI6R05A%05C01AOPATI0

2IP0RT05#I'A%1RACT9RI COOA5A2IP0RT05#I'A%1RACT9RI COOA5AC0R'ICAA%PAR8I5#O5I#M%MIA#T05IAC0R'ICAA%PAR8I5#O5I#M%MIA#T05IA6RA'I#%05C01AOPATI0 TOXICA-6RA'I#%05C01AOPATI0 TOXICA-M0TA(OICA%A50'RI#M0%"I#0CTII0RT0RIA0'PP(%%0PI0P#IM0TA(OICA%A50'RI#M0%"I#0CTII0RT0RIA0'PP(%%0PI0P#I0%I510CTII #I#T0MIC0%20MATOM #9("9RA%05C01AITA C90%I510CTII #I#T0MIC0%20MATOM #9("9RA%05C01AITA C920RP0X #IMP0X%A6T%"0M05TA20RP0X #IMP0X%A6T%"0M05TA

A 0XI#TA PO#I(IITAT0A CA I5 CA"R9 959I "0;0C2II(R9A 0XI#TA PO#I(IITAT0A CA I5 CA"R9 959I "0;0C2II(R9M0TA(OIC3


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SINDROAME TOPOGRAFICESINDROAME TOPOGRAFICE

VASCULAREVASCULARE ART0RA O1TAMICA:ART0RA O1TAMICA:

C0C"ITAT0 MO5OC9ARA TRA5;ITORI03AMA9RO;I#C0C"ITAT0 MO5OC9ARA TRA5;ITORI03AMA9RO;I#196AX196AX

ACM A ORI6I50:ACM A ORI6I50: 20MIP06I0 CO5TROAT + $ 'II = c.20MIP06I0 CO5TROAT + $ 'II = c. 20MI2IPO0#T0;I0 CO5TROAT +1ATA20MI2IPO0#T0;I0 CO5TROAT +1ATA A1A;I0 6O(AA3I5 0"A1A;I0 6O(AA3I5 0" "0'IATI0 CAP #I 6. OC9ARI "0 P. 0;."0'IATI0 CAP #I 6. OC9ARI "0 P. 0;. 20MIA5OP#I0 OMO5IMA CO5TROAT20MIA5OP#I0 OMO5IMA CO5TROAT 506I>AR0A 20MI#P CO5TROAT I5 5"506I>AR0A 20MI#P CO5TROAT I5 5"

ACM RAM9RA A#C05"05TA:ACM RAM9RA A#C05"05TA:


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VASCULAREVASCULARE ACM RAM9RA A#C05"05TA:ACM RAM9RA A#C05"05TA:

2-PAR0;A CO5TROAT ?1ACIO(RA2IAA2-PAR0;A CO5TROAT ?1ACIO(RA2IAA 2-2IPO0#T0;I0 CO5TROAT + 20MI1ATA2-2IPO0#T0;I0 CO5TROAT + 20MI1ATA A1A;I0 PR0". 0XPR0#I'A3I5 "A1A;I0 PR0". 0XPR0#I'A3I5 "

506I>AR0A 20M#PATI99I CO5TROAT3I5 5"506I>AR0A 20M#PATI99I CO5TROAT3I5 5" ACM RAM9RA "0#C05"05TAACM RAM9RA "0#C05"05TA

2O CO5TROAT2O CO5TROAT A1A;I0 PR0"OMI505T R0C0PTI'A 3I5 "A1A;I0 PR0"OMI505T R0C0PTI'A 3I5 " APRAXI0 "0 CO5T#R9CTI0 3I5 5"APRAXI0 "0 CO5T#R9CTI0 3I5 5"

ACM T0RITORI9 T0RMI5A A R. A#C05"05T03(.ACM T0RITORI9 T0RMI5A A R. A#C05"05T03(.P I51.%6IR9#9 A569AR I5 ":P I51.%6IR9#9 A569AR I5 ": #. 60R#TMA553A65O;I0 "I6ITAA%ACAC9I0%CO519;I0#. 60R#TMA553A65O;I0 "I6ITAA%ACAC9I0%CO519;I0

#T6-"R%A6RA1I0#T6-"R%A6RA1I0


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VASCULAREVASCULARE ACM RAM9RI P050TRA5T03PRO195"0ACM RAM9RI P050TRA5T03PRO195"0

2-PAR0;A CO5TROAT ATAXICA2-PAR0;A CO5TROAT ATAXICA ATAXIA M(. "0 AC00A#I PART0ATAXIA M(. "0 AC00A#I PART0 2-2IPO0#T0;I0 CO5TROAT


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VASCULAREVASCULARE ACA R. #9P0R1ICIAAACA R. #9P0R1ICIAA

2-PAR0;A CO5TROAT ? CR9RAA2-PAR0;A CO5TROAT ? CR9RAA I"0M CA A PR0C0"05TA3A ORI6I50I"0M CA A PR0C0"05TA3A ORI6I50

ACA R. PRO195"A!A. R0C9R05TA 209(50R:ACA R. PRO195"A!A. R0C9R05TA 209(50R: 2-PAR0;A CO5TROAT ? 1ACIO-(RA2IAA+!- "I#TO5I0 A AC0#T 5I'02-PAR0;A CO5TROAT ? 1ACIO-(RA2IAA+!- "I#TO5I0 A AC0#T 5I'0

ACA (IAT0RA:ACA (IAT0RA:

"0M05TA C9 APATI0 %MA%PARATO5IA%R. PRIMITI'0%#910RI5TA PIRAMI"AA"0M05TA C9 APATI0 %MA%PARATO5IA%R. PRIMITI'0%#910RI5TA PIRAMI"AA'ARIA(IA%T. "0 M0R#'ARIA(IA%T. "0 M0R# ACP R. #9P0R1ICIAA:ACP R. #9P0R1ICIAA:

2O CO5TROAT = I5 #". "0 TOP "0 A( @ A10CT. (IAT@ C0CITAT0 CORTICAA2O CO5TROAT = I5 #". "0 TOP "0 A( @ A10CT. (IAT@ C0CITAT0 CORTICAA ACP R. PRO195"A TAAMICAACP R. PRO195"A TAAMICA

#."0>0RI50-RO9##3#". TAAMIC:#."0>0RI50-RO9##3#". TAAMIC: 2-2IPO0#T0;I0 CO5TROAT2-2IPO0#T0;I0 CO5TROAT #". A6IC A 5I'09 20MICORP CO5TROAT#". A6IC A 5I'09 20MICORP CO5TROAT

MA5A BTAAMICACO5TROAT%ATAXI0 TIP TA(0TICMA5A BTAAMICACO5TROAT%ATAXI0 TIP TA(0TIC


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VASCULAREVASCULARE ACP R. P050TRA5TA M0;05C01AICA:ACP R. P050TRA5TA M0;05C01AICA:

#. D0(0R:#. D0(0R: 2-PAR0;A CO5TROAT 06A "I#TRI(9ITA2-PAR0;A CO5TROAT 06A "I#TRI(9ITA PAR0;A IP#IAT "0 5.IIIPAR0;A IP#IAT "0 5.III TR0MOR 3A1. 5. RO#9TR0MOR 3A1. 5. RO#9

ACP 95IAT0RA A ORI6I503"ACP 95IAT0RA A ORI6I503" 2O!C'A"RA5A5OP#I0 #9P OMO5IMA +!- PA#TRAR0A '0"0RII2O!C'A"RA5A5OP#I0 #9P OMO5IMA +!- PA#TRAR0A '0"0RIIMAC9AR0MAC9AR0

A0XI0 1ARA A6RA1I0%A5OMI0 P05TR9 C9ORIA0XI0 1ARA A6RA1I0%A5OMI0 P05TR9 C9ORI T9( "0 M0MORI0T9( "0 M0MORI0 20MI2IPO0#T0;I0 CO5TROAT20MI2IPO0#T0;I0 CO5TROAT 2A9CI5ATII2A9CI5ATII

'I;9A0%M0TAMOR1OP#II%T00OP#IA!P0OP#IA3P0RC0PTIA'I;9A0%M0TAMOR1OP#II%T00OP#IA!P0OP#IA3P0RC0PTIAO(I0CT0OR MAI APROPIAT0%I9;IIO(I0CT0OR MAI APROPIAT0%I9;II'I;9A0%POI5OP#IA3P0R#I#TA IMA6. !0XTI5"0R0 #I "9PA'I;9A0%POI5OP#IA3P0R#I#TA IMA6. !0XTI5"0R0 #I "9PA#TIM99 'I;9A%"01ORMAR0A CO5T9R99I%1OTO1O(IA #I#TIM99 'I;9A%"01ORMAR0A CO5T9R99I%1OTO1O(IA #I#IM9TA5 A65O;IA3I5A(IITAT0A "0 A #I5T0TI;A IMA6I5I0#IM9TA5 A65O;IA3I5A(IITAT0A "0 A #I5T0TI;A IMA6I5I0'A;9T0 CA I5TR06'A;9T0 CA I5TR06


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VASCULAREVASCULARE ACP 95IAT0RA A ORI6I5035"ACP 95IAT0RA A ORI6I5035"

2O!C'A"RA5A5OP#I0+!- '0"R0A MAC9RA2O!C'A"RA5A5OP#I0+!- '0"R0A MAC9RA 20MIACROMATOP#IA20MIACROMATOP#IA 2-2IPO0#T0;I0 CO5TROAT31ATA M#%MI2-2IPO0#T0;I0 CO5TROAT31ATA M#%MI 2A9CI5ATII 'I;9A03M0TAMOR1IP#II%T00OP#II%P0OP#II%I9;II2A9CI5ATII 'I;9A03M0TAMOR1IP#II%T00OP#II%P0OP#II%I9;II

'I;9A0%POI5OP#IA%"01ORMAR0A CO5T9R9RIOR%1OTO1O(IA'I;9A0%POI5OP#IA%"01ORMAR0A CO5T9R9RIOR%1OTO1O(IA

"0;ORI05TAR0 TOPO6RA1ICA%PRO#OPA65O;IA"0;ORI05TAR0 TOPO6RA1ICA%PRO#OPA65O;IA ACP (IAT0RA3 A#0M050A #". 8OR#A8O11 A6TEAITACP (IAT0RA3 A#0M050A #". 8OR#A8O11 A6TEAIT 2-A5OP#I0 "9(A 3+!- PA#TRAR0A '0"0RII MAC9AR0- C0CITAT02-A5OP#I0 "9(A 3+!- PA#TRAR0A '0"0RII MAC9AR0- C0CITAT0

CORTICAA #0 I5#OT0#T0 "0 A65O;I0 'I;9AA3C0CITAT0 P#I2ICA%FGCORTICAA #0 I5#OT0#T0 "0 A65O;I0 'I;9AA3C0CITAT0 P#I2ICA%FGCAR0 POAT0 1I :#PATIAA P05TR9 O(I0CT03FH%P05TR9CAR0 POAT0 1I :#PATIAA P05TR9 O(I0CT03FH%P05TR9C9'I5T0!IT0R03A0XI0 @ C0CITAT0 '0R(AAC9'I5T0!IT0R03A0XI0 @ C0CITAT0 '0R(AA

506AR0A C0CITATII@A65O;O65O;I0 'I;9AA cu arietati:506AR0A C0CITATII@A65O;O65O;I0 'I;9AA cu arietati: O 50A6A #I O MA#C20A;A PRI5 CO51A(9ATI0O 50A6A #I O MA#C20A;A PRI5 CO51A(9ATI0

O R0C95O#C "AR O I65ORAO R0C95O#C "AR O I65ORA ACROMATOP#IA3"I#PARITIA C9ORIORACROMATOP#IA3"I#PARITIA C9ORIOR APARXIA MI#C. OC9AR0APARXIA MI#C. OC9AR0 "0;ORI05TAR0 TOPO6RA1ICA #I PRO#OPA65O;IA"0;ORI05TAR0 TOPO6RA1ICA #I PRO#OPA65O;IA "0IR A6ITAT%T9( "0 M0MORI0 ?"0IR A6ITAT%T9( "0 M0MORI0 ? #IM9TA5 A65O;IA#IM9TA5 A65O;IA


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VASCULAREVASCULARE

ACP $rofund:ACP @ teritoriu astACP $rofund:ACP @ teritoriu ast

cortical%subcortical%talamus%,onacortical%subcortical%talamus%,ona

subtalamica%me,encefalsubtalamica%me,encefal

ACP r. $rofunde $tr.:ACP r. $rofunde $tr.: Me,encefal in totalitateMe,encefal in totalitate

TalamusTalamus

#ubtalamus#ubtalamus


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Infarcte $edunculare:Infarcte $edunculare: #. Deber3'0;I MAI #9##. Deber3'0;I MAI #9# #. (enediJt:hemi$are,a tran,itorie urmata de#. (enediJt:hemi$are,a tran,itorie urmata de

miscari coreo-ateto,ice% tremor de $ostura saumiscari coreo-ateto,ice% tremor de $ostura sauintentional de $artea o$usa le,iuniiintentional de $artea o$usa le,iunii

#. de nucleu rosu su$erior@s. cerebelos + misc.#. de nucleu rosu su$erior@s. cerebelos + misc.inoluntare de ti$ coreic de $artea o$usa le,iuniiinoluntare de ti$ coreic de $artea o$usa le,iunii

#. de to$ de ba,ilara:s. $iramidal bilat.%ri*iditate#. de to$ de ba,ilara:s. $iramidal bilat.%ri*iditate

$rin decerebrare%mio,a cu arefe/ie $u$ilara&alte$rin decerebrare%mio,a cu arefe/ie $u$ilara&altemanifestari ischemice in t. me,encefalic:$arali,iimanifestari ischemice in t. me,encefalic:$arali,iioculomotorii%OI5%tulb. $u$ilare %s. 1oille%s.oculomotorii%OI5%tulb. $u$ilare %s. 1oille%s.Parinaud%manif. e/tra$iramidale.Parinaud%manif. e/tra$iramidale.


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Infarcte talamice de natura asculara sunt $artialeInfarcte talamice de natura asculara sunt $artiale I. $aramediane: sd. a.talamo-$erforate3$artea mediana siI. $aramediane: sd. a.talamo-$erforate3$artea mediana si

entrala a tal!subtalamus:entrala a tal!subtalamus: Controlateral:tulb. de sensibilitate ? la fata%


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A $ediculul lenticulo-o$tic din ACM:A $ediculul lenticulo-o$tic din ACM:

durere ? la mb. inf.+hemi$are,adurere ? la mb. inf.+hemi$are,a


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Sindom!" ta"amic c"asic De#eine$Sindom!" ta"amic c"asic De#eine$

Ro!s%Ro!s% CI5C:CI5C:

Controlateral:hemianeste,ie de $artea o$usaControlateral:hemianeste,ie de $artea o$usa

le,iunii%? sensibilit.$rof.!ben,ile,iunii%? sensibilit.$rof.!ben,i

$seudoradiculare!$seudotronculare%hemi$are,a$seudoradiculare!$seudotronculare%hemi$are,a&hemi$are,a ra$id&hemi$are,a ra$id

re*resia%s.cerebelos%hemiata/iere*resia%s.cerebelos%hemiata/ie

cerebeloasa+$seudotabetica&dureri !hi$er$atiecerebeloasa+$seudotabetica&dureri !hi$er$atie

talamica35"M&to$oa*no,ie&asterio*no,ie3?talamica35"M&to$oa*no,ie&asterio*no,ie3?

$tr. sens. $rof.$tr. sens. $rof.

A sindromul talamic clasic cu$rinde inA sindromul talamic clasic cu$rinde in

s$ecial teritoriul a talamo-*eniculate.s$ecial teritoriul a talamo-*eniculate.


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In&acte s!'ta"amiceIn&acte s!'ta"amice

ACP+ACoP 'A#C9ARI;0A;AACP+ACoP 'A#C9ARI;0A;A

RA#PA5TIA #9(TAAMICA:RA#PA5TIA #9(TAAMICA: Controlateral:hemi$le*ie%hemisindromControlateral:hemi$le*ie%hemisindrom

cerebelos%2O%hemianeste,ie3? sensib.cerebelos%2O%hemianeste,ie3? sensib.

$rof%astereo*no,ie%misc. coreo-$rof%astereo*no,ie%misc. coreo-

ateto,ice.ateto,ice.


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In&acte cee'e"oaseIn&acte cee'e"oase

Cerebelul este asculari,at de L a. circumf.Cerebelul este asculari,at de L a. circumf.

lun*i:PICA%ACPA%AC#.lun*i:PICA%ACPA%AC#.

Tablou clinic acut!subac cu :Tablou clinic acut!subac cu : Cefalee ? $osterioaraCefalee ? $osterioara #d. estibular central intens&nista*mus#d. estibular central intens&nista*mus

'arsaturi'arsaturi

"i,artrie"i,artrie

Ata/ie cerebeloasaAta/ie cerebeloasa

Posibil semne de suferinta $ontina cu sd.Posibil semne de suferinta $ontina cu sd.

1oille%$arali,ie 'II ti$ P%coma1oille%$arali,ie 'II ti$ P%coma


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In&acte cee'e"oaseIn&acte cee'e"oase

1orme clinice:1orme clinice: 1. *raa%edematoasa descrisa1. *raa%edematoasa descrisa

1. Bbeni*na cu sd. estibular central si1. Bbeni*na cu sd. estibular central si

cerebeloscerebelos

0/. CT si IRM $reci,ea,a d* de infarct0/. CT si IRM $reci,ea,a d* de infarct

cerebral si o dif. de P0IC saucerebral si o dif. de P0IC sau

hematom cerebeloshematom cerebelos


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VASCULAREVASCULAREAC0CITAT0A CORTICAA3'0;I #. "0 TOP "0AC0CITAT0A CORTICAA3'0;I #. "0 TOP "0

(A;IARA:(A;IARA: IP#A P0RC0PTI0I 'I;9A039MI5A!I5T950RICIP#A P0RC0PTI0I 'I;9A039MI5A!I5T950RIC A(0#5TA CIPIT99I A AM05I5TAR0A(0#5TA CIPIT99I A AM05I5TAR0 R1M PR0;05T I5 6050RAR1M PR0;05T I5 6050RA 1O 5ORMA I5 6050RA1O 5ORMA I5 6050RA T9( P#I2IC0 #I A1A;IC0T9( P#I2IC0 #I A1A;IC0 PI0R"0R0A CAP. "0 ORI05TAR0!M0MORI0 TOPO6RA1ICAPI0R"0R0A CAP. "0 ORI05TAR0!M0MORI0 TOPO6RA1ICA CC "I1. "0 "9(A 20MIA5OP#I0 = 3AR0 '0"0R0CC "I1. "0 "9(A 20MIA5OP#I0 = 3AR0 '0"0R0

MAC9ARA-I5 PRCTICA 59 I5TOT"0A95A 0 PO#I(I "0 "I1MAC9ARA-I5 PRCTICA 59 I5TOT"0A95A 0 PO#I(I "0 "I1

CC 59 AR0 '0"0R0 MAC9ARACC 59 AR0 '0"0R0 MAC9ARA ATAXIA OPTICA @ 0ROAR0 "0 OCAI;AR0 'I;9AAATAXIA OPTICA @ 0ROAR0 "0 OCAI;AR0 'I;9AA#PATIAA 359 POAT0 PRI5"0 95 O(I0CT "I5 C. 'I;9A#PATIAA 359 POAT0 PRI5"0 95 O(I0CT "I5 C. 'I;9A"0CAT CA5" 1IX0A;A PRI'IR0A A AC0 O(I0CT ="0CAT CA5" 1IX0A;A PRI'IR0A A AC0 O(I0CT ="0;ORI05TAR0 'I;9O-#PATIAA@ 0;. "0 6IR9#"0;ORI05TAR0 'I;9O-#PATIAA@ 0;. "0 6IR9#A569AR!MAR6I5AI#A569AR!MAR6I5AI#


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ART0RA C0R0(0OA#A #9P0RIOARA:ART0RA C0R0(0OA#A #9P0RIOARA: ATAXI0 C0R0(0OA#A IP#IAT0RAAATAXI0 C0R0(0OA#A IP#IAT0RAA "I;ARTRI0"I;ARTRI0 2-2IPO0#T0;I0 T0RMOA6ICA CO5TROAT3A10CT TRACT99I2-2IPO0#T0;I0 T0RMOA6ICA CO5TROAT3A10CT TRACT99I

#PI5O-TAAMIC%6R0ATA %'AR#AT9RI#PI5O-TAAMIC%6R0ATA %'AR#AT9RI

A. C0R0(0OA#A A5T-I51A. C0R0(0OA#A A5T-I51 #.MARI0-1OIX:#.MARI0-1OIX:

2-ATAXI0 IP#IAT0RAA%2-PAR0;A CO5TROAT%2-2IPO0#T0;I02-ATAXI0 IP#IAT0RAA%2-PAR0;A CO5TROAT%2-2IPO0#T0;I0T0RMOA60;ICA CO5TROAT3A1. TR.#P-TAAMICT0RMOA60;ICA CO5TROAT3A1. TR.#P-TAAMIC

PICA:PICA: #"R. DA05(0R63#. (9(AR AT:#"R. DA05(0R63#. (9(AR AT:

2-2IPO0#T0;I0 T0RMO-A6ICA CO5TROAT 3A1. TRACT #P-TA2-2IPO0#T0;I0 T0RMO-A6ICA CO5TROAT 3A1. TRACT #P-TA 2IPO0#T0;I0 T0RMOA6ICA A 5I' 10T0I IP#IAT0RA035. '2IPO0#T0;I0 T0RMOA6ICA A 5I' 10T0I IP#IAT0RA035. ' ATAXI0 IP#IAT0RAA%5I#TA6M9#%'0RTI>%6R0ATA%"I#1A6I0%#.ATAXI0 IP#IAT0RAA%5I#TA6M9#%'0RTI>%6R0ATA%"I#1A6I0%#.

2OR50R%#I569T9#2OR50R%#I569T9#


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A( R. PO5TI50 (IAT0RA:A( R. PO5TI50 (IAT0RA: #". OC80"-I53#. PO5TI5 '05TRA (IAT:#". OC80"-I53#. PO5TI5 '05TRA (IAT:

T0TRAP06I0%(IP06I0 'II%OC9OMOTRICITAT0 P0 ORI;O5TAAT0TRAP06I0%(IP06I0 'II%OC9OMOTRICITAT0 P0 ORI;O5TAAA(OITA%A5ARTRI0A(OITA%A5ARTRI0

A( R.P050TRA5T0:A( R.P050TRA5T0: #". RAMO5" 3#. PO5TI5 PARAM0"IA5 #9P0RIOR:2-PAR0;A#". RAMO5" 3#. PO5TI5 PARAM0"IA5 #9P0RIOR:2-PAR0;A

CO5TROAT%PAR0;A "0 'I IP#IAT0RAACO5TROAT%PAR0;A "0 'I IP#IAT0RAA A( R. P050TRA5T0 #I CIRC9M10R05TIA0 #C9RT0:A( R. P050TRA5T0 #I CIRC9M10R05TIA0 #C9RT0:

#". MIAR-69(0R:2-PAR0;A CO5TROAT%PARAI;I0 "0 5. 'I#". MIAR-69(0R:2-PAR0;A CO5TROAT%PARAI;I0 "0 5. 'I#I 'II TIP P0RI10RIC IP#IAT0RA#I 'II TIP P0RI10RIC IP#IAT0RA

A. '0RT0(RAA R. P050TRA5T0 (9(AR0A. '0RT0(RAA R. P050TRA5T0 (9(AR0 #. "0>0RI50-(9(AR M0"IA5:#. "0>0RI50-(9(AR M0"IA5:

2-PAR0;A CO5TROAT2-PAR0;A CO5TROAT 2-2IPO0#T0;I0 PRO195"A CO5TROAT2-2IPO0#T0;I0 PRO195"A CO5TROAT PAR0;A "0 5. XII IP#IATPAR0;A "0 5. XII IP#IAT

A. '0RT0RAA R. CIRC9M10R05TIA0 (9(AR0- '0;I #.A. '0RT0RAA R. CIRC9M10R05TIA0 (9(AR0- '0;I #.DA05(0R6DA05(0R6


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SINDROMUL PSEUDO(UL(ARSINDROMUL PSEUDO(UL(AR

APAR0 I5 A'C%#M%#A%0TCAPAR0 I5 A'C%#M%#A%0TC

I5 A'C :I5 A'C : 9RM0A;A "9PA C0 P9TI5 "O9A IC MA>OR09RM0A;A "9PA C0 P9TI5 "O9A IC MA>OR0

PRO"9#0 I5 MOM05T0 "I10RIT0 %A 5I'00PRO"9#0 I5 MOM05T0 "I10RIT0 %A 5I'00"I10RIT0!AC950 (IAT0RA"I10RIT0!AC950 (IAT0RA

20MIPAR0;A (IAT0RAA PO#I(IA C9 R010X020MIPAR0;A (IAT0RAA PO#I(IA C9 R010X0

CORTICO-#PI5A0CORTICO-#PI5A0

"I;ARTRI0!"I#1A6I0"I;ARTRI0!"I#1A6I0 I5CO5TI505TA 0MOTIO5AA PRI5 0I(0RAR0AI5CO5TI505TA 0MOTIO5AA PRI5 0I(0RAR0A

1CT IM(IC03'0;I #0MIOO6IA #.1CT IM(IC03'0;I #0MIOO6IA #.

P#09"O(9(ARP#09"O(9(AR


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DEMENTA VASCULARADEMENTA VASCULARA

M0CA5I#M0:M0CA5I#M0:F.F. I51ARCT0 C0R0(RA0 95IC0 C9 OCAI;AR0I51ARCT0 C0R0(RA0 95IC0 C9 OCAI;AR0

CRITICA30X. I5 ACM- A1A;I0 C9 T9( CO65ITI'0%#I5"R.CRITICA30X. I5 ACM- A1A;I0 C9 T9( CO65ITI'0%#I5"R.CO519;IO5A AC I5 0MI#10R9 "OMI5A5T&I5 ACPCO519;IO5A AC I5 0MI#10R9 "OMI5A5T&I5 ACPTAAMIC-AM50;I0&I5 ACA = A(9I0%T9(TAAMIC-AM50;I0&I5 ACA = A(9I0%T9(

A1A;IC0!M0MORI0A1A;IC0!M0MORI0.. "0M05TA M9TII51ARCT- IC M9TIP0%?"0 F M6 T0#"0M05TA M9TII51ARCT- IC M9TIP0%?"0 F M6 T0#

C0R0(RAC0R0(RA

L.L. (OAA 'A#0OR MICI = AC950 I5 #9(#T A(A PRO1(OAA 'A#0OR MICI = AC950 I5 #9(#T A(A PRO1C0R0(RAA&C0R0(RAA&

(OAA (I#DA60R3A(9I0%T9( "0(OAA (I#DA60R3A(9I0%T9( "0COMPORTAM05T%#1I5CT0RI050%#I5"R.COMPORTAM05T%#1I5CT0RI050%#I5"R.P#09"O(9(AR%#I5"R.PIRAMI"AP#09"O(9(AR%#I5"R.PIRAMI"A

CT-09COARAIO;A@ BTRA5#PAR05T0 P0RI'05TRIC9AR0CT-09COARAIO;A@ BTRA5#PAR05T0 P0RI'05TRIC9AR0

4.4. A'C 26 @ A56IOPATIA AMIOI"AA'C 26 @ A56IOPATIA AMIOI"A


24/32

INFARCTUL CRIPTOGENETICINFARCTUL CRIPTOGENETIC

#IT9ATII:#IT9ATII: 59 #0 1AC #T9"II "0 A( A"0C'AT059 #0 1AC #T9"II "0 A( A"0C'AT0 T0MPORI;AR0 50A"0C'ATA A 0X "0 A(ORATORT0MPORI;AR0 50A"0C'ATA A 0X "0 A(ORATOR 59 PR0;I5TA AIT IP#IAT0RA0 "0 0MI#10R9 0;AT I5 IC59 PR0;I5TA AIT IP#IAT0RA0 "0 0MI#10R9 0;AT I5 IC

59 PR0;I5TA A5AM50;A "0 0M(OI0 CAR"IACA59 PR0;I5TA A5AM50;A "0 0M(OI0 CAR"IACA 59 #0 PR0;I5TA CA 95 A'C AC95AR59 #0 PR0;I5TA CA 95 A'C AC95AR

IMA6I#TICA 0'I"05TIATA I51ARCT IMITAT3A OIMA6I#TICA 0'I"05TIATA I51ARCT IMITAT3A ORAM9RA!MAI M9T "0 O RAM9RARAM9RA!MAI M9T "0 O RAM9RA

IMA6I#TICA 50I5'A;I'A 59 A "0MO5#TARTIMA6I#TICA 50I5'A;I'A 59 A "0MO5#TART

OC9;IA!#T05O;A 959I 'A# MAR0OC9;IA!#T05O;A 959I 'A# MAR0 0C2O-"OP0R%086!2OT0R!0C2OCOR" 59 0'I"0C2O-"OP0R%086!2OT0R!0C2OCOR" 59 0'I"

0M(OII0M(OII


25/32

INFARCTUL CRIPTOGENETICINFARCTUL CRIPTOGENETIC

A56IO6RA1IA: AR P9T0A 0'I"05TIAA56IO6RA1IA: AR P9T0A 0'I"05TIAOC9;IA "I#TAA A 959I TR95C2I AOC9;IA "I#TAA A 959I TR95C2I A950I A. MA>OR0 #A9 '1.950I A. MA>OR0 #A9 '1.

A(30M(OI0!TROM(O;A!AT#E&ARA(30M(OI0!TROM(O;A!AT#E&ARP9T0A 1I #I 5ORMAA&AR P9T0AP9T0A 1I #I 5ORMAA&AR P9T0A0XI#TA 0M(OII OC9T0 "I1ICI "00XI#TA 0M(OII OC9T0 "I1ICI "0"0MO5#TRAT %"I#195CTII"0MO5#TRAT %"I#195CTII

0MATOO6IC0%#TARI "00MATOO6IC0%#TARI "02IP0R6OA69A(IIT03#I5"R.2IP0R6OA69A(IIT03#I5"R.AP%0M(OII PARA"OXA0AP%0M(OII PARA"OXA0

C C


26/32

TRATAMENT AVC I IN ACUTTRATAMENT AVC I IN ACUT

MASURI GENERALE ) TERAPIE SPECIFICA SIMASURI GENERALE ) TERAPIE SPECIFICA SI

TRATAMENTTRATAMENT

C*IRURGICALC*IRURGICAL

995'-AM0IOR0A;A 0'O9TIA #I PRO65O#TIC9995'-AM0IOR0A;A 0'O9TIA #I PRO65O#TIC9 MO5ITORI;AR0 CAR"IO-R0#P!IOT-MO5ITORI;AR0 CAR"IO-R0#P!IOT-

I5I0 '05OA#AI5I0 '05OA#A

O "ACA #a O


27/32

2IP0R6IC0MIA 5OCI'A &I5 PRIM00 4H OR0 59 #0 "A2IP0R6IC0MIA 5OCI'A &I5 PRIM00 4H OR0 59 #0 "A69CO;A P0R19;A(IA%6IC0MIA ? 5OCI'A I5 ;O5A "069CO;A P0R19;A(IA%6IC0MIA ? 5OCI'A I5 ;O5A "0I51ARCTI51ARCT

6IC0MIA? FHM6!" @ I5#9I5A6IC0MIA? FHM6!" @ I5#9I5A 0"0M9 C0R0(RA:19RO#0MI"%MA5ITO359 MAI M9T "00"0M9 C0R0(RA:19RO#0MI"%MA5ITO359 MAI M9T "0

4H OR0!2IP0R'05TIATI0 M0CA5ICA3#CA"0 1#C&< PR0#4H OR0!2IP0R'05TIATI0 M0CA5ICA3#CA"0 1#C&< PR0#IC A CO L-LN MM26IC A CO L-LN MM26 10(RA ? MAR0#T0 ARIA "0 I51ARCT = A(!IMPAC20TARI10(RA ? MAR0#T0 ARIA "0 I51ARCT = A(!IMPAC20TARI A#PIRI5A < MORTAITAT0A #I RI#C9 "0 R0C9R05TA "ACAA#PIRI5A < MORTAITAT0A #I RI#C9 "0 R0C9R05TA "ACA

59 AR0 CI59 AR0 CI 1I(RI5OI;A C9 RTPA 3ACTI'ATOR TI#9AR "01I(RI5OI;A C9 RTPA 3ACTI'ATOR TI#9AR "0

PA#MI5O605 I5 PRIM00 L OR0&RI#C "0 20MORA6I0 I5PA#MI5O605 I5 PRIM00 L OR0&RI#C "0 20MORA6I0 I5N CA;9RI&< C9 L RI#C9 "0 "01ICIT MI5 #A9 "0OCN CA;9RI&< C9 L RI#C9 "0 "01ICIT MI5 #A9 "0OC"9PA L 95I"9PA L 95I


28/32

20PARI5A I'!20PARI5020PARI5A I'!20PARI50

1RACTI5AT0 %I5"ICATII:1RACTI5AT0 %I5"ICATII:TROM( I5TRACR"IAC 1ARA 20MORA6I0TROM( I5TRACR"IAC 1ARA 20MORA6I0

"I#0CTII ART0RIA0"I#0CTII ART0RIA0

#T05O;0 #0'0R0 "0 ACAI I5AI5T0 "0#T05O;0 #0'0R0 "0 ACAI I5AI5T0 "0

I5T0R'05TIA C2IR9R6ICAAI5T0R'05TIA C2IR9R6ICAA

CI:I51ARCT0 MARI%2TA 50CO5TROATCI:I51ARCT0 MARI%2TA 50CO5TROATT0RAP09TIC%09CARAIO;A.T0RAP09TIC%09CARAIO;A.


29/32

TRATAM05T C2IR9R6ICA:TRATAM05T C2IR9R6ICA: '05TRIC9O#TOMI0'05TRIC9O#TOMI0 "0COMPR0#I0 I5 A'C I I5 ACM MAI65 #I A'C I C0R0(0OA#0 ?"0COMPR0#I0 I5 A'C I I5 ACM MAI65 #I A'C I C0R0(0OA#0 ?

L CM "IAM0TR9L CM "IAM0TR9 05"ART0R0CTOMIA CAROTI"IA5A "9PA CRIT0RII0 5A#C0T #0 'A05"ART0R0CTOMIA CAROTI"IA5A "9PA CRIT0RII0 5A#C0T #0 'A

010CT9A CAT MAI C9RA5" PO#I(I PA5A A #APTAMA5I "9PA010CT9A CAT MAI C9RA5" PO#I(I PA5A A #APTAMA5I "9PA9TIM9 0'05IM05T C-'% A O# T05O;A "0 ? C9 A'C I #I AIT9TIM9 0'05IM05T C-'% A O# T05O;A "0 ? C9 A'C I #I AIT A56IOPA#TIA TRA5#9MI5AA P0RC9TA5A +!- #T05TAR0A #0A56IOPA#TIA TRA5#9MI5AA P0RC9TA5A +!- #T05TAR0A #0

R0#TRA560 A C0I C9 #T05O;0 CAROTI"I050 #0'0R0%A C0I C9R0#TRA560 A C0I C9 #T05O;0 CAROTI"I050 #0'0R0%A C0I C9CI 0AC%#T05O;A I5 ;O5A I5ACC0#I(IACI 0AC%#T05O;A I5 ;O5A I5ACC0#I(IAC2IR9R6I0%R0#T05O;AR0 "9PA 0AC I5ITIA%#T05O;A PO#T =C2IR9R6I0%R0#T05O;AR0 "9PA 0AC I5ITIA%#T05O;A PO#T =IRA"I0R0IRA"I0R0

0AC #I A56IOPA#TIA #0 'A 1AC0 "9PA 0'I"05TI0R0A PAT99I0AC #I A56IOPA#TIA #0 'A 1AC0 "9PA 0'I"05TI0R0A PAT99I'A#C9AR CAR"IAC 0'05T9A #T05TAR0 P05TR9 #T05O;0'A#C9AR CAR"IAC 0'05T9A #T05TAR0 P05TR9 #T05O;0CAROTI"I050 I5 AC00A#I #0"I5TA%AT10 RI#C "0 IMACAROTI"I050 I5 AC00A#I #0"I5TA%AT10 RI#C "0 IMA

A#A+COPI"O6R0 I5AI5T0 #I "9PA #T05TAR0 -G 95IA#A+COPI"O6R0 I5AI5T0 #I "9PA #T05TAR0 -G 95I


30/32

PREVENTIA SECUNDARAPREVENTIA SECUNDARA

TRATAM05T9TRATAM05T91R:2TA%A#C3#TATI50%2IP0IPI"0MI0I%2IP0R6IC0M1R:2TA%A#C3#TATI50%2IP0IPI"0MI0I%2IP0R6IC0MI0I%T9( R0#PIRATORII %T9(. "0I0I%T9( R0#PIRATORII %T9(. "0#OM5%"I0TA&1ORAM05 O'A0 PAT05T %+!-#OM5%"I0TA&1ORAM05 O'A0 PAT05T %+!-A50'RI#M "0 #0PT I5T0RATRIAA50'RI#M "0 #0PT I5T0RATRIA

R0COMA5"ARI:R0COMA5"ARI: T0RAPIA A5TITROM(OTICAT0RAPIA A5TITROM(OTICA

A5TICOA69A5T ORA3AC05OC9MARO!DAR1ARI5A I5 1b AA5TICOA69A5T ORA3AC05OC9MARO!DAR1ARI5A I5 1b Acr!PAROXI#TICA%A'C I CAR"IO-0M(OIC +IMcr!PAROXI#TICA%A'C I CAR"IO-0M(OIC +IMR0C05T3MOM05T9 ACO CO5TRO'0R#AT%A50'RI#MR0C05T3MOM05T9 ACO CO5TRO'0R#AT%A50'RI#M'#%'A'9OPATII%05"OCAR"IT0%PROT0;0'#%'A'9OPATII%05"OCAR"IT0%PROT0;0

'A'9AR0%AIT!A'C I MI5OR%A'C I I5 ACM3?F!L "I5'A'9AR0%AIT!A'C I MI5OR%A'C I I5 ACM3?F!L "I5T0RITORI9 "0 A#T0PTAT ? 4 #APT P05TR9 A "0CI"0T0RITORI9 "0 A#T0PTAT ? 4 #APT P05TR9 A "0CI"0I5"I'I"9AI;AT ACOI5"I'I"9AI;AT ACO

I5R: -L3#9( !P0#T0@ I501ICI05TI5R: -L3#9( !P0#T0@ I501ICI05T A5TIPAC20TAR03A#A%A#A+"IPIRI"AMO%COPI"O6R0 AA5TIPAC20TAR03A#A%A#A+"IPIRI"AMO%COPI"O6R0 A

C0I C9 CI PTR ACOC0I C9 CI PTR ACO


31/32

ACO I5:A'C I CAR"IO-0M(OIC 5006AT "0ACO I5:A'C I CAR"IO-0M(OIC 5006AT "01bA C9 RI#C "0 R0C9R05TA RI"ICAT&1bA C9 RI#C "0 R0C9R05TA RI"ICAT&

ACO A A'C I 5O5-CAR"IO-0M(OIC:AT0ROAM0ACO A A'C I 5O5-CAR"IO-0M(OIC:AT0ROAM0AORTIC0%A50'RI#M 19;I1ORM "0 A(% "I#0CTIIAORTIC0%A50'RI#M 19;I1ORM "0 A(% "I#0CTII

"0 A. C0R'ICA0%1ORAM05 O'A0 PAT05T"0 A. C0R'ICA0%1ORAM05 O'A0 PAT05T+TROM(O;A "0 '050 P0RI10RIC0%A50'RI#M+TROM(O;A "0 '050 P0RI10RIC0%A50'RI#M"0 #0PT ATRIA"0 #0PT ATRIA

ACO+A#P @ 59 A PAC C9 1bA #I (OAAACO+A#P @ 59 A PAC C9 1bA #I (OAACORO5ARIA5A #TA(IACORO5ARIA5A #TA(IA

A5TIPAC20TAR03A#A%A#A+"IPIRI"AMO%COPIA5TIPAC20TAR03A#A%A#A+"IPIRI"AMO%COPI"O6R0 A C0I C9 CI PTR ACO"O6R0 A C0I C9 CI PTR ACO


32/32

AVC RECURENTAVC RECURENT

P0 "9RATA T0RAPI0IP0 "9RATA T0RAPI0IA5TIPAC20TAR0%"ACA APAR0 95 A'CA5TIPAC20TAR0%"ACA APAR0 95 A'C= '0;I AT0 CA9;0 "0 A'C!1ACTORI= '0;I AT0 CA9;0 "0 A'C!1ACTORI

"0 RI#C"0 RI#CT0RAPII AT0R5ATI'0:T0RAPII AT0R5ATI'0:

M05TI50R0A 50#C2IM(ATA A TRATAM05T99IM05TI50R0A 50#C2IM(ATA A TRATAM05T99I #C2IM(AR0A C9 95 AT A5TIA6R06A5T#C2IM(AR0A C9 95 AT A5TIA6R06A5T

A"A96AR0A 959I AT A5TIPAC20TARA"A96AR0A 959I AT A5TIPAC20TAR 1OO#IR0A "0 ACO1OO#IR0A "0 ACO

TRATAM05T R0C9P0RATORTRATAM05T R0C9P0RATOR

avc ischemic curs 4 continare

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