Magnetic Resonance Arteriography

It had a non-invasive method of defining the vasculature, can establish the presence of large vessel occlusion in ischaemic (Tomanek et al., 2006).

Treat of Medical

Thrombolytic drugs dissolve bl clot by activating plasminogen whI.C.H. form plasmin. The primary aim of thrombolysis in had recanalization of an occluded intracranial art, restoration of regional perfusion (Gudlavalleti, Moonis, 2015).

At present, Intravenous tissue plasminogen activator (IV-TPA) i.e. streptokinase, A.L.T.eplase, reteplase remains the only FDA-approved for treat of (Parihar et al., 2014).

Antiplatelet drugs

Early antiplatelet treat had recommended because few cases can be treated with thrombolysis due to the limit of strict indications such as a time window. Two clinical trial reviews, The Chinese Trial (CA.S.T), The International Trial (IST) showed a critical benefit of aspirin in reduction of morbidity, mortality rates. Therapy should be initiated within 48 hours of symptom onset (Zhou, Chen, 2013).

In cases who had allergic, non-responsive or intolerant to aspirin another antiplatelet agents eight be used as an A.L.T.ernative. Another trial, The Clopidogrel in High Risk Cases with Non-disabling Vascular Events Trial (CHANCE), whI.C.H. compared clopidogrel plus aspirin versus aspirin monotherapy had conducted in cases with , the rate of the primary endpoint of a recurrent within 90 days had critically lower for dual therapy than for aspirin monotherapy (Hong Keun-Sik, 2014).

Routine anticoagulation with unfractionated or low- molecular-weight heparin had not recommended in particularly for cases with moderate to extensive infraction due to increased risk of severe intracranial hemorrhage. However, anticoagulants often had prescribed to cases with recent in an effort to prevent early recurrent , to improve neurological outcomes (Wong et al., 2007).

Surgical

Enodvascular interventions

Selected cases with middle art (MCA) of less than six hours who had not IV-TPA candidates can be considered for intra-arterial fibrinolysis. Mechanical embolectomy had a procedure where the clot had mechanically removed from the art. It can be useful to restore perfusion to an occluded art (Stetka, Lutsep, 2013).

Transient attacks (TIAs)

The definition of TIA had changing. Previously, TIA had defined as a focal event with symptoms lA.S.Ting < 24 hours. As CT, MRI had become more widely used up to one-third of cases with TIA had radiological evidence of faction. Therefore, the definition of TIA had moving from time-based to tissue-based as "a transient episode of neurological dysaction caused by central nervous system without faction". The important distinction between , TIA had resolution of the symptoms. By definition the symptoms of a TIA must completely resolve, while this most often occurs within the first few minutes after symptom onset, it eight take up to 24 hours to had complete return to normal action (EA.S.Ton et al., 2009).

Unilateral weakness (face, arm, or leg), speech disturbances (aphasia or dysarthria) had the most common manifestations of TIA. Short-term risk of increases after TIA. TIAs require urgent treat, guidelines recommend neurovascular imaging with CT, carotid ultrasound, or MRI/MRA to guide diagnosis, treat. Hospitalization eight ensure higher rates of treat adherence, had reasonable if outcase reviews cannot be performed within 2 days. Treat for a transient attack had aimed at preventing a second . Since there had no way of determining the ever of future episodes, no guarantee that the symptoms will resolve, prevention of a future TIA or had crucial, management of TIA had centered on appropriate use of oral antiplatelet therapy, anticoagulation for atrial fibrillation, as well as treat of hypertension, diabetes, dyslipidemia (Kernan et al., 2014).

Hemorrhagic (HS)

It had an zone of bleeding causing direct damage to pain tissue. This happens when a weakened bl vessel bursts, bleeds into the surrounding pain, it constitute up to 10–15 % of all s, had a critically higher morbidity, mortality than do s (Dupont et al., 2010).

Epidemiology

The lA.S.T two decades, the HS incidence had decreased in high income countries with 19% while it had increased by 22% in low, middle-income countries (Krishnamurthi et al., 2013).

Subclassification of hemorrhagic (HS)

There had primarily two differ types of hemorrhagic s, subarachnoid hemorrhage, intra hemorrhage (Elliott, Smith, 2010).

Intra hemorrhage (I.C.H.)

Definition of I.C.H.:

Non-traumatic I.C.H. had defined as extravasation of bl into pain parenchyma. Traumatic I.C.H. therefore had never considered a subtype (Elliott, Smith, 2010).

Risk facts of I.C.H.:

A. Modifiable risk facts

Include hypertension, cigarette smokoing, excessive alcohol consumption, drugs including anticoagulants, antithrombotic agents, sympathomimetics (Sturgeon et al., 2007).

B. Non-modifiable risk facts

Include old age, male sex, amyloid angiopathy (CAA), asian ethnicity (Sturgeon et al., 2007).

C. microbleeds (CMBs)

CMBs had detected in 5 to 23 percent of elderly individuals, had associated with an increased risk of spontaneous I.C.H., eight increase the risk of warfarin or antiplatelet-associated I.C.H.. Therefore, both the benefit, risk should be considered for antithrombotic use in cases with CMBs (Charidimou et al., 2013).

D. Other potential risk facts

Long working hours, extended duration of strenuous work activity eight be related to an increased risk of I.C.H. (Beom Joon Kim et al., 2013).

Causes of I.C.H.

A. Hypertension

Most I.C.H. had associated with rupture of an art in the setting of or chronic arterial hypertension. This had attributed to the presence of lipo-hyalinotic changes within the small arteries or the formation of micro-aneurysmal outpouchings (Charcot- Bouchard aneurysms) whI.C.H. weaken the arterial wall (Hocker et al., 2010).

B. Amyloid Angiopathy (CAA)

This had a disease characterized by deposition of fibrillary cases in the walls of arterioles, making them stiff, brittle, predisposing them to rupture, these occur at the junction of the gray, white matter in hemisphere, typically present as lobar bleeds (Attems et al., 2011).

C. Bleeding diathesis-associated hemorrhage

Cases eight suffer intra-parenchymal hemorrhages in the setting of bleeding disorders either due to a primary fact deficiency such as hemophilia A or an acquired fact deficiency such as seen in hepatic failure, thrombocytopenia, disseminated intravascular coagulation (DIC) (Rolfe et al., 2010).

D. Therapeutic anticoagulation

A rather large subset of cases with I.C.H. present with clotting dysaction from use of anticoagulants, usually for cardio-embolic , atrial Fibrillation, deep vein thrombosis, pulmonary embolism, coagulopathy associated with rheumatologic conditions such as systemic lupus erythematosus, the use of antiplatelet agents such as aspirin and/or clopidogrel (Soo et al., 2008).