8 modules on stroke: cerebrovascular anatomy and the Circle of Willis, the molecular ischemic cascade (excitotoxicity, Ca²⁺, ROS), Eichenholtz-style staging of hemorrhage, NIHSS scoring, ASPECTS and CT perfusion, the modern reperfusion era (thrombolysis, thrombectomy, DAWN/DEFUSE-3), and secondary prevention.
Eight Modules
- Part I — Overview & Epidemiology: ~6.5 M deaths/yr (#2 globally), leading cause of adult disability, INTERSTROKE 10 modifiable risk factors (~90% PAR), Saver’s "1.9 M neurons/min", FAST/BE-FAST recognition.
- Part II — Cerebrovascular Anatomy: Internal carotid & vertebrobasilar systems, Circle of Willis, MCA/ACA/PCA territories, perforating arteries (lenticulostriates, thalamoperforators), watershed zones. With Circle of Willis SVG.
- Part III — Ischemic Pathophysiology: CBF thresholds (penumbra 12–22 mL/100g/min vs core <10), energy failure, glutamate excitotoxicity, NMDA Ca²⁺ flood, ROS, mitochondrial collapse, Astrup & Symon 1981 penumbra concept. PDB: tPA, NMDA receptor.
- Part IV — Hemorrhagic Stroke: ICH (hypertensive, amyloid, AVM), Charcot-Bouchard microaneurysms, SAH (aneurysmal, Hunt-Hess, Fisher), vasospasm, ICP physiology and Cushing reflex, decompressive surgery.
- Part V — Clinical Syndromes: MCA, ACA, PCA, lacunar (Fisher’s five), brainstem (Wallenberg, Weber, locked-in), aphasias and higher-cortical syndromes, full NIHSS table, pre-hospital severity scales (LAMS, RACE, C-STAT).
- Part VI — Imaging: Non-contrast CT, ASPECTS (10-region map), CTA, CT perfusion (core/penumbra), DWI/PWI MRI, the 4.5h→6h→24h window decisions.
- Part VII — Acute Management: Alteplase & tenecteplase IV thrombolysis, mechanical thrombectomy (HERMES NNT~3), DAWN/DEFUSE-3 imaging-selected late window, BP targets, decompressive hemicraniectomy. PDB: tPA, fibrinogen.
- Part VIII — Prevention & Rehabilitation: Mechanism-based antithrombotics, DOACs in AF, statins (SPARCL), BP control (PROGRESS, SPRINT-MIND), Mediterranean diet, PFO closure, neuroplasticity, motor and aphasia rehabilitation.
The acute-management module covers the post-2015 reperfusion revolution — HERMES meta-analysis NNT~3 for one mRS-shift, DAWN/DEFUSE-3 extending the window to 24h, and the 2022 BAOCHE/ATTENTION trials proving thrombectomy benefit in basilar occlusion.