2.3- Stroke 1 Lecture Flashcards
What is a cerebrovascular accident (CVA)?
a sudden onset of neurologic symptoms due to disturbance in blood supply to the brain lasting longer than 24 hours (stroke)
Name 3 facts about strokes?
- Most common disabling neuologic condition in adults
- 3rd leading cause of death; leading cause of disability
- 700,000 new per year with 4 million survivors in US
- 10-26% die within the first few days
- 10% have no significant effects
- A large percentage are diablied to some degree
a) 80% can do ADL’s
b) very few return to work-social and physical adjustment is very difficult
What is the most common disabling neurologic condition in adults?
CVA/stroke
How many new cases of stroke happen per year with 4 million survivors in the US?
700,000
What is the 3rd leading cause of death and leading cause of disability?
CVA/stroke
What percent of stroke die within the first few days?
10-26%
What percent of strokes have no sigificant effects?
10%
What is a sudden onset of neurologic symptoms due to disturbance in blood supply to the brain lasting longer than 24 hours?
CVA
What 2 adjustments are very difficult after a stroke?
social and physical (very few return to work)
True/False
A stroke can NOT happen in the spinal cord?
FALSE… it CAN happen in the SC
What is an Ischemic stroke?
Lack of blood supply to an area of the brain
_______ of stroke affects the resulting signs and symptoms.
Site
What are 2 types of Ischemic strokes?
- Thombotic
2. Embolitic
What type of stroke is slow to occur?
thrombotic
What happens with a thrombotic stroke?
a blood vessel is injured, platelets and fibrin form a clot reducing blood flow through the artery
What type of stroke is often proceeded by a TIA?
Thrombotic stroke
What is a transient ischemic attack (TIA)?
every symptom of a stroke but only lasts 24 hours
What is an Embolitic stroke?
a blood clot or plaque that breaks loose from another area of the body and becomes lodged in an artery
What type of stroke often has an origin in the LE’s?
Embolitic
What type of stroke is often associated with cardiovascular disease-atrial fibrillation, MI, and valve disease?
Embolitic
What is TPA (tissue plasmenogin activator)?
A super clot buster given for Ischemic strokes
Should a TPA be given for Hemmorhagic stroke? why/why not?
NO– only Ischemic strokes, with hemorrhagic strokes there is an open bleed on the brain.
What is the time frame a TPA can be given in order to be effective?
3-4 hours of onset of stroke
What percent reach the hospital in time to be given a TPA?
3-5%
What percent suffer an ischemic stroke?
85%
What type of stroke is treatable a drug called TPA?
Ischemic
What is a hemorrhagic stroke?
open bleed into brain tissue or subarachnoid space caused by rupture of a vessel
Where does a hemorrhagic stroke often occur?
in the bend of blood vessels or malformations of an area of the vessel
What is an aneurysm?
weakening of the wall of the vessel, the thinning can allow the vessel to balloon or burst
What happens if the aneurysm occurs in the brain?
it will increase pressue
What happens if the aneurysm occurs in the subarachnoid space?
the ballooning will not cause pressure problems
True/False:
If an aneurysm is found before it bursts, it be surgically tied off?
mostly true (depending on location)
True/False:
If the vessel bursts during an aneurysm, TPA will make it better?
FALSE (TPA stops clotting- would continue to bleed)
__________ after a hemorrhagic stroke is done to tie off the blood vessel and remove excess blood (reduces pressure).
surgery
What can cause hemorrhagic dementia after an aneurysm?
blood
What is very damaging to neurons? Why?
blood
can cause hemorrhagic dementia after the event
What are the symptoms of a stroke?
- can become unconscious (but not always)
- headache (more with hemorrhagic than inchemic)
- confusion, slurred speech/problems with communication
- numb/tingle 1/2 of body
- lack of movement 1/2 of body
- loss of coordination
- nausea **must get to ER ASAP earlier Dx=better chances
- Symptoms of TIA are the SAME
What is a warning sign that a stroke is imminent?
TIA
What are the risk factors for a stroke?
- TIA’s and previous stroke
- Heart conditions (a-fib, valve disease)
- HBP
- weight and lack of ex
- age-after 45 risk doubles each 10 years
- diabetes
- men higher than women (slight)
- black is higher than white (sickle cell anemia and high BP)
- birth control pills (esp with smoking)
- smoking
* any vasuclar accident before age 6 is grouped as CP not stroke
What are the 2 major systems of circulation?
- Anterior
2. Posterior
________ ____________ are 2 pipelines that run through the cervical vertebrae that eventually join together
Vertebral arteries
How many vertebral arteries do we have?
2
What is formed by a branch off each vertebral artery and the branches join into 1 artery and run down the anterior surface of the spinal cord?
Anterior spinal artery
What supplies the anterior 2/3 of the spinal cord?
Anterior spinal artery
This artery is important for breathing, heart rate etc?
posterior inferior cerebellar artery
What branches off the vertebral artery and supplies the surface of the cerebellum and portions of the medulla?
Posterior inferior cerebellar artery (2)
What is formed by the 2 vertebral arteries joining together and has several branches?
Basilar artery
What are the branches of the Basilar Artery?
- anterior inferior cerebellar artery (2)
- pontene branches (several)
- superior cerebellar artery
- posterior cerebral artery
What does the anterior inferior cerebellar artery feed?
the inferior surface of the cerebellum
What artery supplies the pons?
pontene branches
What artery supplies medial and posterior areas of the cerebrum in the temporal and occipital areas?
posterior cerebral artery
What artery supplies the superior surface of the cerebellum, and portions of the midbrain and pons?
superior cerebellar artery
What arteries supply the face?
external carotid (2)
For anterior circulation, what arteries run off the aorta and form 2 branches?
carotid arteries
What is the main pipeline that supplies cerebrum via several branches?
Internal carotid (2)
What artery is most affected by strokes?
Middle cerebral artery
What artery runs through the lateral fissue to supply lateral surface of cerebrum (frontal, parietal, and temporal lobes?)
Middle cerebral artery
If you have a stroke here you can expect to see motor speech problems, facial droop, swallowing issues, loss of facial sensation?
middle cerebral artery
This artery runs medial and anterior into the longitudinal fissure to supply the medial surface of the frontal and parietal lobes (also runs up and over the fissure some)?
Anterior cerebral artery (2)
Where is the watershed area?
The area on the lateral portion of the hemisphere that is supplied by the anterior cerebral artery from above and the middle/posterior cerebral artery from below
What area is supplied by both the anterior cerebral artery and the middle/posterior cerebral artery but is at risk because it is at the end of each artery?
watershed area
Lack of blood flow would affect this UE motor area, especially the arms?
watershed area (sometimes decreased pressure of blood b/c of plaque -> becomes starved area -> UE areas will be affected)
What artery connects the 2 anterior cerebral arteries?
Anterior communicating artery (1)
What artery is an “insurance policy” giving an alternate flow path and had no actual blood flow when the system is working correctly?
anterior communicating artery
What artery connects the anterior and posterior cerebral arteries (thus connecting the anterior and posterior circulation)?
Posterior communicating arteries
What makes up the circle of willis?
9 arteries
Major:
- anterior cerebral (2)
- posterior cerebral (2)
- internal carotid (2)
amastamose via communicating arteries
- anterior communicating (1)
- posterior communicating (2)
_________ are more likely to affect anterior circulation than posterior circulation.
emboli
What allows blood to flow around a blockage?
circle of willis
What happens initially after a stroke?
Patient may go into spinal or cerebral shock-CNS shuts down
Why is positioning key initially after a stroke?
the pt may be flacid and not able to move to one side to the body
- position to avoid contractures-no protective reactions (ex stretching a joint could damage)
- watch skin integrity
MODE OF PROTECTION & PREVENTION
Why is positioning key initially after a stroke?
the pt may be flaccid and not able to move to one side to the body
- position to avoid contractures-no protective reactions (ex stretching a joint could damage)
- watch skin integrity (pressure ulcers)
MODE OF PROTECTION & PREVENTION
What portion of the body often forms flexor synergy?
UE
What portion of the body often forms extensor synergy?
LE
A patient has problems with balance, coordination, breathing, and heart rate. What artery is affected?
Posterior Inferior Cerebellar Artery (2)
*supplies surface of cerebellum and portions of the medulla
A patient experiences problems with balance, posture, and complex muscular movement. What artery is affected?
Anterior Inferior Cerebellar Artery (2)
*inferior surface of the cerebellum
A patient is struggling with balance, equilibrium, and coordination movements. What artery might be affected?
Pontene branches
*supplies pons
A patient has issues with reflexes, including righting of the head and auditory reflexes, balance, and posture. What artery might be affected?
Superior Cerebellar Artery
*superior surface of the cerebellum, portions of midbrain and pons
A patient has vision problems. What artery might be affected?
Posterior Cerebral Artery
- supplies medial and posterior areas of the cerebrum in the temporal and occipital areas
A patient has problems with LE motor and sensory. What artery might be affecting this?
Anterior Cerebral Artery
*supplies the medial surface of the frontal and parietal lobes
