4 Etiologies of CVA/Stroke Flashcards
What are the 4 types?
Ischemic - thrombotic
Ischemic - embolic
Hemorrhage - intracerebral
Hemorrhage - subarachnoid
Key question/observation for
Hemorrhage - intracerebral
Upon straining
Key question/observation for
Hemorrhage - subarachnoid
THUNDER CLAP headache
Ischemic Thrombotic CVA/Stroke
What is atherosclerosis?
What are the types?
Complications of the late stage?
“Athero” meaning soft, fatty, glue-like
“atheroma” meaning a fomration of “athero” within vessel that results in luminal narrowing
Thick - Hard - Less Elastic
Present with low distal perfusion, may develop aneurysms, prone to rupture with hypertension
Ischemic Thrombotic CVA/Stroke
What are the vessels at risk?
Internal carotid (carotid endarterectomy)
Upper vertebral (angioplasty)
Lower basilar (Rx & prevention)
Ischemic Thrombotic CVA/Stroke
What are the risks?
8
High cholesterol, triglycerides, lipids
Hypertension
Stress increases cortisol (lipids) & catecholamines
Hereditary
Sedentary lifestyle (lack of exercise)
Birth control pill, smoking & weight gain
Cardiac disease, dysrythmia
Diabetes Mellitus
Ischemic Thrombotic CVA/Stroke
What’s the prevention?
EMS care/Acute management?
Antiplatelet agents to prevent atherothrombosis
ASA & ticlopine are used most often
Carotid endarterectomy for internal carotid TIA
Angioplasty
Position the patient on their affected (body) side with the head elevated @ 30 degrees
High concentration oxygen & assisted ventilation with support of spontaneous breathing & augmentation of rate to no greater than 20 min.
Ischemic Embolic CVA/Stroke
What are the causes/risks for HYPERTENSION & ATHERTHROMBOTIC PLAQUE?
What are the causes/risks for IMPAIRED BLOOD FLOW LEADING TO STASIS?
What are the causes/risks for DAMAGED VALVE LEADING TO CLOT/FIBRIN EMBOLI?
It is an Embolus from atheromatous plaque in the carotid sinus or internal carotid artery.
Diabetes, hyperlipidemia, smoking, b/c pill, prior, overweight or + weight gain, sedentary lifestyle
CSM or Chiropractic neck manipulation.
Hyper viscosity syndromes & Glue sniffing
Recent AMI with dyskinetic left ventrical
Atrial Fibrillation
Rheumatic Heart disease
Prosthetic valves
Bacterial Endocarditis
Mitral Valve Prolapse
Ischemic Embolic CVA/Stroke
What area of the brain is USUALLY affected (the vessel)?
The # of emboli determines?
The left middle cerebral artery, especially the upper division, is the most frequent site of cerebral emboli b/c it is straighter which means less resistance to emboli
the extent of damage
Ischemic Embolic CVA/Stroke
What’s the prevention?
What’s the EMS care/Acute management for an ischemic embolic stroke?
Decrease other risk factors which cause hypertension & atherothrombotic plaque.
Avoid CSM & neck manipulation
Antiplatelet agents – warfarin more effective than ASA for preventing ischemic stroke
associated with AF
Thrombolytic therapy for acute care
Position the patient on their affected (body) side with the head elevated @ 30 degrees
High concentration oxygen & assisted ventilation with support of spontaneous breathing & augmentation of rate to no greater than 20 min
Intracerebral hemorrhage (ICH) CVA/Stroke
What does it mean?
How does it happen?
intraparenchymal means deep tissue (there’s a hematoma deep in the brain tissue)
- Bleeding occurs in the space surrounding the tissue.
- Distal brain cells become hypoxic immediately resulting in a focal presentation. (e.g., weakness in one hand).
- Blood is particularly irritating to local arteries which spasm in response to contact.
- The spasm may involve quite a large area resulting in an ever expanding / evolving presentation.
- Clot will form & brain tissue in the area becomes liquid.
- Clot eventually is removed by phagocytosis & replaced with blood vessels, astroglia fibers & fibrin to fill void.
*Brain tissue does not replace dead cells.
Intracerebral hemorrhage (ICH) CVA/Stroke
What’s the symptom onset?
What are the complications?
What are the causes?
Slower to get worse
Initially focal
necrotic tissue & the edema causes herniation through the tentorium.
missile injury
tumors which bleed
hypertensive crisis (50% of cases)
arteriosclerosis
Intracerebral hemorrhage (ICH) CVA/Stroke
Where is it usually located?
Who does it affect?
anterior portion of the temporal lobes & the posterior portion of the frontal lobes
older men (68)
Intracerebral hemorrhage (ICH) CVA/Stroke
What’s the prevention?
What’s the EMS care/Acute management?
Stop the use of alcohol, tobacco, & use of cocaine & amphetamines
Mannitol & other osmotic agents reduce ICP caused by edema
Position the patient on their affected (body) side with the head elevated @ 30 degrees
High concentration oxygen & assisted ventilation with support of spontaneous breathing & augmentation of rate to no greater than 20 min
Intracerebral hemorrhage (ICH) CVA/Stroke
What’s the prognosis for a supratentorial hematoma GREATER than 5cm?
What about an infratentorial (pontine) hematoma GREATER than 3cm?
Poor
FATAL!!
