6A. Neurologic Disorders Flashcards
Stroke
Sudden interruption of oxygenated blood to the brain
• Focal necrosis of brain tissue – Motor \_\_\_\_ – Speech impairment – \_\_\_\_ – Death
• \_\_\_\_ etiology • \_\_\_\_(80%) – Mortality rate of approx. 8% • \_\_\_\_(20%) – Mortality rate of approx. 45%
dysfunction paralysis vascular ischemia hemorrhage
Epidemiology
• 3rd most common cause of death in the U.S.
• 700,000 new or recurrent strokes / year – 1 stroke / minute
• ____% of people survive their stroke / year
• ____ have a 38% greater risk of first stroke than Caucasians
– Risk of death is ____x greater than Caucasians
• Risk of stroke increases with ____
– 5% of the population over age 65 has had at least one stroke
75
AA
2-4
age
Ischemic Strokes
• Most commonly caused by: – ____ thrombi
– Emboli of ____ origin
• Extent of infarction determined by: – \_\_\_\_ of occlusion – \_\_\_\_ of the occluded vessel – \_\_\_\_ of the occlusion – Presence of \_\_\_\_ circulation
atherosclerotic
cardiac
site
size
duration
collateral
As an example, the red circle on slide shows an area of clot at ____ cerebral artery (PCA). The change in color (purple) shows that later supply of PCA is cut off, causing an area of ischemia to this posterior part of brain, including ____ area (for speech production) as well as visual and tactile senses.
Part of the reason this clot area would be so devastating is because there is no ____ circulation here. So if we clot the only supply to that area, there will be NO blood supply or ability to get oxygen here, leading to loss of oxygen and loss of function over time.
posterior
broca’s
collateral
Types of ischemic stroke syndromes
- Large Vessel Stroke
• Thrombotic occlusion of a major vessel
• ____ artery
– Most common
• Vertebral artery
• Intracranial arteries
• Often results in extensive ____ damage
carotid
cerebral
ypes of ischemic stroke syndromes
- Small Vessel Stroke
- AKA “____ stroke”
- Refers to size (
lacunar
15
small
high
High Risk Conditions for Cardioembolism Development
- ____ valve(s)
- Atrial fibrillation
- ____ stenosis with atrial fibrillation
- Recent MI (
mechanical
mitral
4
cardiomyopathy
Intracerebral Hemorrhage
• Most common cause is ____
– Microaneurysms of the arterioles
• Rupture leads to:
– Extravasation of ____
– Displaces brain tissue
– Increased ____
This is MRI of brain showing intracerebral hemorrhage. It is ____ bc its liquid and it is filling the space that otherwise brain tissue would occupy.
hypertensive atherosclerosis
blood
intracranial volume
bright
Subarachnoid Hemorrhage
• Rupture of a ____ aneurysm at the bifurcation of a major ____ artery or in the ____
This MRA angiogram shows aneurysm within major vessel with extravasated blood by too much pressure trying to get into division into smaller arterioles.
Too much pressure causes weakness in vessel wall and additional area (aneurysm). As increased pressure continues, unless there’s anything that allows it to go back to normal pressure, this can eventually rupture causing a ____.
berry
cerebral
circle of willis
hemorrhage
This shows a subarachnoid hemorrhage. We have more ____ between brain tissue and skull itself all filled with blood which is compressing the area that brain tissue can take up.
This in turn compresses the ability of brain tissue to function the way it should bc it has less room for all the neurons and microglia and other tissue.
This post-mortem specimen shows the aftereffects of displacement of brain tissue after hemorrhage. This is a localized one with increased amount of blood/blood products.
We can see how a brain is usually symmetrical becomes ____ from the extravasation and compression of brain tissue.
volume
asymmetrical
Neurologic phenomena associated with stroke
• Transient ischemic attack (TIA)
– “____”
• Temporary disturbance in blood supply to a localized area of the brain
– ____
– Weakness
– ____ / numbness
- May last approximately ____ minutes
- Major stroke is preceded by TIAs within several ____ of the first episode
stroke hemiplegia tingling 10 days
Signs and Symptoms of Acute Stroke
- ____
- Aphasia
- ____ loss
- Numbness
- ____
- Double Vision
- ____
- Incoordination
weakness
visual
vertigo
imbalance
In a stroke, ____ is brain tissue (MOST IMPORTANT TAKEAWAY FROM THIS LECTURE)
time
Acute Stroke Management
• Activate EMS – \_\_\_\_ as indicated • Transport to \_\_\_\_ • Administration of \_\_\_\_ within 4.5 hours of stroke – Prevent further thrombosis – Lyse existing thrombi or emboli
- stabilize with ____ medications
• Surgery
• Rehabilitation
BLS/ALCS
hospital
IV tPA
anticoagulant
Laboratory Evaluation • Routine lab tests • Lumbar puncture – Check for \_\_\_\_ in CSF – Altered \_\_\_\_ pressure • Imaging – \_\_\_\_ – MRI – \_\_\_\_
blood/protein
CSF
CT
MRA
Medical Management • Prevention • Modification of risk factors – Screening for \_\_\_\_ • \_\_\_\_ agents • \_\_\_\_ agents
co-morbidities
anticoagulant
antiplatelet
Prevention: Risk Factor Modification
• Non-Modifiable – \_\_\_\_ – Sex – \_\_\_\_ – Heredity
• Modifiable – \_\_\_\_ – Cardiac disease (AFib) – \_\_\_\_ – Hypercholesterolemia – \_\_\_\_ smoking – Excessive alcohol – \_\_\_\_ Inactivity
age
race-ethnicity
hypertension
diabetes
cigarette
physical
Prevention: Anti-thrombotics
• Consider risk of recurrent stroke and hemorrhage in acute setting
• Anticoagulation
– ____ stroke
– ____ states
• Antiplatelet agents
– ____ vessel disease
– ____ vessel disease
cardioembolic
hypercoagulable
large
small
Prevention: Anticoagulation • Warfarin (Coumadin): \_\_\_\_ antagonist – Goal INR \_\_\_\_, dosage individualized – Reversible by \_\_\_\_ – Requires close \_\_\_\_
• Dabigatran (Pradaxa): direct \_\_\_\_ inhibitor • Apixaban (Eliquis): \_\_\_\_ inhibitor • Rivaroxaban (Xarelto): \_\_\_\_ inhibitor – No pharmacologic \_\_\_\_ agent available – Does not require \_\_\_\_
vitamin K
2.0 to 3.0
vitamin K
monitoring
thrombin factor Xa factor Xa reversal monitoring
Prevention: Antiplatelet agents • \_\_\_\_ • Clopidogrel (Plavix) • \_\_\_\_ (Ticlid) • Dipyrimadole (Persantine) • \_\_\_\_/Dipyramidole (Aggrenox)
• Enoxaparin (Lovenox) – LMWH
aspirin
ticlopidine
ASA
