9 - Intracranial Regulation: Stroke, Spinal Cord Injury, + Dementia Flashcards
transient ischemic attack [TIA]
temporary episode of neurological dysfunction [less than 24 hrs.] caused by focal [localized] cerebral or retinal ischemia but w/o evidence of cerebral infarction
thrombotic stroke
stroke resulting from the formation of a blood clot in a diseased and narrowed blood vessel in the brain – blocks the passage of the blood through the artery
embolic stroke
stroke that occurs when an embolus lodges in and occludes a cerebral artery [blocks blood flow], resulting in infarction and edema of the area supplied by the involved vessel
hemorrhagic stroke
stroke that results from bleeding into the brain tissue itself or into the subarachnoid space or the ventricles – blood seeps into and damages brain tissues until clotting “shuts off” the leak
intracerebral hemorrhage
type of hemorrhagic stroke in which bleeding occurs within the brain caused by a rupture of a blood vessel [cerebral artery]
what are the typical symptoms of a TIA?
- hemiparesis
- loss of balance
- hemiparesthesia
- dysarthria + dysphagia
- diplopia or monocular blindness contralateral to effected limbs
what are the typical symptoms of a TIA?
- hemiparesis
- loss of balance
- hemiparesthesia [on OPPOSITE side of where ischema is]
- dysarthria + dysphagia
- diplopia or monocular blindness contralateral to effected limbs [aka on same side where ischemia is]
what is the most common cause of a TIA? explain how this would lead to transient symptoms and why multple TIAs often present w different symptoms
most common cause is a cerebral embolism [clot forms somewhere in the body + travels to the brain]
rapid fibrinolysis of the embolism explains why symptoms are transient and why multiple TIAs often present w different symptoms - embolisms shooting up to the brain might follow diff. vascu;lar pathways which would explain diff. symptoms related to the location of the embolus
identify the cardiac causes of a TIA
- valve disease
- arrhythmia [ex- afib]
- endocarditis
- MI
- rupture / fissure of atherosclerotic plaque in carotids
describe the non-cardiac sources of emboli in the body
polycythemia [thick, viscous blood]
sickel cell disease
anemia
systemic inflammatory diseases
following a TIA - how many patients are predicted to have a CVA w/in 2 days? 90 days?
what factors increase the risk of a CVA after a TIA?
more than 5% will have a CVA w/in 2 days
10% w/in 90
risk increased in old poeple, diabetic pts, or those whose symptoms lasted longer than 10 mins + involved weakness / speech impairment
what is a TIA a warming of?
a TIA can serve as a warning of an impending stroke.
how do we treat a TIA?
as it’s happenign we treat it like a stroke until proven that it isn’t one
aspirin / antiplatelets
anticoag w warfarin - esp. in afib pts
for lesions > 70% –> carotid endarterectomy
reduce CV risk factors.
what is the main cause of strokes?
plaque in cerebral or carotid arteries
what do hemorrhagic strokes often arise from?
prolonged + severe HTN and / or cerebral aneurysm
which type of stroke is most severe: embolic, thrombotic, or hemorrhagic?
hemorrhagic - more severe + destructive - increase ICP to a greater degree
describe the 4 potential secondary effects of intracranial bleeding
cerebral edema
vasospasm
acidosis
electrolyte imbalance
what do the manifestations of a stroke depend on?
location of obstruction
size of involved artery
functional area affected
artery affected
how do we treat a CVA [STROKE]?
emergency treatment of ischemic stroke requires an angioplasty, thrombectomy / embolectomy, or rapid fibrinolysis to restore blood to affected area’
TPA activates plamin to digest fibrin - only effective w/in 3 hrs. of the onset of symptoms
must r/o hemorrhagic stroke before administering any agents like that
investigate + treat underlying cause
how do we treat a CVA [STROKE]?
emergency treatment of ischemic stroke requires an angioplasty, thrombectomy / embolectomy, or rapid fibrinolysis to restore blood to affected area’
TPA activates plasmin to digest fibrin - only effective w/in 3 hrs. of the onset of symptoms
must r/o hemorrhagic stroke before administering any agents like that
investigate + treat underlying cause
Identify some of the manifestations of a right-brain stroke
- hemiplegia on L side
- L sided neglect
- spatial-percpetual deficits
- tends to deny or minimize problems
- rapid performance, short attention span
- impulsive; safety problems
- impaired judgement
- impaired time concepts
Identify some of the manifestations of a left-brain stroke
- hemiplegia on R side
- impaired speech-language [aphasias]
- impaired R L discrimination
- slow performance, cautious
- aware of deficits - depression, anxiety
- impaired comprehension related to language + math
