Aspects of Stroke Flashcards
Stroke
Brian Attack CVA Mini-stroke Pin-Stroke TIA (transit ischemic attack) (transit=passing)
Stroke Awareness
- 19% are unaware that stroke is preventable
- 38% do not know where in the body a stroke occurs
- 42% cannot identify the most common s/s of stroke (weakness/numbness)
-92% do not realize what a TIA represents
(smaller stroke is sign of something more to come)
Stroke Defined
Describes the clinical consequences of a focal or diffuse disruption of brain circulation secondary to an ischemic or hemorrhagic event
*Interruption of blood flow in the brain
50% of the general population is at risk
>50% of healthcare workers are at risk
Stroke Statistics
- 3rd leading cause of death in the USA(Heart Disease is #1; Cancer is #2)
- 750K new cases each year; 500K are preventable (Roughly 1 every 45s)
- Every 3m a person dies from stroke
- Leading cause of disability; 90% of survivors have deficits
Stroke Epidemiology
Age: risk for stroke doubles each decade after age 55y
Race: African Americans: 233/100K
Hispanics: 196/100K
Whites: 93/100K
Heredity: Paternal Stroke: 2x as likely for stroke
Maternal Stroke: 1.4x as likely for stroke
Time is brain…
- 2 million brain cells die every minute during a stroke
- 80% of strokes are preventable
Based on ~730K strokes annually:
- Decrease heavy alcohol use: 34K
- Decrease smoking: 90K
- Decrease cholesterol: 145K
- Decrease Hypertension: 360K; 130/85 is HTN
Atrial Fibrillation
Risk factor for stroke
AF is a type of irregular heartbeat resulting in ineffective pumping of one of the chambers of the heart
(a quivering in one of the chambers; can cause clot and therefore a stroke)
Impacts 2 million Americans:
- 9% of persons age 65y+ have AF
- s/s: rapid heartbeat, irregular heartbeat
- tx: blood thinners; proper tx prevents stroke
Risk Factors for Stroke
Diabetes Physical Inactivity Obesity (Metabolic Syndrome) Oral Contraceptives Alcohol Abuses Illicit Drug Use Hypercoagulable States Dietary Factors Infection/Inflammation Hyperhomocysteinemia Vascular Inflammation
Modifiable Risk Factors
DM HTN (120/80 is a sign of possible high blood pressure) Smoking Alcohol Consumption Obesity/Overweight AF High Cholesterol
Non-Modifiable Risk Factors
Age Race Gender Previous TIA/CVA Family Hx
Common Stroke Symptoms
- Sudden numbness or weakness
- Sudden confusion trouble
- Sudden trouble seeing in one
- Sudden trouble walking dizziness loss
- Sudden severe headache
Rapid Detection of Stroke
Follow the acronym FAST:
[F] FACE: Ask the Patient to smile; Any drooping?
[A] ARM: Ask the Person to raise both arms; Any drifting?
[S] SPEECH: Ask the Person to repeat simple sentences; Any dysarthria?
[T] TIME: Observe any signs; Call 911!
Stroke Classifications
- Ischemic
- Hemorrhagic
- SAH
- ICH
- IVH
Ischemic Strokes
Occur when arteries are blocked by blood clots or by the build up of plaque and other fatty deposits
As such, blood flow is insufficient to a given area
*80%+ of strokes are ischemic in nature
Thrombotic
Embolic
Thrombotic (Ischemic Stroke)
blood clot forms within a blood vessel in the brain; vessel supplying blood to the brain
Embolic (Ischemic Stroke)
blood clot forms with in the heart or elsewhere, dislodges, and becomes lodged in the brain
Pulmonary Embolism
PE from a DVT
Lungs= pulmonary
PE is blood clot blocking the arteries of the lungs
s/s: SOA (shortness of air/breath); pain (can look like a heart attack)
Lacunar Infarct (Ischemia)
Obstruction of blood flow in the small, deep brain arteries; occur frequently in the BG, IC, TH, BS
-more focal
Ischemic Penumbra
The penumbra is an area of dysfunctional ischemic tissue; suggests a possible lacunar state
-the area that surrounds the blood clot (hyporefused) blood is not getting to this area; the area that is dying
Hemorrhagic Stroke
Occurs when a blood vessel in the brain breaks leaking blood into the brain; accounts for ~15-17% of all stroke but are responsible for more than 30% of deaths
- Intracerebral Hemorrhage
- Subarachnoid Hemorrhage
- Intraventricular Hemorrhage
Intracerebral Hemorrhage
(inside the cortex)
Bleeding inside the brain
Results from chronic HTN
Often coincides w/severe headaches
Subarachnoid Hemorrhage
Bleeding that occurs within the meninges
Possible rupture of an aneurysm
Sudden headaches with LOC
Women>Men
Intraventricular Hemorrhage
Extension of both intracerebral hemorrhages and/or subarachnoid hemorrhages into the ventricular spaces
Aneurysm
Localized, blood-filled dilation of a blood vessel caused by disease or weakening of a vessel wall
Commonly occur in arteries at the Circle of Willis or the aorta; bifurcation of vessel
Most common complaint is “pain behind the eyes”
- can happen anywhere in the brain; it bursts and causes a hemorrhagic stroke
- the blood is circling where it is pooled at and causes more pressure; high blood pressure causes more pressure
Clipping an Aneurysm
-a way to fix an aneurysm
clip off the aneurysm and let it stay and blood will clot
-it is in violation of MKH but the brain will just work around it; leave clip in
Coiling an Aneurysm
-another way to fix an aneurysm
put a mesh material up into the blood vessel till it fills the aneurysm and then makes a blood clot that “remakes” the wall
Arteriovenous Malformation
(AVMs or AV Malformations)
The majority of cases involve a congenital disorder comprised of snarled tangles of arteries and veins
Impacts ~300K Americans occurring in males/females of all racial or ethnic backgrounds at equal rates
AVMs damage the brain and/or spinal cord through three basic mechanisms:
Reducing the amount of oxygen reaching neurological tissue
Causing bleeding (hemorrhaging) into surrounding brain tissues
Compressing/Displacing parts of the brain or spinal cord
Brainstem Stroke
Brainstem strokes are especially devastating
The brainstem controls all of our involuntary, life-support functions:
- Breathing rate, BP, and heartbeat
- Eye movements, Speech, Audition, and Deglutition
- Patients may incur paralysis on unilateral or bilateral paralysis of the UE/LE due to cortical pathways
(hemorrhagic stroke is more devastating in brainstem than ischemic )
Locked-In Syndrome
Neurological disorder characterized by paralysis of voluntary muscles in all parts of the body except for those that control eye movements
May result from TBI, diseases of the circulatory system, demyelinating diseases, or medication overdose
Persons are conscious with intact cognition but are unable to speak or move
Disorder leaves the patient completely mute/paralyzed
Cerebellar Stroke
The cerebellum aids in control of our reflexes and assists in maintaining balance and coordination
A stroke that occurs at the cerebellar level may:
- Abnormal reflexes of the head and torso
- Coordination and balance problems
- Vertigo
- Nausea/Vomiting
Strokes Can Happen in:
- Cortical
- Subcortical
- Brainstem
- Cerebellar
- Spinal
Medical Management of Hemorrhagic Strokes
Prevention is paramount through reducing modifiable risk factors
Identify s/s of CVA early: “Time is Brain”
GLUCOSE: Hypoglycemia mimics stroke
Control BP
Frequent neuro checks via NSG, MDs, Therapists
Medical Management of Ischemic Strokes
Prevention is paramount through reducing modifiable risk factors
Identify s/s of CVA early: “Time is Brain”
GLUCOSE: Hypoglycemia mimics stroke
Identify etiology and reverse if able.
Frequent neuro checks via NSG, MDs, Therapists
Thrombolytic therapies (tPA)
tPA (Tissue Plasminogen Activator)
(clot bluster)
Tissue plasminogen activator
Extreme criteria must be met before administration
- Must be given (if IV) 180m post onset s/s of stroke
- For some patients, tPA can be given at 4.5h
- May be given within 6h if administered via intra-arterial catheter
- tPA IS CONTRAINDICATED FOR HEMORRHAGIC STROKES
tPA Contraindication
Evidence of intracranial hemorrhage Suspicion of subarachnoid hemorrhage Recent ABI/TBI Hx of CVA Hx of intracranial hemorrhage Uncontrolled HTN Seizure at onset of CVA Active internal bleeding AVM Aneurysm
Other Ischemic Therapies
Catheter directed tPA
Endovascular retrieval
MERCI system
MERCI system
-treatment for blood clots
put tube in blood vessel and find clot put screw in it then suck up the clot into the tube
-have to be careful because a piece can break off can causes a stroke
Prognostic Indicators
- YOUNG or Old with outgoing personalities
- Treatment programs that were started EARLY or Late
- Receptive or EXPRESSIVE aphasia
- Patient’s that Do or DO NOT have perceptual or sensory impairments
- ABIITY or Inability to self-correct
- SINGLE or Multiple lesions
- Patients whose treatment program was initiated BEFORE or After six month window (post stroke)
- HIGHER or Lower intelligence
- MILD-MODERATE or Severe Impairments
- ABILITY or Inability to point to pictures when named
- GOOD or Poor comprehension
- Rigid or GO-WITH-THE-FLOW personality
- Patient is INDEPENDENT or Dependent Upon the SLP
Brodmann’s Areas Frontal Lobe
Area 4
Area 6
Area 44 and 45
Brodmann’s Area Parietal Lobe
Area 3,1,2
Area 39
Area 40
Brodmann’s Area Temporal Lobe
Area 41
Area 21 and 22
Brodmann’s Area Occipital Lobe
Area 17
Area 18 and 19
Functional Pathways
Primary Visual Perception Wernicke's Area Auditory Perception Somatosensory Perception Primary Motor Function Broca's Area
Pathways 1
The connection between Wernicke’s and Broca’s Areas mediates expression of language utterances in speech
The connection between Broca’s Area and the Primary Motor Strip mediates speech sound production
The connection between the Primary Auditory Cortex and Wernicke’s Area mediates language comprehension
Pathways 2
The connection between Wernicke’s Area and the Visual Areas mediates reading ability
The connection between the Somatosensory Perception Area and Wernicke’s Area would mediate language reception via tracing letters on the skin or reading braille
