Atherosclerotic Cerebrovascular Disease with CVA and TIA - Pales Flashcards
3rd leading cause of death in US
stroke
CVA
stroke
abrupt onset of neuro eficit - attributable to focal vascular cause
types of strokes
hemorrhagic
ischemic (majority)
ischemic penumbra
brain tissue around necrosis that is reversible - with appropriate tx
large artery thrombosis
rupture of plaque with fibrous plaque
blood clot forms - occluding artery
emboli
from atherosclerotic plaque or thrombus
paradoxical emboli
from lower leg DVT
atrial cardiac emboli
A-fib
atrial septal aneurism
tumor - myxoma
A-fib
fast/ineffective atrial contraction
-stasis and thrombus formation
atrial septal aneurysm
weak and outpouch of septum - stasis and thrombus formation
atrial myxoma
piece of tumor tear off and embolize
ventricular emboli
cardiomyopathy
MI
ventricular aneurysm
cadiomyopathy
weak dilated ventricle - stasis and thrombi formation
libman sacks endocarditis
with SLE
marantic
non-bacterial thrombi from cardiac source
malignancy or hypercoag state
tighter the stenosis
higher risk of stroke
hole in heart
with paradoxical emboli
lacunar infarct
subcortical areas of brain
-asymptomatic/minor sx
large artery branch to small artery right away - get lipohyalinosis from high pressure
hyperplasia and hyalinosis of vessel walls - narrow and occluded
watershed infarct
with profound hypotension
sepsis, bleeding, dehydration
hemostasis
3 parts working other
coag system
anticoag system
thrombolytic system
hypercoagulable state
factor V - leiden mutation protein C and protein S antithrombin deficiency plasminogen deficiency prothrombin mutation
antiphospholipid Ab syndrome
arterial clotting
anticardiolipid Abs
lupus anticoagulantas
hyperhomocysteinemia
hyperhomocysteinemia
hypercoag
other hypercoag states
pregnancy cancer HRT prolonged bed rest/immobile myeloproliferative
vasculitis
inflammed vessels
-cause of stroke
vasospasm
cocaine use
stroke
moyamoya disease
large intracranial artery occlusion
stroke presentation
depend on size of vessel
area of brain supplied by vessel
weakness of one side of body
hemiparesis
paralysis of one side of body
hemiplegia
loss vision same visual field both eyes
homonymous hemianopia
difficulty perform math
acalculia
difficulty recognize object, people, sounds, shapes, etc.
agnosia
inability to speak
aphasia
inability to read
alexia
inability to write
agraphia
difficulty swalowing
dysphagia
slurred speach
dysarthria
inability to attend to one side of body
hemispatial neglect
inability to perform specific task
apraxia
unawareness or denial of existance of disability
anosognosia
difficutly recall words or names
anomia
unsteady gait
ataxia
middle cerebral artery syndrome
C/L hemiplegia - face and upper extremities
C/L homonymous hemianopia
dominant - aphasia, alexia, agraphia, acalculia
non-dominant - hemineglect, dressing apraxia, anosognosia
posterior cerebral artery syndrome
homonymous hemianopia, alexia without agraphia - can’t read - can write**
visual or color anomia
lateral pontine syndrome
marie foix syndrome
anterior inferior cerebellar a
ataxia - arm and leg
weak upper and lower extremity
hemisensory loss - pain and temp
lateral medullary syndrome
wallenberg syndrome
posterior inferior cerebellar a
facial sense loss/pain ataxia nystagmus vertigo hoarse dysphagia horner syndrome** hemisensory loss hiccups
locked in syndrome
quadriplegia, B/L facial paralysis, dysarthria
ventral pontine syndrome
raymond syndrome
- lateral gaze weakness
- C/L hemiplegia
millard-gubler syndrome
ventral pontine syndrome
- C/L upper/lower extremity weak
- C/L hemiplegia
ataxic hemiparesis
C/L upper/lower extremity weakness and ataxia
anton syndrome
cortical blindness
blindnes and denial
amaurosis fugax
temporary one eye blindness
warning sign of stroke
embolic - carotid artery
also - hemodynamic, ocular, neuro, idiopathic
TIA
stroke lasts less than 24 hours
10% risk of CVA within first 3 months
diagnosis of stroke
neuro and mental status exam
CT without contrast
MRI - very sensitivte
CT and stroke
to rule out bleeding - so can give clot buster or not
lower face only affected
with central bells palsy - CN VII
tx of stroke
acute tx
primary stroke prevention
secondary stroke prevention
acute tx of stroke
rtPA and aspirin
IV fluid - keep BP sufficient for saving penumbra
swallowing eval
early rehab
non-modifiable stroke risk fx
age fam hx race - AA and hispanics gender - men med hx
modifiable stroke risk fx
HTN A-fib smoking DM carotid stenosis hyperlipidemia obesity alcohol/drug use
stroke prevention
diet
exercise
control BP, blood sugar, cholesterol
quit smoking
stroke prevent meds
aspirin
clopidogril
ASA, dipyridamole
warfarin, heparin, LMWH
