Cerebrovascular Dz Flashcards
2 types of stroke
Primary ischemic
Primary hemorrhagic
Primary stroke
80% of strokes
Cerebral Embolism = 30%
Large artery thrombosis = 30%
Small artery thrombosis
Primary hemorrhagic stroke
20% of strokes Intracerebral hemorrhage (ICH) = 14% Subarachnoid hemorrhage (SAH) = 6%
Epidemiology of stroke
CVA affects 500K Americans each year 3rd leading cause of death in USA Men > Women Blacks > Whites Incidence of stroke doubles for each decade beyond 55
Risk Factors for stroke
Male Black >55 Atrial Fibrillation Hypertension ** Diabetes Smoking genetics
Risk Factors of CVA in Younger Population
Mitral Valve Prolapse Patent Foramen Ovale Migrainous infarction Hypercoaguable state Illicit drug use
Presentation of hemorrhagic stroke
Headache Alteration in consciousness Speech disturbance Visual field deficits-homonymous deficit Cognitive impairment
Presentation of the Patient with CVA (Brainstem / Cerebellar Stroke)
Dysarthria Dysphagia Ataxia Diplopia Vertigo Nausea Nystagmus
Strokes in a Middle Cerebral Artery territory have what symptoms?
In dominant hemisphere would include aphasia / dysphasia
Contralateral motor weakness (central facial + arm > leg)
Posterior Cerebral Artery territory what symptoms
Contralateral homonymous hemianopsia
Speech unaffected – no weakness likely
Vertebrobasilar artery territory have what symptoms?
Bilateral blindness
Lacunar (small vessel) stroke:
Paresis affecting face / arm / leg equally with no sensory loss
internal capsule stroke has what presentation
pure motor stroke
Berg Balance Scale
Good tool for determining pts who can safely ambulate vs require W/C Scale is 0 – 56 0 – 20 high fall risk 21-40 medium fall risk 41 – 56 low fall risk
Cerebral Arteriography is the gold standard for?
thrombosis, stenosis, arterial dissection, vascular anomalies such as aneurysms, AVM’s
Contraindications for TPA
Hemorrhagic stroke Large infarct >3 hrs since onset Any question of coagulopathy Recent major surgery Prior stroke Severe hypertension / severe metabolic disturbance
11 Guidelines for the General Management of the Acute Stroke Patient
- Stabilize vital signs
- Protect Airway and prevent aspiration
- Assess swallowing capacity
- Early mobilization
- Bowel program
- Prevent pressure sores
- Anti-embolus precautions
- Rehab/therapy as indicated by deficit
- Social service eval
- Assess for post stroke depression
- Long term mgmt of stroke risk factors.
Most common locations for hypertensive ICH are
Basal ganglia
Thalamus
Cerebellum
Pons
Intracerebral Hemorrhage management
Use of mannitol – potent osmotic diuretic that reduces cerebral edema
Evacuation of the hematoma may be indicated
Control BP aggressively
ICP can be lowered by intubating patient and placing on a vent
Subarachnoid Hemorrhage
Bleeding into the subarachnoid space
Very common etiology of SAH is head trauma
Common with aneurysm or AVM rupture
Confirmed by LP – bloody CSF
Symptoms of SAH
similar to meningitis due to meningeal irritation from blood – stiff neck (nuchal rigidity), photophobia, severe H/A, low grade fever
Complications associated with aneurysms?
rebleed
hydrocephalus
cerebral edema
vasospasms
What is embolic phenomena
similar to stroke except the embolus moves on before infarction can occur – so pts symptoms are of ischemia
Difference between TIA and stroke
TIA resolves with NO deficit – CVA pt has neurological deficit
CT of TIA pt is negative for cerebral infarction
CT of Stroke pt is + for cerebral infarction
By old parlance of TIA – pt w/deficit after 24 hours had stroke
Carotid TIA symptoms include? (5)
Amaurosis fugax Aphasia Hemiparesis Hemisensory deficit Homonymous hemianopsia
Posterior circulation (Basilar artery) TIA symptoms include?
Ataxia Bilateral visual loss Quadriparesis Perioral numbness Vertigo / syncope / dysarthria / diplopia / nausea / dysphagia Homonymous hemianopsia
Treatment for TIA?
Anticoagulation
Look for possible cardiac source of emboli
Anticoagulation with Warfarin (Coumadin) aiming for INR of 2 – 3.
Coumadin does increase bleeding risk especially in elderly who are more prone to falls.
How do you prevent stroke?
Recognize and counsel high risk pts
Reduce complications of cerebro- vascular disease w/early interventions
Reduce risk of diabetes
Smoking cessation, weight reduction, lower cholesterol, treat arrhythmias
