Ch 1 - Stroke: Introduction Flashcards
What is a cerebrovascular event?
Signs of focal or global disturbances of cerebral function lasting >24 hrs or leading to death secondary to vascular causes
What is a transient ischemic attack?
Symptoms of a CVA <24 hrs
What are nonmodifiable risk factors for stroke?
Age (risk doubles each decade >55)
Sex (male>female)
Race (AA 2x>Caucasian> Asians)
Family history of stroke
What is the most important modifiable risk factor for ischemic and hemorrhagic stroke?
HTN
What are modifiable cardiac causes of stroke?
HTN CHF/CAD 2x AFib 5x Carotid stenosis Patent foramen ovale (PFO)
What level of stenosis does carotid endarterectomy most beneficial?
70-99% carotid stenosis
What are modifiable non-cardiac causes of stroke?
DM 2x Cigarette smoking 2x ETOH/cocaine abuse High dose estrogens Systemic hypercoagable diseases Migraines Sleep apnea Obesity/sedentary lifestyle
What does the middle cerebral artery supply?
Most lateral aspect of the hemisphere
What does the anterior cerebral artery supply?
Medial aspect of the hemisphere from lamina terminalis to cuneus
What does the posterior cerebral artery supply?
Inferior surface of temporal lobe and visual cortex
Where is CSF produced?
Ependymal cells in choroid plexus in lateral, 3rd and 4th ventricles
Where does CSF circulate?
Lateral ventricles to the foramina of Monro,
3rd ventricle, aqueduct of Sylvius, 4th ventricle, foramen of Magendie and foramina of Luschka, and subarachnoid space over brain and spinal cord.
What are types of ischemic strokes?
Thrombotic
Embolic
Lacunar
When do thrombotic strokes occur?
During sleep
What is the cause of thrombotic strokes?
Perfusion failure distal to site of severe stenosis or occlusion of major vessels
What is the presentation of thrombotic strokes?
Slow (gradual),
progressive deficit
What precentage of thrombotic strokes precede with TIA?
50% in same vascular territory
When do embolic strokes occur?
While awake
What is the cause of embolic strokes?
Cardiac source
What is the presentation of embolic strokes?
Sudden, immediate
deficit (seizures may occur)
Where do lacunar strokes occur?
– putamen – pons – thalamus – caudate – internal capsule/ corona radiata
What is the presentation of lacunar strokes?
Abrupt or gradual onset
When do intracerbral hemorrhages (ICH) occur?
90% of cases occur when patient is calm and unstressed.
What is the cause of intracerbral hemorrhages (ICH)?
HTN
What is the presentation of intracerbral hemorrhages (ICH)?
Gradual onset (minutes to days) or sudden onset of local neurologic deficits
When do subarachnoid hemorrhages (SAH) occur?
During strenuous activity
What is the cause of subarachnoid hemorrhages (SAH)?
Ruptured aneurysms
and vascular malformations
What is the presentation of subarachnoid hemorrhages (SAH)?
Sudden onset
