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Elsa AACN > Ch 26 Stroke > Flashcards

Ch 26 Stroke Flashcards

1
Q

Stroke or CVA

A

sudden onset of impairment in neurologic functioning due to severe decrease of blood supply to the brain

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2
Q

What a stroke caused by

A

Ischemia or hemorrhage

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3
Q

What does ischemia do

A

It provides an infarct in the brain related to occlusion- (thromboembolic)

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4
Q

Transient ischemic attack

A

Brief episodes of neurologic dysfunction resulting from focal cerebral ischemia
Lasts less than an hour but up to 24 hours
Warning sign of a future stroke

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5
Q

Chronic persistent symptoms of a stroke depend on what factors

A 
Location and size of stroke
age
hand preference
previous stroke
time post stroke
other med factors
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6
Q

Prenatal stroke

A

Occurs between 20 weeks gestation to first 28 days of life

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7
Q

Childhood strokes

A

strokes occurring 1 month - 18 years

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8
Q

Intraventricular hemorrhage is excluded from pediatric stroke

A

-

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9
Q

Subdural and epidural hemorrhages arising from trauma or excluded in pediatric strokes

A

-

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10
Q

Most common stroke types in adults

A

Thromboembolic ischemic stroke 88%

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11
Q

Thromboembolic ischemic stroke can originate from where

A

Site of occlusion (thrombus)

or at a distance from the occlusion (embolus)

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12
Q

Which part of the brain is typically most affected in thromboembolic ischemic stroke

A

The anterior circulation in 80%

  • anterior cerebral arteries (ACA)
  • middle cerebral arteries (MCA)

posterior circulation 20%
- Posterior cerebral artery (PCA)

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13
Q

Middle cerebral artery encompasses what percentage of the brain

A

50-60

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14
Q

What percentage of strokes are accounted for by hemorrhagic stroke

A

12%

  • 9% intracerebral hemorrhage
  • 3% SAH
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15
Q

Mortality rate of subarachnoid hemorrhage

A

50% in the first 6 mos after stroke

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16
Q

What is affected in the brain usually by intracerebral hemorrhage

A

They are localized deep in the area and affect small penetrating arteries

Slow leak
gradual symptom onset

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17
Q

Etiology for deep intracerebral hemorrhage

A

Hypertension

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18
Q

Two common reasons for stroke and younger adults

A

Aneurysm or AVM

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19
Q

Most common cause of subarachnoid hemorrhage

A

Aneurysm

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20
Q

Which kind of stroke is more common in children

A

Ischemic and hemorrhagic stroke or equally common in children

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21
Q

Two major forms of infarct in children

A

Arterial ischemic stroke (AIS)
- MORE COMMON!!!!

cerebral Sinovenous thrombosis (CSVT)
- more common in neonates than in older kids

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22
Q

The most common location of arterial ischemic stroke for children

A

MCA territory

subcortical infarction

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23
Q

Which type of stroke is less common in children

A

Ischemic stroke in posterior circulation < anterior circulation

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24
Q

How long does it take to produce neuronal damage in ischemia

A

6 to 8 minutes

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25
Q

How long would it take for microscopic changes to be seen after ischemia

A

Six hours

swelling happens after that

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26
Q

Does the zone of ischemic damage or infarct recover

A

No

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27
Q

Does the surrounding ischemic penumbra recover after a stroke

A

Yes, if blood flow is restored within six hours

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28
Q

What leads to better outcome for ischemic stroke

A

faster treatment

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29
Q

tPA in adults

A

Dissolves occlusive clot and increase blood flow to the surrounding ischemic penumbra

Needs to be used within 3 to 4 1/2 hours of symptom onset

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30
Q

TPA used in children

A

Controversial because of lack of strong evidence base

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31
Q

What can happen after a hemorrhagic stroke

A

Brain herniation and death can occur if intracranial pressure is not managed

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32
Q

Examples of secondary injury after ischemic stroke

A

vasospasm

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33
Q

Risk factors for stroke

A 
Age - risk doubles every decade after 55 years
Hypertension - 3 to 6 x
Atrial fibrillation - untreated 3-5x, treated 1.5x
Family history - 3 x
Prior transient ischemic attacks 
cocaine use 
smoking 
sleep apnea 
serum lipid abnormality 
obesity
diabetes
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34
Q

Risk factors for stroke in childhood

- Perinatal ischemic stroke

A 
Maternal infertility 
preeclampsia 
prolonged rupture of membranes
chorioamnionitis
congenital heart disease 
Bacterial meningitis
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35
Q

Most common cause of perinatal CSVT

A

infection

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36
Q

Risk factors for stroke in childhood

- childhood ischemic stroke

A

Cardiac disease
sickle cell
infection

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37
Q

Risk factors for stroke in childhood

- hemorrhagic stroke

A

Trauma - most common cause of intracranial hemorrhage in children

AVM or brain tumors - can cause non-traumatic hemorrhagic stroke

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38
Q

Mortality due to stroke increase or decrease

A

decrease

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39
Q

stroke prevalence increase or decrease

A

increase

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40
Q

Strokes more common with what factors

A

age

females

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41
Q

Gender difference in stroke incidence

A

Females have higher stroke incidents than males only later in life

42
Q

Racial difference in stroke incidence

A

Blacks higher than Whites

43
Q

Gender difference in incidence of stroke in childhood

A

Boys more than girls

44
Q

Mortality rate for a childhood stroke increase or decrease

A

increase

45
Q

Mortality rate for ischemic stroke in childhood

A

10%

46
Q

Mortality rate for hemorrhagic stroke and children

A

25-35%

47
Q

What factor is associated with poor outcomes after childhood stroke

A

Post stroke epilepsy

48
Q

recurrence rate for childhood stroke

A

10-25%

lower for perinatal strokes

49
Q

What are the determinants of severity in stroke

A 
Age of patient,
size and location of infarct or hemorrhage
acute treatment (tpa, surgery)
medical comorbidities
previous stroke
secondary medical events
50
Q

Presentation of hemorrhage

A

Headache, nausea, vomiting

loss of consciousness, coma

51
Q

Deficits associated with anterior circulation strokes

A 
Hemiparesis, 
hemi anesthesia, 
aphasia, 
visual spatial deficits, 
visual field cuts if visual pathway is affected
52
Q

Deficits associated with middle cerebral artery MCA

A

Hemiparesis in superior branch of MCA

visual field cuts in inferior branch of MCA and PCA

53
Q

Left MCA superior infarct deficits

A

Brocas aphasia
right face and arm weakness
working memory and executive functions

54
Q

Left MCA inferior infarct deficits

A 
Wernickes aphasia, 
right visual field deficit, 
right face and arm sensory loss, 
limb apraxia, 
parts of Gertsmann syndrome
55
Q

Left MCA deep infarct deficits

A

Right pure motor hemiparesis

large infarcts could produce aphasia

56
Q

Left MCA stem infarct deficits

A 
Same as left MCA deep territory with 
R hemiplegia, 
R hemianesthesia, 
R hemonymous hemianopia
global aphasia
Left gaze preference
57
Q

Right MCA superior branch infarct deficits

A

Left face and arm weakness
impaired working memory and executive function
some left hemi neglect

58
Q

Right MCA inferior branch infarct deficits

A 
PROFOUND L hemineglect 
L visual field and somatosensory deficits 
L motor neglect 
anosognosia
Vs
59
Q

Right MCA territory infarct deficits

A

Left pure motor hemiparesis

large infarcts produce L hemineglect and VS deficits

60
Q

Right MCA stem infarct deficits

A 
Same as right MCA territory infarct
L hemiplegia 
L hemianesthesia
L homonymous hemianopsia 
profound L hemineglect 
VS deficits 
anosognosia
right gaze preference
61
Q

Left ACA infarct deficits

A 
R leg weakness 
R leg sensory loss 
grasp reflex 
executive function deficits 
transcortical motor aphasia
62
Q

Right ACA infarct deficits

A 
L leg weakness 
L leg sensory loss 
grasp reflex 
executive function deficits 
may have left hemiplegia
63
Q

Left PCA infarct deficits

A

Right homonymous hemianopsia

64
Q

Rights PCA infarct deficit

A

Left homonymous hemianopsia

65
Q

Most common presentation of AIS in childhood

A

Seizures #1

Hemiparesis
altered mental status
Focal neurological signs

66
Q

Posterior strokes presentation

A

Ataxia
vomiting
vertigo

67
Q

Hemorrhagic stroke presentation in infants and young children

A

Non-specific features,
altered mental status,
convulsions,
less common focal neurological signs

68
Q

Outcome after subarachnoid hemorrhage

A

85% of adults need supervision

33% continue to have cognitive impairment and impaired ADL after six months

69
Q

CT is most sensitive to what kind of stroke

A

Acute intracerebral hemorrhage

CT is not as sensitive to ischemic damage especially in the first 24 hours

70
Q

Normal CT is a good indicator of whether the stroke produced damage. True or false

A

F

71
Q

while MRI can be normal for a few hours after stroke, what can detect infarct within minutes of symptom onset

A

DW MRI!

72
Q

What kind of imaging is more sensitive for ischemic stroke

A

MRI is more sensitive than CT

73
Q

What type of imaging is sensitive to lacuna infarcts

A

MRI

74
Q

Other test to identify etiology of ischemic or hemorrhagic stroke?

A

cerebral angiography
MRA
CT anteriography
- both can identify aneurysm and AVM in the case of hemorrhage or vessel narrowing in the neck or head for ischemic stroke

75
Q

How is Doppler ultrasound useful for stroke assessment

A

-identify carotid artery narrowing in the neck

76
Q

How is electrocardiograms useful for stroke assessment

A

evidence of cardiac ischemia

arrhythmias

77
Q

first thing to assess after stroke in an evaluation

A

Language

78
Q

rate of depression in adults after stroke

A

20-30%

79
Q

A common mechanism of occlusion due to embolism or thrombosis?

A

artherosclerosis 动脉硬化

80
Q

artherosclerosis动脉硬化

A

a disease of the arteries characterized by the deposition of plaques of fatty material on their inner walls.

81
Q

Treatment of AVM

A 
surgical
endovascular embolization (threading a catheter to the malformation's feeder artery to block blood flow with glue)
82
Q

treatment of hemorrhage

A

discontinue anticoagulants
anti hypertensive meds
intraventricular catheter
endovascular coil insertion

83
Q

treatment of strokes in children

A

similar to adults

antithrombotic drugs in ischemic stroke

not enough research on tPA

84
Q

primary goal of LT management of childhood stroke

A

prevent recurrence

85
Q

how to prevent secondary stroke

A

antithrombotic drugs
aspirin
chronic blood transfusion

86
Q

treatment of cerebral arteriopathy

A

anti inflammatory and immunosuppresive meds

bone marrow transplant

87
Q

when does the greatest degree recovery occur

A

soon after stroke
1-3 mons post > 4- 6 mos post
most recovery would happen by 1 year

88
Q

independent risk factor for morbidity and mortality of stroke?

A

depression

89
Q

Common complication of childhood stroke

A

Motor weakness, spasticity, dystonia

90
Q

Do children with acute aphasia improve over time

A

yes

91
Q

Patient fully recover after a stroke?

A

No. 70% of stroke survivors report persistent diffuse or non-use of their upper limb up to four years after stroke

92
Q

Which type of aphasia is associated with higher incidence of frustration and depression after stroke?

A

higher incidence of depression and frustration in Broca’s aphasia (possibly because but higher incidence of depression of the left frontal damage)

93
Q

which age group has the poorest outcome after stroke?

A

after perinatal stroke

94
Q

younger children are less likely to demonstrate…

A

classic aphasia symptoms or aphasia syndromes

95
Q

focal lesions are NOT necessarily more benign for younger children

A

but it may result in less localizing and more diffuse pattern of impairment

96
Q

endarterectomy

A

most well established intervention for carotid stenosis

97
Q

lesion in area that is associated with worst cog outcome in childhood AIS (arterial ischemic stroke)

A

Left temporal and basal ganglia

98
Q

CT is the least sensitive to

A

Acute ischemia

99
Q

most common cause of childhood ischemic stroke?

A

cerebral arteriopathy #1

congenital heart disease also a common cause

100
Q

cause of cerebral sinovenous thrombosis?

A

bacterial meningitis

Elsa AACN (35 decks)

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