Clinical Stroke Flashcards
uncontrollable risk factors of stroke
- age (>55)
- diabetes
- african american descent
- male
- sickle cell disease
- family hx of stroke
medical risk factors of stroke
- previous stroke/TIA
- high BP
- heart disease
symptoms of stroke
SUDDEN
- blurred/decreased vision in one or both eyes
- weakness/numbness/paralysis of face/body on one or both sides of the body
- difficulty speaking or understanding
- dizziness or loss of balance
- unexplained change in pattern of headache
signs/symptoms of intracerebral hemorrhage
- may have sudden onset with smooth progression of deficit
- focal deficits
- headache (bc incr. ICP)
- nausea/vomiting
- decreased consciousness
causes of intracerebral hemorrhage
- HYPERTENSION
- congophilic angiopathy
- hemorrhagic masses (tumor)
- hemorrhagic transformation of infarct
treatment of intracerebral hemorrhage
- BP management
- supportive
aneurysms (size, peak onset, location)
- 2mm to 3 cm
- 90% on circle of willis
- 35 to 65 years old
symptoms of cerebral aneurysms
- asymptomatic
- mass effect
- rupture
symptoms of subarachnoid hemorrhage
- SUDDEN ONSET headache
- stiff neck
- photophobia
- nausea/vomiting
- transient loss of consciousness
diagnosis of subarachnoid hemorrhage
- history (50% have sentinal bleed)
- CT scan
- lumbar puncture: RBCs, xanthochromia
- angiography
Hunt and Hess classification of subarachnoid hemorrhage
Grade 1: asymptomatic, mild headache, slight nuchal rigidity
Grade 2: moderate/severe headache, nuchal rigidity, no neurological deficit other than cranial nerve palsy
Grade 3: drowsiness, confusion, mild focal neurologic deficit
Grade 4: stupor, moderate/severe hemiparesis
Grade 5: coma decerebrate posturing
major concerns of subarachnoid hemorrhage
- rebleeding
- vasospasm
- seizure
- increased ICP
atriovenous malformation (AVM) - general definition
- tangle of abnormal vessels
- form from aberrant communication between arterial and venous systems
- abnormally thin walled vessels
AVM symptoms
- subarachnoid hemorrhage
- intraparenchymal hemorrhage
- seizures
- headaches
- focal deficit
- cranial bruits
AVM treatment
obliteration of malformation by:
- surgical excision
- endovascular thrombosis
- radiation
common mechanisms of cerebral ischemia
- lipohyalinosis
- embolism
- decreased perfusion through a fixed stenosis
lacunar stroke
- small infarct
- deficit could be large
- associated with hypertension, diabetes, cholesterol
other causes of cerebral ischemia
- vasculitis
- collagen vascular disease
- meningitis
- arterial dissection
- hematologic disorders
- hypercoagulable states
- vasospasm
- reversible cerebral vasoconstriction
mimics of cerebral ischemia
- migraine
- seizure
- subdural hematoma
- tumor
- syncope
- cardiac arrhythmia
- panic attack
- hypoglycemia
- demyelinating disease
- amyloid angiopathy
- brain abscess
- encephalitis
treatment of carotid artery stenosis
- medical management
- surgical intervention
Medical management:
- risk factor control
- antiplatelet agent
- HMG-CoA reductase inhibitor
high risk cardiac conditions associated with cerebral embolism
- atrial myxoma
- infective endocarditis
- dilated cardiomyopathy
- atrial fibrillation
- anterior MI with thrombus
- ventricular aneurysm
- prosthetic cardiac valves
- nonbacterial thrombotic endocarditis
investigations for hypercoagulative states
-protein S
-protein C
-antithrombin III
-Factor V Leiden
-antiphospholipid antibodies
prothrombin gene mutation
-antiphosphatidylserine antibodies
ischemic penumbra
- infarctic core in ischemic zone expands
- penumbra = difference between ischemic zone and infarctic core
- main target for treatment
strategies for acute stroke treatment
- revascularization: “plumbing approach”: thrombolytics
- preventing damage from ischemic cascade: “neuroprotection”
stroke patients treated with thrombolytics within ______ (timeframe) of symptom onset had a 30% better chance of recovery without symptoms
stroke patients treated with thrombolytics within 3 HOURS of symptom onset had a 30% better chance of recovery without symptoms
risk of IV-tPA
- could cause an ischemic stroke to become a hemorrhagic stroke
- still so much benefit
