CVA Part 1 Flashcards
what is cerebrovascular disease
non traumatic sudden loss of neurological function d/t interruption of blood flow to brain
can have motor, sensory, cognition, perception, language and consciousness problems
what is the golden period for early acute management
4-8 mins
what is the golden period for stroke rehab
3-6 mo.
stroke is _____ leading cause of death
4th
stroke is most common cause of _____ in adults/elderly
disability
weight of adult brain
1500 grams or 1 kg or 2% of BW
normal cerebral BF
50 or 60 mL / 100g grams of brain tisuee
the brain can produce _____ every 24 hrs
150g glucose and 72L oxygen
upon interruption of cerebral blood flow irreversible damage occurs after ____
4-8 mins
what is ischemic penumbra
lethargic cells that are reversible
they surround the irreversible damage
what is the significance of ischemic penumbra
after 8 mins the penumbra dies = irreversible damage grows
need to treat in 4-8 mins to reverse the damage
normal range BF
100% or 50 gm-min
metabolic changes BF
80% or 40 gm-min
mild ischemia BF
60% or 30 gm-min
moderate ischemia or penumbra BF
40% or 20 gm-min
severe ischemia BF
20% or 10 gm-min
stroke risk factors: non-modifiable
> 65 yo
M>F but equal at menopause
AA>ASIAN>WHITES
genetics
hx of previous stroke or TIA
why is TIA a risk factor for stroke
after 5 yrs of TIA - at risk of major stroke
discuss TIA
temporary interruption of BF to brain
deficits last for few mins to hours but no more than 24 hrs c no residual sx
no blockage on MRI
discuss RIND
focal neurologic deficits fully recover w/in a week
more than 24 hrs but less than 1 wk
after 1 wk no more deficits and findings on MRI
discuss stroke in evolution
stepwise incremental inc in neurologic deficits
SD
SD + W
SD + W + D
SD + W + D + CoordProb
discuss completed stroke
no further deterioration in neurologic status - stabilized na
no progression unless mag ka attack ule
temporal classification of stroke
TIA
RIND
completed stroke
etiologic classification of stroke
ischemic
hemorrhagic
discuss ischemic stroke
90% most common type
from dec pressure or BF
endothelial injury theory
lipid infiltration theory
unified hypothesis
what are the kinds of ischemic stroke
thrombotic
embolic
lacunar
discuss thrombotic ischemic stroke
40% most common ischemic stroke
blood clot blocks BF - atherosclerosis
affects larger arteries
insidious onset - during sleep
- HA - weakness - sleep - ngiwi
discuss embolic ischemic stroke
30% most common ischemic stroke
dislodged clot - usually cardiac origins (CABG pts)
from aorta
sudden onset - occurs in morning p physical activity
hallmark of embolic ischemic stroke
seizures, aphasia and unilateral neglect
discuss lacunar ischemic stroke
10% most common ischemic stroke
from uncontrolled HTN or DM
affects lenticulostriate arteries
insidious or sudden
pure motor or pure sensory
discuss hemorrhagic stroke
10% - rarest type of stroke
over dilated vessels - rupture of aneurysm = loss of consciousness
catastrophic - 50-70% mortality
but if recovered - best prognosis
discuss hemorrhagic intracerebral stroke
10-15% most common type of hemorrhagic stroke
does not follow anatomic pattern - dissects through tissue planes = VERY MASSIVE
assoc c charcot-bouchard
- d/t long standing HTN
younger pts and dramatic onset
discuss hemorrhagic subarachnoid stroke
5-10% most common type of hemorrhagic stroke
at dural space around brain
can be:
- saccular: degen of tunica adventitia = lose outside support
- AVM: tangled arteries and veins = fusion of blood = burst d/t diff pressures
worst HA of my life
F > M
management classification of stroke
TIA
major stroke - stable and severe deficits
deteriorating stroke - neuro status deteriorates p hospi
young stroke - younger than 45 yo
