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Stroke > Etiology and Prognosis > Flashcards

Etiology and Prognosis Flashcards

1
Q

What percentage of strokes are ischemic and what are hemorrhages

A

80% ischemic
20% hemorrhage (ICH and SAH)

percentage of hemorrhage is higher in global data

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2
Q

What are the three main mechanisms of cerebral ischemia?

A
  1. Thrombosis
  2. Embolism
  3. Systemic Hypoperfusion
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3
Q

What is a Transient Ischemic Attack?

A
  1. Symptoms of ischemia lasting < 24 hours (classical definition)
  2. More evolving concept: Tissue based definition (ischemic tissue needs to be observed)
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4
Q

What are thrombotic (ischemic) strokes?

A

Thrombotic strokes are caused by a thrombus in an artery that either causes critical stenosis (artery closes to blood flow) or results in thrombo-embolic phenomenon.

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5
Q

Stenosis

A

Constriction of a vessel. Could be critical, if it starts blocking blood flow

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6
Q

What are the different types of thrombotic strokes (based on location of the artery where the thrombus is)

A
  1. Large Artery (extra-cranial or intra-cranial i.e., circle of Willis and it’s major branches)
  2. Small Vessel
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7
Q

Atherosclerosis

A

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

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8
Q

What is peculiar about aorta as a source of embolism?

A

Since the aorta is close to the heart, therefore, even though it is a large artery, the embolism from the aorta may be functionally classified as a cardio-embolic phenomenon.

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9
Q

What are the two main circulatory pathways for blood supply to the brain?

A

Anterior (80%) and Posterior circulation (20%)

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10
Q

What are different types of embolic stroke? (depending on where the source of embolism is)

A
  1. Cardiac
  2. Possible cardiac or aortic
  3. Arterial
  4. Unknown
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11
Q

What is TOAST classification for ischemic strokes?

A

TOAST is an etiological classification of ischemic stroke. According to TOAST ischemic stroke can be caused by the following:

  1. Large Artery Athro
  2. Cardio embolism
  3. Small Vessel Occlusion
  4. Stroke of other determined etiology
  5. Stroke of undetermined etiology
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12
Q

What is SSS-TOAST?

A

Updated TOAST which takes into consideration the weight of the evidence. Therefore stroke etiology could either be evident, probable, or possible.

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13
Q

How many people in the US get a stroke every year? How many of them are new (incident) strokes and how many are recurrent strokes?

A

795,000 total
610,000 first ever
185,000 recurrent

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14
Q

Typically what are the presenting signs of a Middle Cerebral Artery (MCA) Stroke?

A
  1. Gaze deviation
  2. Hemiplegia (half of body is paralyzed)
  3. Aphasia
  4. Neglect
  5. Visual field defect
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15
Q

On the NIHSS scale what value is regarded as severe stroke?

A
  1. 15 for right hemisphere stroke

2. 20 for left hemisphere stroke

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16
Q

What are the major predictors of stroke prognosis?

A
  1. Stroke severity (NIHSS scale)
  2. Patients age
  3. Infarct volume
  4. Infarct location
  5. Diffusion - Perfusion mismatch
  6. Etiology (lacunar and cryptogenic may have better initial outcomes but may continue to cause longer-term deficits. Cardioembolic and large artery have poor initial prognosis)
  7. Comorbidities (heart, blood, brain, kidney, diabetes)
  8. Epidemiology (sex, race, SDOH)
17
Q

Why should you be cautious about decreasing blood pressure in stroke patients

A

brains of hypertensive patients are often used to higher pressure environments, dropping the blood pressure too low will cause loss of oxygen in other areas (systemic hypoperfusion)
ALSO need blood pressure to feed at-risk areas (penumbra)

18
Q

What are the major post-stroke complications?

A
  1. Pneumonia (Aspiration)
  2. Intubation / mechanical ventilation
  3. Gastrointestinal bleeding
  4. Cardiac arrest
  5. Deep vein thrombosis (veins in the leg)
  6. Pulmonary embolism
  7. UTI
19
Q

What is the post-ischemic stroke 30-day case fatality globally?

A

16% - 23%

20
Q

What is the post hemorrhagic stroke 30-day case fatality globally?

A

30% - 45% (confirm)

Stroke (7 decks)

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