Ischemic Stroke Flashcards
Stroke
- acute onset of neuro dysfunction
- 24 hours or more
- ischemia/hemorrhage
Transient episodeof neuro dysfunction
- focal brain, spinal cord, retinal ischemia
- no acute infarction
- no Imaging evidence of damage
TIA
CVA? Ministroke?
NO
Majority of strokes?
Ischemic strokes
2) primary hemorrhages
3) subarachnoid hemorrhages
Ischemic stroke
“Blockage stroke”
Also hypoperfusion/hypotension
Arteries to brain
Common carotid R/L
Left vertebral artery R/L
Internal external carotid R/L
Main Circle of willis arteries to brain
ACA
MCA
PCA
Most reliable stroke symptom
ACUTE ONSET
Medical risk factors
HTN Afib Hyperlipidemia DM Carotid Stenosis
Behavioral riskfactors
Cig smoking
Sedentary lifestyle
Illicit drugs
ETOH heavy
Other risk factors
Pre-eclampsia/eclampsia
Migraines w/ aura
Cardiac (list)
Genetic (list)
Stroke subtypes
- Large artery atherosclerosis
- cardioembolism
- lacunar infarctions
Large artery atherosclerosis
Extracranial
Carotid a
Vertebral a
Lacunar infarction (small vessel)
Large arteries becoming blocked or hardened
- brain stem pons
- deep structures (putamen)
- thalamus
DM/HTN
Acute Stroke Management
- activate brain attack
- Start ABCs
- Assess patient + perform a basic neuro exam
- NIHSS exam
- Basic Hx
- establish last known normal time
Acute Imaging
Negative CT rule out ischemic stroke?
NO
Good for hemorrhagic stroke
Diffusion weighted imaging MRI
MOST sensitive!
But CT scan best – time
If CT neg, still treat
Apparent diffusion coefficient
Dark = stroke
Diffusion Weighted Imaging
White = stroke
rT-Pa
- give w/in 3-4.5 hours of onset = up recovery at 90 days
- no improvement after 24hours
- *some have hemorrhages
Tissue loss /time
1.9 million neurons/minute
NOT TOTALLY TRUE
Giving blood thinner Tpa
NOT to
High risk bleeder
- prev surgery
- anticoag Rxs
- Etc.
Acute endovascular thrombectomy (catheter)
(Pulling out clot with catheter)
Up to 6 hours from onset
- unless posterior (basilar stroke)
- must be proximal
Early stroke management goal
- BP management
- Dysphagia/Aspiration Pneumonia
- DVT/PE
- recurrent stroke