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Clinical Conditions II > Lecture 4: Stroke > Flashcards

Lecture 4: Stroke Flashcards

1
Q

Stroke

A

Nontraumatic brain injury caused by occlusion or rupture of cerebral blood vessels that result in sudden neurologic deficit.

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2
Q

Transient Ischemic Attack

A
  • Reversible neurologic deficit within a few, up to 24, hours
  • Brain injury likely if beyond 1 hour
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3
Q

Most strokes are

A
  • Ischemic
    • thrombotic (60%)
    • Embolic (20%)
    • Vasculitic, hypercoaguable
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4
Q

Hemorrhagic strokes

A
  • Intracerebral (10%)
  • Subarachnoid (5%)
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5
Q

Pathophysiology Ischemia

Thrombosis (at the site)

A
  • Plaque
  • Fatty streaks at an early age
  • Lipid core
  • Vessel narrowing
  • Small/large vessel
  • could become embolic
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6
Q

Pathophysiology Embolic

(clot travels)

A
  • A-fib, cardiomyopathy, valve disease, patent foramen ovale
  • Calcified plaque
  • Infectious endocarditis
  • Rheumatic Heart disease
  • Breaak off part of thrombus
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7
Q

Pathophysiology Hypercoaguable

A
  • Sickle cell anemia
  • Polycythemia vera
  • Protein C & S defecient
  • Factor V
  • Antithrombin III defecieny
  • Antiphospholipid syndrome
  • Hyperhomo.
  • Essential throbocytosis
  • Prothombin gene mutuation
  • Lupus
  • Anticardiolipid antibodies
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8
Q

Thrombotic stroke clinical presentation

Ischemic

A
  • Slower
  • Stuttering
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9
Q

Embolic stroke clinical presenation

Ischemic

A
  • Sudden onset
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10
Q

Hemmorhagic stroke presenation

A
  • Severe headache
    • Worst headache of my life
  • Sudden
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11
Q

Risk factors for stroke

Nonmodifiable

A
  • Age
    • risk doubles every decade after 55
  • Sex: female/older age
  • Race
  • Previous stroke
  • Family history
  • Coronary artery disease: modifiable?
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12
Q

Risk factors for stroke

modifiable

A
  • HTN
  • Hyperlipids
  • A fib
  • Diabetes
  • Smoking
  • Oral contraceptives
  • physical inactivity
  • Diet
  • Sleep apnea
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13
Q

Allow permissive ___ first few days after stroke

A

HTN

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14
Q

Exercise, diet and logevity

A
  • Protecting your tolemeres (caps on your DNA)
  • Plant based diet
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15
Q

Primary treatment of CVA

A
  • Reverse or limit impact
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16
Q

Secondary treatment of CVA

A
  • Prevent the recurrence
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17
Q

BEFAST

A
  • Balance
  • Eyes
  • Face
  • Arm
  • Speech
  • Time
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18
Q

First thing you do to diagnose a stroke

A

CT Scan

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19
Q

Primary treatment of stroke

A
  • Alteplase (TPA)
    • Symptoms less than 4.5 hours
    • No hemmorrhage
    • SBP less than 185; DBP less than 110
    • No recent surgery, MI, bleeding
    • No minor or improving defecits
    • Given IV
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20
Q

Things that may be given with alteplase

A
  • Throbectomy
  • Large vessel occlusion
  • At times up to 24 hours
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21
Q

Asprin and primary stroke treatment

A

IF NOT GIVEN ASPRIN → HIGH RISK OF EXTENSION OF ISCHEMIC STROKES IN THE FIRST WEEK

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22
Q

Secondary prevention of stroke

A
  • asprin
    • not reccommended if no previous CVA/TIA
  • Clopidrogel (plavix)
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23
Q

Carotid Endartarectomy

A
  • Indicated for 70-99% stenosis in men
  • Not indicated for less than 50% stenosis
  • Risk is perioperative stroke
24
Q

Stroke outcomes

A
  • Mortality
    • 20% overall
    • Higher in hemorrhagic
  • Strength: 3 months
  • Language/Cognition: 6 months
  • Function: early or late
  • Cortical involvement: worse outcome
25
Q

4 pillars of care

A
  1. quality
  2. safety
  3. efficiency (cost)
  4. satisfaction (relationships)
26
Q

How to improve care

DMAIC

A
  1. Define
  2. Measure
  3. Assess
  4. Improve
  5. Control
27
Q

Post stroke care

A
  • Prevent deconditioning
  • Splinting/positioning
  • Spastic reduction
  • Swallow assessemnt
  • Monitor clinical stauts
  • Functional training
  • Braching
28
Q

Antidepressants & SSRI in post stroke care

A
  • Improves motor recovery
  • Given in first 3 months
29
Q

Left MCA

A
30
Q

Right MCA

A
31
Q

Posterior cerebral arteries

4 D’s

A
  1. Diplopia
  2. Dizziness
  3. Dysphagia
  4. Dysarthria
32
Q

1 goal of patients after a stroke

A
  • Gait
    • Need balance
    • Need hip flexion
    • Braces can help; they are not a “crutch”
33
Q

acute impatient

A
  • Intensive: 3hrs/day, 5-6x/weel
  • short stay
34
Q

subacute impatient

A
  • longer term, less intense caare
35
Q

TBI

A

Definition: physical injury to brain tissue that temporarily or permanently impairs brain function

36
Q

TBI population

A
  • more common in men
  • peak incidence teens and elderly
  • most common causes
    • falls: under 17 or over 55
    • MVA: 18-55
    • Sports
    • Violence
37
Q

most common cause of TBI

A

falls of ppl > 75

38
Q

fall prevention

A
  • address polypharmacy, balance impairments, orthostatic hypotension, minimze sedating meds
39
Q

Glascow Coma scale

A

Mild: > 12

Moderate: 9-12

Severe: 8 or less

40
Q

Diffuse axonal injury

A
  • Leading cause of morbidity → primary injury stroke (cognitive, behavioral, and arousal defecits in TBI)
  • Occurs during acceleration and deceleration events
41
Q

Imaging and TBI

CT vs MRI

A

CT: acute blood and bone injury

MRI: diffuse axonal injury

42
Q

Epidural hematona

A
  • Buildup of blood occurring between the dura mater (the brain’s tough outer membrane) and the skull
  • Results from a blow to the side of the head leading to a fracture of the temporal bone tearing the middle meningeal artery (high pressure → bleed quickly)
43
Q

Subdural hematoma

A

Build-up of blood between the dura and the arachnoid (the middle layer of the meninges)

  • Caused by head injury where velocity changes within the skull may stretch and tear small bridging veins (low pressure → slow bleeds)
  • Common in the elderly and alcoholic due to cerebral atrophy
  • “Crescent shaped”
  • Shaken Baby Syndrome
44
Q

Subarachnoid Hemorrhage

A
  • Bleeding into the subarachnoid space-the area between the arachnoid membrane and the pia mater.
  • Cause by traumatic and nontraumatic brain injury (ruptured aneurysm)
  • Thunderclap headache-“Worst headache in my life.”
45
Q

Epidural hematoma pic

A
46
Q

Subdural hematona pic

A
47
Q

Subarcahnoid hemmorhahe pic

A
48
Q

hemorrhagic contusions

A
49
Q

AVM

A

Congenital disorder of the connections between veins and arteries in the vascular system

  • “Tangle of Spaghetti” on arteriogram
  • Can bleed with devastating-stroke-like effects
50
Q

Sugical management of AVM

A
  • Craniotomy
  • Epidural Hematoma
  • Subdural Hematoma
  • Burr hole drainage
  • ICP monitoring
  • Ventricular drain
51
Q

Medical management of AVM

A
  • Close observation
  • Prevent hyperthermia which has poorer outcome
  • Elevated ICP
  • Hyperventilation
  • Osmotic diuretics: mannitol
  • Elevate head
  • Cerebral perfusion pressure goal: 70-100 mm Hg
  • ICP goal: 5-15 mm Hg
  • SBP goal 100-180 mm Hg
  • Ventricular drain
  • Sedation to prevent ICP spikes
52
Q

Complications of TBI

A
  • DVT/PE
  • Pneumonia
  • Skin breakdown
  • Pain
  • Bowel/Bladder dysfunction
  • Spasticity
  • Contractures
  • Deconditioning
53
Q

TBI sequlae

A
  • Neurologic findings
  • Cognition
  • Executive function
54
Q

Spasticity Management

A
  • Cold
  • Prevent noxious stimuli
  • Manual techniques
  • Splinting/ serial casting
  • Botulinum Toxin and Phenol Injections
  • Baclofen Pump
  • Medications
  • Baclofen, Zanaflex, dantrium, clonidine, valium
55
Q

Botulinum Toxin

A
  • Different types
  • Best for focal spasticity
  • Indications
  • Medication failure
  • Improve function
  • Improve hygiene
  • Prevent Pain
56
Q

Baclofen Pump

A
  • Indications
  • Lower extremity spasticity
  • Improve function, hygiene
  • Lessen pain
  • Procedure
  • Test dose
  • Surgical implantation
  • Refill every 3 months

Clinical Conditions II (5 decks)

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