Midterm study guide: Neuro Flashcards
Ischemic Stroke: what (two types)
*An ischemic stroke results from an interruption of blood flow to the brain → 2 types (thrombotic & embolic).
*87% of strokes
Thrombotic stroke: Def
*Results from the accumulation of atherosclerotic plaque (fat in the arteries) especially at the bifurcations (curves) of the vessels
Embolic Stroke: Def
Occur when an embolus (blood clot) from the heart or lower circulation lodges in a small vessel resulting in loss of blood supply to the brain
Thrombotic stroke: RF
main one + 4 others
!The greatest risk factor is hypertension!
*Other risk factors: diabetes, smoking, dyslipidemia, CAP
Embolic Stroke: RF
main +3
!The greatest risk factor is A-Fib!
*Other risk factors: Mitral stenosis, valvular issues, endocarditis
Ischemic stroke patho
ischemic or embolic event (something blocks blood supply)→ reduced cerebral blood flow insufficient to maintain neuronal viability (no blood flow = no brain work) → Ischemia occurs (decreased blood flow)→ sustained anoxia (lack of o2) leading to lactic acidosis and high cellular CA → irreversible neuronal cell death (leads to vasoconstriction with elevated BP) → affected brain tissue softens and liquefies (ew)
Ischemic strokes: Characteristic signs
*Sudden onset of focal neurological signs (weakness, visual deficits, paralysis, decreased coordination, facial droop, seizures
*focal stroke is localized to specific area of the brain as opposed to whole brain
Ischemic stroke: Accompanying signs
*Hemiparesis (half paralysis)
*hemianopia (visual fields cut out)
*altered language (aphasia)
Do ischemic stroke pts lose consciousness?
Not usually (unless stroke in brain stem), then will present in a stupor or coma
Confirmation of ischemic stroke
Confirmation of ischemic stroke is the first step because its important for treatment = you give thrombolytics so = you DO NOT want to give thrombolytics in case its hemorrhagic stroke cause then bleeding would just get worse
*GET STAT CT SCAN
IS medical management:
7 points
1: reverse or minimize the cause of the stroke
*Gold standard: thrombolytics: Give rt-PA. 10% over 1 min. 90% over 60 min (this is the thrombolytic)
*give o2: Maintain SPO2 at 95%
*Decrease metabolic requirements: treat high glucose levels, mild sedatives, stool softener
*Maintain cerebral perfusion: treat A-fib with **cardioversion **
*Treat HTN → if not reduced below 185/110 then rt-PA should not be used. **Labetalol (IV) **is an antihypertensive that can be used.
*Give platelet aggregation inhibitors after 24 hours of rt-PA use:
*ASA (aspirin), heparin/lovenox (INR goal 1.7), ticlid/plavix (but not for 24hrs if receiving thrombolitics)
IS management time line
6 points
10 min door to MD → 15 min to neuro consult → 25 min CT scan → 45 min CT interpretation → 60 min give drugs → 3 hrs admit to monitored bed
Hemorrhagic stroke (HS): what
There are subarachnoid hemorrhages (SAH) & there are intracerebral hemorrhages (ICH)
SAH: what
bleeding into the subarachnoid space. Usually caused by rupture of a cerebral aneurysm or arteriovenous malformation
SAH RF (1 main + 3 others)
!HTN!, smoking, ETOH, stimulants (like meth)
SAH: s/s (biggest red flag +4 others + hx)
*“worst headache of my life”
*Accompanied by a brief loss of consciousness, NV, focal neuro deficits
*Also stiff neck!
*Hx: previous episodes of sudden onset of HA and vomiting (these are warning leaks, blood irritates the meninges causing HA, stiff neck, and photophobia)
