Neuro- stroke/TIA Flashcards
TIA vs stroke (CVA): what are they both? what is the difference between their timing and reversibility
vascular problem in the brain:
TIA (“mini stroke”): symptoms temporary (<24 hours) w/out permanent brain damage (aka reversible) … but if between 24 hours and 7 days, may only be partially reversible (but >24 hours without resolving = “completed stroke”
CVA: can be evolving or complete. >24 hours- may be irreversible
two main causes/types of stroke, two subcategories of each
ischemic (thrombotic- static/local clot or embolis- moving/distant clot)
hemorrhagic: rupture of artery w/ bleeding into the brain (intracerebral and subarachnoid)
what can cause atrial fibrillation?
stroke
how does an ischmemic (aka artherothrombotic) stroke come about?
stroke caused by an embolis (more often) or thromis
- a “vulnerable plaque” (plaque exposed to bloodstream) ruptures and forms the clot which enters the cerebral vasculature
age, cardiac disease, HTN, hyperlipidemia, polycythemia, and severe anemia are all risk factors for what?
CVA
*anything that causes CVD can cause CVA
what is polycythemia?
increase RBC level
what are the 2 main causes of an intracerebral hemorrhagic stroke?
bleed in the brain: pressure (BP increase) and vascular disease that is bad enough to cause an aneurysm
what is an aneurysm?
An aneurysm occurs when an artery’s wall weakens and causes an abnormally large bulge. This bulge can rupture and cause internal bleeding. Although an aneurysm can occur in any part of your body, they’re most common in the: brain
what causes a subarachnoid hemorrhagic stroke?
bleed between arachnoid and pia or brain:
from pressure on the brain
what are lacunar infarcts?
intracerebral hemorrhage leaves a small area of damage which develops into a “little lake” - lacunae
- these show scattered throughout the brain in white matter
what are two main blood supplies to the brain?
carotid arteries- internal and external
vertebral arteries
-joined in the circle of willis (anastomosis)
what is the difference in supply from the internal vs external carotid?
external: face, thyroid, tongue, pharynx, dura
internal: anterior cerebral, middle cerebral, opthalmic
what is the path of the vertebral arteries? … where do they originate, fuse and divide?
originate- subclavian
fuse- basilar
divide- posterior cerebral
what is the difference in the effects from vascular occlusions (stroke) in the anterior cerebral, middle cerebral and vertebral area?
anterior cerebral: contralateral paralysis (lower>upper)
middle cerebral: contralateral paralysis (lower>upper) and aphasia (dominant hemisphere)
vertebral: visual and labyrinthine (coordination)
what is amaurosis fugax?
opthalmic nerve occlusion that can last minutes to hours
- can come from TIA
what is the clinical presentation of TIA?
amasurosis fugax weakness/paresthesias/hemiplegias dysphasia visual problems/diplopia amnesia episodes ataxia/imbalance/stagger/"drop attacks"
what is considered a “herald of ischemic stroke” and what is the significance of this
TIA, there is an opportunity to intervene (b/c not complete)
A-fib with TIA/CVA? what must you do?
treat and anticoagulate
what drugs would you give for TIA/CVA for plaque stabilization and lipid control?
statins