PRELIMS Flashcards
Sudden occurence of a focal, non-convulsive neurologic deficit
Cerebrovascular Accident (Stroke )
Two types of stroke
Ischemic
Hemorrhagic
anything about motor or sensory
May be embolic or thrombotic- both may clog , embolic- travel
Ischemic
Characterized by sudden loss of blood circulation to an area of the brain, resulting in a corresponding loss of Neurologic function
Ischemic
Signs and symptoms of Ischemic stroke
Hypothalamus - body temperature; altered thermoregulation
If pons or medulla oblongata ang affected =respiratory center
Most of the patients are conscious
Ischemic
Bleeding occurs in the brain
Hemorrhagic
Common signs and symptoms of hemorrhagic stroke
Headache, nausea, vomiting
Types of Hemorrhagic stroke
Intracerebral Hemorrhage (ICH)
Subarachnoid hemorrhage
spontaneous rupture of small vessels accounts for approximately 80% of hemorrhagic strokes
Caused mainly by uncontrolled hypertension
Primary ICH
Abnormality in embryonal development that leads to tangles of arteries and veins in the brain that lacks a capillary bed.
Absence of capillary bed leads to dilation of the arteries and veins and eventual rupture
Common cause in young people
Secondary ICH
- Arteriovenous malformations (AVM)
Dilation of the walls of a cerebral artery that develops as a result of weakness in the arterial wall.
Cause is unknown
Secondary ICH
Intracranial (cerebral) Aneurysm
May be due to atherosclerosis (result in a defect in the vessel wall with subsequent weakness of the wall), Congenital defect of the vessel wall, Hypertensive vascular disease, Advance age
Any artery within the brain that can be affected usually occurs at the bifurcations of the large arteries at the circle of willis.
Most commonly affected are the internal carotid artery, posterior communicating artery, posterior cerebral artery, and middle cerebral artery
Secondary ICH
Intracranial (cerebral) Aneurysm
Bleeding occurs in the brain parenchyma which may die to
¤ Leakage from small intracerebral arteries damaged by chronic hypertension
¤ Bleeding diathesis - high risk for bleeding
¤ Iatrogenic anticoagulation- results of a medical intervention; side effect of an intervention
** anti-platelet: clopidogrel, aspirin = prone to bleeding
¤Cerebral Amyloidosis Angiopathy - common cause in older adults. Involves damage caused by the deposit of beta-amyloid protein in the small and medium-sized blood vessels of the brain.
–> Fragile and prone to bleeding
¤Cocaine Abuse - damages to the blood vessels
–> Chronic use: Mawawalan ng tensile strength (blood vessel) = madaling mag rupture= hemorrhage
Patients with intracerebral bleeds are most likely than those with ischemic stroke to have:
•headache
•altered mental status
•seizures
•nausea and vomiting
•marked hypertension
Compensatory mechanisms
Monro-Kellie Hypothesis
Bleeding occurs at the subarachnoid space, which is the area between the brain and the tissue covering the brain
May occur as a result of an AVM, Intracranial aneurysm, trauma, or hypertension
Subarachnoid hemorrhage
Manifestations are : severe headache, nausea and vomiting and loss of consciousness
Subarachnoid Hemorrhage
Common causes of Subarachnoid hemorrhage
leaking aneurysm in the area of the circle of willis and a congenital AVM of the brain
Manifestations of Subarachnoid hemorrhage
Severe headache, nausea and vomiting and loss of consciousness
Thrombotic or embolic can lead to hemorrhage
True or false
True
General approach on stroke
*Assessment
Health history
Neurologic examinations
SPERM (Sensorium, Pupillary Reaction, Eye movement, Reflexes, Muscle strength)
