Secondary Stroke- Patho, Symptoms, Risk Factors Flashcards
Carotid artery stroke symptoms
Unilateral weakness, and sensory symptoms
Aphasia- difficulty understanding speech (receptive aphasia) or speaking (expressive aphasia), or both
Monocular vision loss
Transient global amnesia
Vertebrobasilar stroke symptoms
Bilateral weakness, sensory, and/or visual complaints
Diplopia, vertigo, ataxia without weakness
dysphagia (difficulty swallowing)
General signs and symptoms of a stroke
Unilateral weakness and sensory symptoms, dysphasia, dysarthria, vision disturbances, sudden confusion/mental status changes, facial droop, seizures (rare), asymmetric face, slurred speech, pronator drift, ataxia, loss of balance, vertigo, dizziness, dysphagia, headache, vomiting
Etiologies that can present as stroke
Seizures, migraines, syncope, brain tumors, hyponatremia, hypoglycemia, Bell’s palsy, MS, conversion disorder
Patients at the most risk of having a stroke
Patients who already had a stroke
Treatable risk factors
HTN, HLD, heart disease (especially Afib), DM, smoking, excessive alcohol intake, physical inactivity, obesity, carotid bruit, post-menopausal hormone therapy
Untreatable risk factors
Age (age >55), sex (men > women), race (AA and Hispanics are more at risk), prior stroke, hereditary
Organ with the highest metabolic rate
Brain
Blood flow to the brain
750ml/min
When blood goes through the aortic arch, where is its first stop?
Carotid artery
Ask patient where the stroke happened; if it’s thromboembolic, ask where the thrombus came from
Anterior arteries supply what area of the brain
Frontal area
Feature about the carotid artery
Comes out of the neck (extra cranial) and goes back in (intracranial)
Feature about the vertebral arteries
Come up the spinal column and fuse together to become the basilar artery to supply the brainstem
Is it possible to have a completely occluded artery and be asymptomatic?
Yes, if the occlusion occurred over a long period of time
The medulla is supplied by what arteries
anterior spinal and vertebral arteries, posterior inferior cerebellar artery
The pons is supplied by what artery?
Basilar artery
The midbrain is supplied by what arteries
posterior cerebral, posterior communicating
The middle cerebral area vascularizes what area?
Lateral surface of the frontal, temporal, and parietal lobes
Functional areas supplied by the middle cerebral
auditory cortex, language, and speech areas of the dominant hemisphere, sensory and motor areas of the homunculus
The anterior cerebral area vascularizes what?
medial aspect of the frontal and parietal lobes
Functional areas supplied by the anterior cerebral
sensory and motor areas of the lower extremity homunculus
Posterior cerebral area vascularizes what?
medial and part of the lateral surfaces of the occipital lobe and inferior surface of the temporal lobe
Functional areas supplied by the posterior cerebral
visual cortex and memory areas
Homunculus main takeaway point
IT’S NOT A DEMOCRACY, more areas of the brain are dedicated to some areas over others (face has more areas vs. the leg)
Gray matter vs. white matter
There’s a lot of gray matter, so if an occlusion of a vessel occurs there, it could be without consequence because there’s other areas blood can flow through that aren’t affected by an infarction. If this happens in the white matter, there may be a symptomatic infarction
Ischemic strokes make up how much (% out of 100) of strokes?
71%
Embolic stroke definition
Embolism from somewhere else in the body goes upstream into the brain; can start in the heart and go to the brain but can also originate in the cerebral vasculature
Hemorrhagic strokes make up how much (% out of 100) of strokes?
26%
Subtypes of hemorrhagic stroke
Subarachnoid, intracerebral
Subarachnoid hemorrhage definiton
aneurysm in a large vessel that transverses the surface of the brain into the subarachnoid space → vessel bursts → inflammation and bleeding → pressure pushes it down onto the brain
NOT A BRAIN BLEED
Intracerebral hemorrhage definiton
BLEEDING INTO THE BRAIN TISSUE → blood is neurotoxic to the brain if it’s outside the blood vessel and can expand the infarction further
What does the CHA2DS2VASc score do?
Estimates stroke risk
What score of the CHA2DS2VASc prompts anticoagulation?
≥2
Risk factors in CHA2DS2VASC score and how many points they each get
Congestive heart failure- 1 point
HTN (>140/90)- 1 point
Age >75- 2 points
Diabetes- 1 point
Stroke history/TIA- 2 points
Vascular disease (MI, aortic plaque, etc.)- 1 point
Age 65-74- 1 point
Sex- being female gives you 1 point
True or false: ischemic strokes are all treated the same way acutely and for prophy
True, the exception is if it’s AFib
Thrombus formation patho
Asymptomatic atherosclerotic plaque → platelet deposition → occlusive thrombus formation → plaque fissure → red thrombus → embolism
Platelet cascade in thrombus formation patho
Lipid plaque has a fissure → fissure in endovascular interarterial plaque → body recognizes it as an injury → platelets activate → platelets adhere to the fissure → platelets aggregate → fibrin and RBCs are called in → thrombus formation
Feature of activated platelets
Activated platelets change biochemically and release a cascade of biochemical and calls in additional platelets to aggregate → biochemical storm and exponential increase in platelets that are activated and aggregate and have morphological changes in the platelets
What do activated platelets do to aggregate?
IRREVERSIBLY INTERLOCK
Cardiogenic embolus patho
blood stasis → thrombus → ejected to brain
