Stoke Flashcards
Sudden loss of neurological function as the result of disruption to blood flow resulting in tissue death
CVA
Types of CVA
Ischemic
Hemorrhagic
Risk factors We can control
HTN (>160/95)
Smoking
Hyperlipidemia (fat)
If your diastolic lowers by 5-6 mmHg, how much does risk of CVA decrease
40%
What are risk factors we cannot control
Age Sex (Male>females) Hereditary Race (AA>caucasian) Geography
Signs of Stroke
Numbness Difficulty speaking Trouble seeing Ataxia Headache
Acronym FAST… for getting there ASAP
Facial droop
Arm weakness
Speech Difficulties
Time
How are Strokes Dx
Non-contrast CAT scan MRI MRA EKG Echo TEE Telemetry Carotid Doppler
What results in lysis of fibrin?
tPA
What is tPA? And what is it used with?
Tissue Plasminogen Activator
Ischemic Strokes
What is the predictor for stroke after Transient Ischemic Attack?
U of Oxford ABCD scale
What does ABCD scale stand for
Age
BP
Clinical Features
Duration
Standardized tool to assess impairment from stroke
NIH Stroke Scale
To assess if tPA needed
When is NIH Stroke scale performed?
What is the max score>?
Baseline 2 hours post Tx. 24 hrs 7-10 days 3 months
42 max
NIH Score Severity for
0 1-4 5-15 16-20 21-42
No stroke Symptoms Minor Moderate Mod to severe Severe
80% of CVAs are
Ischemic
Decrease Blood flow from Ischemic attacks caused by
Thrombus
Embolic
An occlusion of small vessels associated with HTN or diabetes
Lacunar Infarct
excessive production of neurotransmitters
Ischemic tissue death
Toxic levels of lactic acide and hydrogen ions
Anaerobic Metabolism
Rim of mild to moderate Ischemic tissue around area of infarction
Penumbra
Brain tissue requires ____ of regular Blood flow to survive
20-25%
Common meds prescribed
Antiplatelets Anticoagulants Statins Antihypertensives Diabetic meds
Sudden onset stroke
Linked to HTN
Causes decreased level of consciousness, headache, nausea, vomit
Hemorrhagic Stroke
Hemorrhagic stroke includes
Intracerebral hemorrhage
Subarachnoid hemorrhage
Subdural hematoma
Epidural hematoma
Arterial bleeding into brain parenchyma
Intracerebral hemorrhage
Etiology of Intracerebral Hemorrhage
Atherosclerosis
Increase in BP
>65 y/o
Blood in subarachnoid space
Subarachnoid hemorrhage
40% of subarachnoid hemorrhage present with
60% with
Sentinel Headache
Nausea,vomit,coma
Causes of Sub arachnoid hemorrhage
Atriovenous Malformation Age Trauma Neoplasm Inf HTN
Most common AVM in subarachnoid hemorrhage
Where does it occur?
Berry Aneurysm
Biforcations (Circle of Willis)
Trauma causing tear in bridging veins between brain surface and dural sinus
Subdural Hematoma
What happens when subdural hematoma is small?
Large?
Small:Absorbed by body
Large: Requires evacuation
Traumatic tearing of Meningeal arteries that supply periosteal layer of dura
Epidural Hematoma
Epidural hematoma is a medical emergency that
Requires evacuation
Difficulties speaking and interpreting speech
Aphasia
3 types of aphasia and function loss
Brocas: expressive speech
Wernickes: Receptive Speech
Global: Mixed
Impairment in reading
Alexia
Impairment in writing
Agraphia
Inability to execute voluntary Motor movement
Apraxia
Loss of ability to perceive auditory, visual, and tactile input
Agnosia
Lack of awareness of illness
Anosognosia
Motor speech disorder affective respiration articulation and phonation
Dysarthria
Difficulty swallowing
Dysphagia
Unable to refrain from certain behaviors
Perseveration
Know your flexion and extension synergies
Facts.
What is most common region of CVA? And common cause
MCA (51%)
Internal carotid Thrombus
2 divisions of MCA
Superior (hemiparesis/Brocas Aphasias)
Inferior (Homonymous hemianopsia/ wernickes aphasia)
Responsible for learned behavior, voluntary initiation, planning
Right hemisphere
Responsible for leaning and using language symbols
Left hemisphere
Pusher syndrome midline
Ipsilesional
Pusher syndrome presents with
Spontaneous posture to side of involvement
Resistance to passive correction of posture
Pusher syndrom treatment involves
Visual
Somatosensory
And motor learning
PCA CVA results in
Thalamic syndrome
Homonymous hemianopsia
Ataxia
Damage to cerebellar arties result in
Ataxia
Dysmetria
Nausea
Vertigo
Vertebral artery syndromes
Wallenberg
Horners
Dysphagia
Vertigo
Nystagmus
Impaired sensation on ipsi face and contra limbs
Wallenberg syndrome
Ptosis of eyelid
Constriction of pupil
Lost of pain and temp contralateral
Horners syndrome
results in mute, mortality, tetraplegia, and spared cognition
Basilar artery syndrome
