Stoke and CVA Flashcards
cerebrovascular accident
CVA
old term for stroke, may still be heard in hospitals
penumbra
area around infarct that is not dead yet that clinicians are trying to save w/Tx
causes of ischemic stroke
large a thrombosis
embolism
lacunar
sources of embolic strokes
arterial (carotid, aorta)
heart (atrial, ventricular, valvular)
paradoxical emboli
other causes of ischemic stroke
watershed infarcts hypercoagulable disorders vasculitis vasospasm moyamoya
large artery thrombosis
bascially like a MI of brain
best type of stroke to treat w/tPA
plaques rupture -> platelets -> WBC -> block aa
atrial sources of emboli
A fib/flutter (most common)
atrial septal aneurysm (congenital)
atrial tumors/myoxoma
ventricular sources of emboli
cardiomyopathy
MI (most common)
ventricular aneurysms (most common post MI)
cardiomyopathy
weak and dilated ventricle isn’t pumping efficiently -> blood stasis and thrombus formation
hypertrophic usually forms the clot
MI
part of wall is not moving, creating stasis -> mural thrombosis
valvular cardiac emboli
rheumatic mitral stenosis prosthetic valves infective and non-infective endocarditis nonbacterial thrombotic endocarditis (CA) calcific valves bicuspid aortic valves inflammatory valvulitis
carotid a artherosclerosis/stenosis
may cause embolic or thrombotic strokes
lacunar infarct
-forms in subCx areas of brain supplied by small deep penetrating aa arising from big aa
-BP does not decrease in smaller vessels of brain like it does elsewhere in body, therefore HTN can be devastating to the small vessels of the brain
-may be d/t atheroemboli or lipohyalinosis
frequently asymptomatic
watershed infarcts
when MAP <60
disorders which are more likely to cause arterial clotting
antiphospholipid Ab syndrome
anticardiolipid Abs
lupus anticoagulants
hperhomocysteinemia
other hypercoagulable states
CA prego (increased E) hormone replacement therapy prolonged bedrest/immobility, MI, stroke myeloproliferative disorders (polycythemia vera or essential throbocytosis)
vasospasm
usually caused by cocaine
subarachnoid bleed
myoyamoya disease
poorly understood occlusive disease involving large intracranial aa
hemiparesis
weakness on one side of body
hemiplegia
complete paralysis of one side of body
homonymous hemianopsia
aka hemianopia
loss of vision in same visual field of both eyes
aclculia
cannot form simple math task
agnosia
inabiliyt to recognize objects, persons, shapes, smells
alexia
inability to read
agraphia
inability to write
dyarthria
slurred speech
apraxia
inability to perform simple task
anosognosia
unawareness or denial of diability
anomia
difficulty w/recalling words or names
middle cerebral a syndrome
-most common ischemic stroke syndrome b/c MCA supplies a major area of Cx
-c/l hemiplegia and sensation loss
c/l homonymous hemianopsia
middle cerebral a syndrome on dominant side
most common
aphasia, alexia, agraphia, acalcula, finger agnoisa, R/L confusion
middle cerebral a syndrome on non-dominant side
u/l neglect
dressing apraxia
anosognosia
constructional apraxia
anterior a syndrome
c/l sensory and motor loss of lower extremity
loss of bladder control
posterior cerebral a syndrome
homocymous hemianopsia
alexia w/o agraphia
visual or color anomia
lateral pontine syndrome
AICA
ataxia
weakness
hemisensory loss (pain and temp)
lateral medullary syndrome
aka wallenberg syndrome PICA facial sensory and pain loss ataxia nystagmus vertigo hoarseness dysphagia horner syndrome hemisensory loss hiccups
basilar a strokes
locked in syndrome lateral potine syndrome ventral pontine syndrome ventral potine syndrome ataxic hemiparesis cortical blindess
amaurosis fugax
transient mono-ocular blindness
loss of vision in 1 eye for a few hours
often sign of ischemic stroke from carotid
TIA
same symptoms and etiology of stoke, but lasts <24 hrs
rtPA Tx
must be given w/in 3hrs of onset
intravenous or intra-arterial
have to have a thrombus for this to work
must do CT to rule our hemorrhage
race risk for stroke
african americans and hispanics higher risk of stroke, and have higher mortality
stroke and gender
more men have strokes
more women die from strokes
