Stokes - Chapter 57

Question 1

FAST for warning signs of stroke. (what does it stand for)

Answer 1

F - Face drooping
A- Arm weakness
S - Speech difficulties
T - Time

Question 2

What are the non modifiable risk factors for stroke?

Answer 2

• age
• gender
• ethnicity or race
• family hx or hereditary

Question 3

What do you know about strokes and African Americans?

Answer 3

• higher rate incidence of strokes than white
• 3x more likely to have hemorrhagic stroke
• experience increased rates of hypertension, diabetes mellitus and sickle cell anemia
• Higher incidence of smoking and obesity than whites
• are twice likely to die from stroke than whites

Question 4

What are the modifiable risk factors for strokes?

Answer 4

• 90% of strokes occur from modifiable risk factors

include:
- hypertension, heart disease, diabetes mellitus, smoking, obesity, sleep apnea, metabolic syndrome, lack of physical exercise, poor diet and drug and alcohol abuse

Question 5

What does TIA stand for and what is it?

Answer 5

• Transient ischemic attack (TIA)
• Its a transient episode of neurologic dysfunction caused by focal brain, spinal cord or retinal ischemia BUT without acute infarction of the brain. Symptoms last less than an hour. Has possibility to turn into a stroke.

Question 6

In a TIA block of the carotid system what do you expect to see?

Answer 6

• pts may have temp loss of vision in one eye (amaurosis fugax), transient hemiparesis, numbness or loss of sensation or sudden inability to speak.

Question 7

In a TIA block of the vertebrobasilar system what do you expect to see?

Answer 7

tinnitus, vertigo, darkening or blurred vision, diplopia, ptosis, dysarthria, dysphagia, ataxia, unilateral or bilateral numbness or weakness

Question 8

Two different types of strokes?

Answer 8

Ischemia and hemorrhagic

Question 9

Which is a more common stroke?

Answer 9

Ischemia accounts for 87% of all strokes

Question 10

What are the two types of ischemic strokes?

Answer 10

Thromobtic and embolic

Question 11

Thrombotic strokes (gender/age, warning and onset and prognosis)

Answer 11

• occurs in men more than women
• warning can be TIA (30-50%)
• onset during or after sleep
• S/s develop slowly usually some improvement in survivors (20-25%)

Question 12

Embolic strokes (gender/age, warning and onset and prognosis)

Answer 12

• men more than women
• warning TIA (UNCOMMON)
• onset most likely during activity
• single event s/s develop quickly, usually some improvement, recurrence often if underlying problem not treated

Question 13

What are the two types of hemmorhagic strokes?

Answer 13

intracerebral and subarachnoid

Question 14

Intracerebral (gender/age, warning and onset and prognosis)

Answer 14

• slightly higher in women than men
• warning Headache 25%.
• onset activity often
• progression over 24 hrs
• poor prognosis, fatality more likely with presence of coma

Question 15

Subarachnoid (gender/age, warning and onset and prognosis)

Answer 15

• slightly higher in women
• youngest median age
• Warning HEADACHE often
• onset activity, most commonly related to head trauma
• usually single sudden event, fatality more likely with presence of coma

Question 16

Anterior Cerebral stroke manifestations

Answer 16

• motor and/or sensory deficit (conlateral), sucking or rooting reflex, rigidity, gait problems, loss of proprioception and fine touch

Question 17

Middle cerebral stroke maifestations

Answer 17

Dominant side: aphasia, motor and sensory deficit, hemianopsia (decreased vision or blindness on one side)

• non dominant side: neglect, motor and sensory deficit, hemianopsia

Question 18

Posterior cerebral

Answer 18

• hemianopsia (decreased vision or blindness on one side), visual hallucination, spontaneous pain, motor deficit

Question 19

Vertebral

Answer 19

• cranial nerve deficits, diplopia, dizziness, nausea, vomiting, dysarthria, dysphagia and/or coma

Question 20

Right-brain damage (stroke on right side of the brain)

Answer 20

• paralyzed left side: hemiplegia
• left side neglect
• spiatal-perceptual deficits
• tends to deny or minimize problems
• rapid performance, short attention span
• impulsive, safety problems
• impaired judgement
• impaired time concepts

Question 21

Left-brain damage (stroke on the left side of the brain)

Answer 21

• paralyzed right side (hemiplegia)
• impaired speech/language apahasias
• impaired right/let discrimination
• slow performance, cuatious
• aware of deficits: depression, anxiety
• impaired comprehension related to language, math

Question 22

What are the 3 different types of aphasia?

Answer 22

Broca’s, wernicke’s, global and ‘other’

Question 23

Broca’s characteristics

Answer 23

• type of nonfluent aphasia
• damage to frontal lobe of the brain
• frequenctly speak in short phrases t hat make sense but are produced with great effort
• Often omit small words such as is, and and the
• may say walk dog, meaning “i will take the dog for a walk” or “book book two table for “there are two books on the table
• Typically understand speech of others fairly well
• often aware of their difficulties and can become easily frustrated

Question 24

Wernickes aphasia characteristics

Answer 24

• type of fluent aphasia
• damage occurs in left temporal lobe , although it can result from damage to the right lobe
• May speak in long sentences that have no meaning, add unnecessary words, and even create made-up words
• may say “you know that smoodle pinkered and that i want to get him round and take care of him like you want before”
• Often difficult to follow what person is trying to say
• usually have great difficulty understanding speech
  often unaware of their mistakes

Question 25

Global aphasia characteristics

Answer 25

• type of nonfluent aphasia
• results from damage to extensive portions of language areas of the brain
• have severe communication difficulties
• may be extremely limited in ability to speak or comprehend language

Question 26

Other aphasia characteristics

Answer 26

• results from damage to different language areas in the brain
• some pts may have difficulty repeating word and sentences, even though they can speak and they understand the meaning of the word or sentence
• other pts may have difficulty naming objects, even though they know what the object is and what its use is

Question 27

How do you diagnose a stroke?

Answer 27

Diagnosis of stroke (including extent of involvement)

• ct scan
• ct angiography (CTA)
• MRI
• Magnetic reasonance angiography (MRA)
• CT/MRI perfusion and diffusion imaging

Cerebral blood flow

• cerebral angiography
• carotid angiography
• digital subtraction angiography
• transcranial doppler ultrasonogrphy
• carotid dublex scanning

Cardiac assessment

• electrocardiogram
• chest xray
• cardiac marker (troponin, creatine, kinase-MB)
• echocardiography (transthoracic, trnasespophageal)

Additional studies
- complete blood count (including platelets and glucose]
- coagulation studies; prothrombin time, activated partial thromboplastin time
- electrolytes, blood glucose
renal and hepatic studies
- lipid profile
- Cerebrospinal fluid analysis

Question 28

What lifestyle changes can you do to prevent a stroke?

Answer 28

• reduce sodium intake
• maintain a normal body weight
• maintain BP
• increase level of physical exercise
• avoid cigarette smoking or tobacco products
• limit alcohol consumption
• follow diet low in saturated fats, total fats, dietary cholestrol and high in fruits and vegetables