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Med Path Fall 2020 > Stroke 1 > Flashcards

Stroke 1 Flashcards

1
Q

Brain is __% of the body weight

Brain uses __% of cardiac output

Brain uses __% of total body oxygen

A

2% of body weight
Uses 15% of CO
Uses 20% of total body oxygen

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2
Q

What arteries supply the anterior and posterior portions of the brain?

A

Anterior 3/5th supplied by internal carotid.

Posterior 2/5 (cerebellum, brainstem) supplied by the vertebral arteries that join to form the basilar arteries.

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3
Q

Why are neurons primarily aerobic?

A

They need O2 and glucose.
They don’t store glucose- they require continuous supply of glucose and O2.

Few minutes of ischemia= irreversible injury.

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4
Q

Subdural vs epidural hematoma

A

Subdural: Bleeding into the space between the dura mater and brain itself

Epidural: Bleeding into the space between the dura mater and skull.

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5
Q

What happens in the brain if oxygen and glucose levels are low?

A

Oxidative stress.
Ischemia causes mitochondrial disfunction.
Excess glutamate causes cell death
Excess intracellular calcium causes cell death.
ROS causes mitochondrial disfunction.

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6
Q

Transient Ischemic Attack

A

A brief period of inadequate cerebral perfusion. Sudden focal loss of neurologic function.

*Rapid onset and resolution. Less than 5 mins of duration. Usually followed by full recovery within 24 hours.

Transient loss of blood flow, but no permanent damage

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7
Q

Difference between TIA and mini stroke

A

TIA: Transient loss of blood flow, but no permanent damage

Mini stroke: small strokes with permanent defects

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8
Q

*TIA possible causes

A

*Intermittent vessel obstruction- clots/thromboses, plaques

temporary vasospasm due to drugs, stress, smoking, or migraines.

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9
Q

*___% of patients who have TIA will have a full blown stroke if left untreated within 1 year

A

35%

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10
Q

TIA symptoms

A
  1. Paresis in arm, legs, or face.
  2. *Diplopia
  3. *Transient vision loss, amaurosis fugax

Vertigo, loss of speech, loss of understanding, loss of balance

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11
Q

TIA distinguishing symptoms of non-TIA events

A 
*Speed of onset. Fast, not slow!
lightheaded 
Tightness in the chest 
Stomach upset 
History of similar epodes where TIA was ruled out
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12
Q

TIA workup

A

Main:
Carotid auscultation, carotid ultrasound, echocardiogram.

Additional: CTA, MRA, lab work, ECG

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13
Q

Stroke defintion

A

Disturbance of blood supply causing loss of brain function. More severe than TIA by definition.

Permanent disturbance/damage to neurons.

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14
Q

Stroke is #__ cause of death in US

A 
5.
#6 world wide
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15
Q

High risk population for stroke

A

Older adults
African americans, american indians, alaska natives
Low level of education
Southeastern US

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16
Q

Stroke risk factors

A

*****HTN
*Diabetes
Obesity
Heart disease
Atherosclerosis
High cholesterol
Smoking
Previous stroke or TIA

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17
Q

2 types of stroke

A

Ischemic, Hemorrhagic

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18
Q

Ischemic stroke is what percentage of all strokes and what is the mortality

A

80-85% of all strokes

40% mortality

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19
Q

Hemorrhagic stroke is what percentage of all strokes and what is the mortality

A

15-20% of all strokes

Mortality is 80%

20
Q

What is the most common cerebral artery affected by CVA? What percentage of strokes?

A

Middle Cerebral artery
50-75% of strokes

8.5% of strokes are due to posterior cerebral artery

21
Q

Ischemic stroke is primarily due to blood vessel occlusion. What 4 things causes this?

A

Thrombotic (35%)
Embolic (30%)
Lacunar (20%)
Dissection (5% due to carotid and vertebral)

22
Q

Ischemic stroke is due to which two things?

A

Primary: Blood vessel occlusion.
Secondary: Systemic hypofusion. Pump failure and hypovolemia. (hypovolemia can lead to shock)

23
Q

Most at risk areas for ischemic stroke

A

Watershed areas. These are most distal areas supplied by arteries. Minimal overlap of blood supply. Location is between major arteries- border zones.

24
Q

Embolic stroke due to which main two things?

A

Artery/vein thrombosis

Plaque fragments from carotid arteries

25
Q

What causes a hemorrhagic stroke?

A

Intracranial artery rupture. due to hypoxic or hydraulic damage.

26
Q

Common causes of hemorrhagic stroke

A

HTN.!!!!!!!!!!!!!!!

27
Q

Symptoms of hemorrhagic stroke

A

Sudden onset, severe HA.

28
Q

2 main locations of hemorrhagic stroke

A

Extra axial- outside brain tissue.

Intra axial- inside brain tissue.

29
Q

3 locations for extra axial hemorrhagic stroke

A
  1. Epidural due to middle meningeal artery (80%)
  2. Subdural due to acceleration/deceleration injury.
  3. Subarachnoid due to saccular aneurysm rupture or trauma.
30
Q

Intracranial cerebral hemorrhage due to

A

Rupture and hemorrhage into the brain- hypoxic or hydraulic injury.

Associations: HTN

31
Q

Example of arteriovenous malformation

A

Wyburn-ason Syndrome.

32
Q

Stroke in adults less than 65 years old is __% of all strokes

A

25%

33
Q

More serious risk factors for stroke in young adults

A

Trauma and migraines

Clotting disorders, vascular abnormalities, cardiac embolism.

34
Q

X ray

  • What does it image?
  • Pros?
  • Cons?
A

High energy EMR to image bone.

  • Fractures of bony defects
  • Sacro-iliac junction
  • Chest

Pros: Fast and cheap
Cons: poorer resolution compared to CT. Radiation exposure.

35
Q

Angiography

-Cons

A

X ray + contrast combo
Pinpoints exact location of blockage/bleeding in brain

Cons: Increased thrombosis risk, invasive, radiation exposure.

36
Q

CT

  • Images what and how?
  • Injection of what
A

Uses many X rays + computer to view bones/orbit, intracranial bleeds, infractions.

Requires injection of iodine dye.

37
Q

When do you need an urgent head CT?

A

Identifies hemorrhagic vs ischemic stroke very quickly.

38
Q

MRI

-Images what and how?

A

Magnetic field + computer to view soft tissue details, intracranial bleeds, and infarctions.

No radiation!

39
Q

PET scan

-images what?

A

Detects functional rather than structural abnormalities.

Used for epilepsy or tumor biopsy.

40
Q

How can you use MRi to diagnose or detect strokes?

A

Identifies and further localizes the site of the stroke and find the source.

pro: Very safe, no radiation. OK on pregnancy.

Con: $$$, poor bone detail.

41
Q

Stroke suspects in ER what do you do?

A

Emergent/STAT CT scan to see if it is ischemic or hemorrhagic.

THEN tailor treatment pending results from CT.

42
Q

Ischemic Stroke Tx

A

Tissue plasminogen activator: intravenous. Dissolves clot. May cause hemorrhaging so it is contraindicated in hemorrhagic strokes.

This must be administered within 3 hours of stroke onset and it must be ischemic.

Further tx: Monitor and control risk factors.

43
Q

Tissue plasminogen activator

A

intravenous. Dissolves clot. May cause hemorrhaging so it is contraindicated in hemorrhagic strokes.

This must be administered within 3 hours of stroke onset and it must be ischemic.

44
Q

Hemorrhagic stroke Tx

A

Monitor closely
Surgery
*Control blood pressure
Discontinue anticoagulant therapy.

45
Q

Main risk factor for stroke

A

HTN

46
Q

Stroke rule of 3rds

A

1/3 recover with no or minimal disability.

1/3 Recover with residual disability

1/3 die

47
Q

Stroke prognosis scale

0-3 months
3-6 months
6-12 months
12+ months

A

0-3: largest change of recovery

3-6: Some recovery possible

6-12: Unlikely recovery

12+ months: permanent

Med Path Fall 2020 (20 decks)

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