Stroke Flashcards
What are the two types of strokes? Define each and which one is the most common?
Ischaemic - most common and is caused by a blood clot -> block of blood flow to the brain. Results in swelling and oedema
Haemorrhagic - break in vessel in or around the brain causing bleeding -> lack of O2 and nutrients
Ischaemic strokes can be further classified into 2 sub categories. List and explain the aetiology
Embolic: where a clot forms somewhere in the body (usually heart) and travels up to the brain -> clot small blood vessels
Thrombotic: build up of cholesterol plaques that narrows or blocks the artery -> blocks blood flow to the brain. Typically causing deposits in the brain
What is meant by the phrase ‘time is brain’?
The greater the time w/o blood flow, the greater the damage to brain tissue
Ideally, treat within 3 hrs of symptoms to minimise disability
Describe the pathophysiology of an ischaemic stroke
lack of perfusion of blood flow through an artery –>
ischaemia and odema in surround tissue –>
death of brain cells and tissue –>
more damage and oedema that resolves only with perfusion
Describe the pathophysiology, symptoms, and mortality of a haemorrhagic stroke
- bleeding in the brain causing lack of O2
- may result from uncontrolled hypertension, aneurysms, vascular malformations
- symptoms: intense, painful headache; nausea, vomiting
- MR higher than for ischaemic stroke
What are 3 classes (list suffixes) of drugs that can be used to reduce the risk of stroke? What are their indications, MOA and provide an exmaple
- OLOL: hypetension and angina. Blocks beta-receptor to reduce HR, BP, heart contractility. ATENOLOL
- IPINE: hypertension. Blocks calcium channels in periphery, reduce blood vessel resisatnce. AMLODIPINE
- STATIN: hypercholesterolaemia. Limits cholersterol synthesis . ATORVASTATIN
A history of a transient ischaemic attack (TIA) is significant because….
- a sign of an impending stroke
- greatest risk of stroke in 1st week following a TIA
- some people may experience multiple TIAs before a significant stroke event
What are some non-modifiable risk factors for an iscahemic stroke?
- increased age (>65)
- sex: men more likely
- race: African Americans > Caucasians
- family history
- atrial fibrillation (fast irregular heart beat)
What are some modifiable risk factors of ischaemic strokes?
- hypertension: increases risk
- diabetes: increases risk
- abdominal - obesity
- exercise: reduces risk
- smoking: increases risk
What are the differences in risk factors between embolic and thrombotic strokes?
Embolic: dysrhythmias, enlarged heart, bacterial endocarditis, heart failure, aortic valve disease
Thrombotic: Atherosclerosis, blood clotting disorders, increased plates, vasculitis
What are the signs and symptoms of an acute ischaemic stroke?
- weakness/numbness: face, arms, legs often on one side
- confusion, frustration
- difficulty in speaking or understanding
- difficulty in walking/falling
- severe headaches
- visual disturbances: loss, blurred vision
What clinical features are seen in right-brain stroke?
- left-side weakness/paralysis
- impaired perception, memory and judgement
- left side neglect
- short attention span
- impulsive
What clinical features can be seen of left-brain stroke?
- right-side weakness/paralysis
- impaired language and math skills
- impaired left-right distinction
- cautious
- aware of deficits; depression, anxiety
Stroke can occur from the blockage of cerebral artery (CA) List the 4 locations is can occur in and some of the associated symptoms
Middle CA: facial symmetry, unilateral arm/hand weakness, diff. speaking
Anterior CA: sensory loss, lower body weakness, incontinence, abnormal behaviour
Posterior CA: visual disturbances and complete loss of vision
Vertebral-Basilar artery:
- cerrebellum: dizzinesss, N/Vs, slurred speech, headache
- brain stem: cross with isachemia signs. Quadriplegia, double vision,
decreased consciousness
What drug would be administered to a patient having an ischaemic stroke? What is it’s MOA and the route of administration?
Alteplase: thrombolytic drug
MOA: converts plasminogen > plasmin -> lysis of fibrin (clot) -> venous flow
Given: w/i 4.5 hrs of onset
DOSE: IV bolus dose (0.1mg/kg) –> infusion (0.8mg/kg) over 60 minutes
