Stroke Flashcards
Define stroke
reduced or interrupted blood flow to the brain resulting in inadequate perfusion/oxygenation
Ischemic stroke
oxygen-rich blood depravation due to arterial blockage
Hemorrhagic stroke
an intracranial artery leaks or ruptures - bleeding in brain, not getting perfused. Will see bright white bld on CT.
s/s: sudden severe HA, confusion, seizures
Types of ischemic stroke
thromboembolic (blood clot), large vessel (atherosclerosis), lacunar (small vessel that supply deep brain tissue), watershed (where 2 major arterial supplies meet and receive dual bld flow there)
Complications of stroke
aphasia cognitive impairment contracture in weakened extremity depression dysphagia incontinence memory impairment motor deficit pressure injury from immobility residual facial droop seizure sensory impairment
Lifestyle changes to reduce stroke risk
blood pressure reduction blood glucose control if diabetic diet low in fat, cholesterol, sodium encourage establishment w/ PCP treat underlying hypercoagulability treat underlying heart arrhythmias
Arteriovenous Malformation (AVM)
capillary between artery and vein tangled causing turbulent bld flow. Veins subjected to arterial pressure may rupture over time. Usually present at birth. Increases risk for hemorrhagic stroke.
Recognizing stroke
Facial drooping Arm weakness (or leg, unilaterally) Speech difficulty (aphasia) Time (importance of getting help quickly)
S/S stroke
altered mental status, difficulty understanding or expressing speech, facial drooping, visual disturbances, sudden headache, weakness, numbness, imbalance, dizziness, ataxia
- all would be sudden onset if having a stroke
Aneurysm
Ballooning area of endothelial tissues come off a blood vessel. Weakens the vessel and causes turbulent bld flow in the area
Subarachnoid hemorrhage (SAH)
bleeding from bld vessels below meninges. May be due to trauma, aneurysm or AVM. S/S - sudden severe headache
Receptive aphasia
having difficultly understanding meaning of speech
Expressive aphasia
difficulty expressing / getting words out
homonymous hemianopia
visual field loss on the same side of both eyes (ex. can only see R half of vision field)
Anterior cerebral artery (ACA)
- least commonly affected vessel
- feeds frontal and parietal lobes
- primary sx: motor/sensory deficit in contralateral lower extremity
Posterior cerebral artery (PCA)
- feeds medial occipital and medial/inferior temporal lobes
- primary sx: vision loss (contralateral homonymous hemianopia)
Middle cerebral artery (MCA)
your typical FAST symptoms
Cerebellar strokes
presents with balance and coordination problems
Brainstem strokes
Very rare
- severe symptoms up to quadriplegia
Left hemisphere stroke can cause
- R sided motor weakness/sensory changes
- Aphasia
- R homonymous hemianopia
- difficulty with math, reasoning, analysis
- depression, hesitancy
- difficulty reading, writing, learning new concepts
R hemisphere stroke can cause
L sided motor weakness/sensory changes
- L sided neglect
- L homonymous hemianopia
- issues with spatial awareness, depth
- behavioral changes
- memory problems
- difficulty with object/location recognition
Acute blood on CT scan
bright white
Transient ischemic attack (TIA)
temporary blockage of an artery
- may present with s/s of stroke but deficits don’t last (resolve within in min to hour)
- often doesn’t show up on imaging since it resolves
- major warning sign of future stroke
tPA: tissue plasminogen activator
Protein responsible for initiating clot degradation - converts plasminogen to plasmin
- can be administered w/in 3 hours of symptom onset
- can’t have if on anticoagulants, recent surgery, bleeding disorder, pregnancy, active bleeding
- can be given IV or through angiography
- risk of stroke conversion (ischemic to hemorrhagic)
tPA: tissue plasminogen activator
Protein responsible for initiating clot degradation - converts plasminogen to plasmin
- can be administered w/in 3 hours of symptom onset
- can’t have if on anticoagulants, recent surgery, bleeding disorder, pregnancy, active bleeding
- can be given IV or through angiography
- risk of stroke conversion (ischemic to hemorrhagic)
NEVER give for hemorrhagic stroke
thromboectomy
removal of blood clot causing stroke, restores bld flow to the ischemic area
tx of hemorrhagic stroke
- never give tpa
- if on anticoagulant, give reversal
- surgical clipping, surgical coiling,
elevated intracranial pressure s/s
altered mental status, excessive sleepiness, irritability, headache, vomiting, posturing
+ cushings triad
Cushing’s triad
3 primary signs that often indicate increase in ICP (late signs)
- systolic HTN and widening pulse pressure
- bradycardia
- decreased/irregular respirations
Cerebral vasospasm
complication usually following anereurysmal SAH (hemorrhagic)
- the blood outside the vessels irritates other vessels causing spasm, slowing bld flow - leads to secondary stroke
- highest risk 3-7 days post bleed, can be up to 21 days post bleed (do q1hr neuro checks)
- s/s: reduced consciousness, speech difficulty, motor deficits contralateral side
- tx: Nimodipine - ca channel blocker
Target: stroke
guidelines to improve stroke outcomes
- EMS prenotification
- single call stroke team activation
- CT done w/in 25 min of arrival and read w/in 45min of arrival
- door to needle time: 60 min (if pt is going to get TPA, needs to be this fast)
nerves that contribute to swallowing
5,7,9,10,12
