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HEHI > Stroke > Flashcards

Stroke Flashcards

1
Q

Define stroke

A

reduced or interrupted blood flow to the brain resulting in inadequate perfusion/oxygenation

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2
Q

Ischemic stroke

A

oxygen-rich blood depravation due to arterial blockage

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3
Q

Hemorrhagic stroke

A

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

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4
Q

Types of ischemic stroke

A

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)

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5
Q

Complications of stroke

A 
aphasia
cognitive impairment
contracture in weakened extremity
depression
dysphagia
incontinence
memory impairment
motor deficit 
pressure injury from immobility
residual facial droop
seizure
sensory impairment
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6
Q

Lifestyle changes to reduce stroke risk

A 
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
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7
Q

Arteriovenous Malformation (AVM)

A

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.

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8
Q

Recognizing stroke

A 
Facial drooping
Arm weakness (or leg, unilaterally)
Speech difficulty (aphasia)
Time (importance of getting help quickly)
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9
Q

S/S stroke

A

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

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10
Q

Aneurysm

A

Ballooning area of endothelial tissues come off a blood vessel. Weakens the vessel and causes turbulent bld flow in the area

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11
Q

Subarachnoid hemorrhage (SAH)

A

bleeding from bld vessels below meninges. May be due to trauma, aneurysm or AVM. S/S - sudden severe headache

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12
Q

Receptive aphasia

A

having difficultly understanding meaning of speech

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13
Q

Expressive aphasia

A

difficulty expressing / getting words out

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14
Q

homonymous hemianopia

A

visual field loss on the same side of both eyes (ex. can only see R half of vision field)

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15
Q

Anterior cerebral artery (ACA)

A
  • least commonly affected vessel
  • feeds frontal and parietal lobes
  • primary sx: motor/sensory deficit in contralateral lower extremity
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16
Q

Posterior cerebral artery (PCA)

A
  • feeds medial occipital and medial/inferior temporal lobes

- primary sx: vision loss (contralateral homonymous hemianopia)

17
Q

Middle cerebral artery (MCA)

A

your typical FAST symptoms

18
Q

Cerebellar strokes

A

presents with balance and coordination problems

19
Q

Brainstem strokes

A

Very rare

- severe symptoms up to quadriplegia

20
Q

Left hemisphere stroke can cause

A
  • R sided motor weakness/sensory changes
  • Aphasia
  • R homonymous hemianopia
  • difficulty with math, reasoning, analysis
  • depression, hesitancy
  • difficulty reading, writing, learning new concepts
21
Q

R hemisphere stroke can cause

A

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
22
Q

Acute blood on CT scan

A

bright white

23
Q

Transient ischemic attack (TIA)

A

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
24
Q

tPA: tissue plasminogen activator

A

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)
25
Q

tPA: tissue plasminogen activator

A

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

26
Q

thromboectomy

A

removal of blood clot causing stroke, restores bld flow to the ischemic area

27
Q

tx of hemorrhagic stroke

A
  • never give tpa
  • if on anticoagulant, give reversal
  • surgical clipping, surgical coiling,
28
Q

elevated intracranial pressure s/s

A

altered mental status, excessive sleepiness, irritability, headache, vomiting, posturing
+ cushings triad

29
Q

Cushing’s triad

A

3 primary signs that often indicate increase in ICP (late signs)

  • systolic HTN and widening pulse pressure
  • bradycardia
  • decreased/irregular respirations
30
Q

Cerebral vasospasm

A

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
31
Q

Target: stroke

A

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)
32
Q

nerves that contribute to swallowing

A

5,7,9,10,12

HEHI (11 decks)

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