Stroke Flashcards
what is another name for a stroke
cerebral vascular accident
what is a stroke
problem with blood supply to the brain
what are the types of stroke
ischemic: thrombotic, embolic, hemorrhagic conversion,
hemorrhagic
what are the risk factors for a stroke
HTN
HLP
tobacoo use
DM
race
oral contraceptives
age
male
hx of TIA
A fib
sickle cell anemia
what are the manifestations of CVAs
numbness or weakness on one side of body
sudden confusion
trouble speaking
slurred speech (dysarthria)
trouble seeing
ataxia
severe headache
what is an ischemic stroke
occlusion of cerebral caused by a thrombus or embolus
- manifestations will depend on where the occlusion is
what is the patho of an ischemic stroke
decrease in blood supply
oxygen deprivation
neuro deficits within 1 min
continued loss of supply leads to irreversible damage
what are the causes of an thrombotic ischemic stroke
atherosclerosis
hypercoaguable state
what are the causes embolic ischemic stroke
cardiac source:
- mural thrombus
- A fib
- venous clot if atrial septal defect or patent foramen ovale
- thrombus of vegetation of valves
carotid plaque –> carotid bruit
what is a penumbra
ischemic area that is still viable
- area around the blockage that is still able to be saved
how long do you have to save the penumbra
3 hours
what is a hemorrhagic stroke
bleeding within the brain parenchyma caused by a ruptured vessel
what is the most common cause for a hemorrhagic stroke
long standing severe HTN
what is another risk of a hemorrhagic stroke
aneurysm
what is the difference between a hemorrhagic and ischemic CT scan
ischemic: dark shaded area
hemorrhagic: big white spot
what happens during a hemorrhagic stroke
large area fills e blood causing
- inc intracranial pressure with inflammation
- herniation
- death
what is the prognosis for someone with a hemorrhagic stroke
- older age can be a benefit bc the brain is atrophied and allows for more room to swell
- location and size
- how rapid the bleed, how much the bleed distorts the brain and shifts it
what are the types of intracranial hemorrhage
epidural: above the dura
subarachnoid space
subdural: below the dura
what are the characteristics of an epidural hemorrhage
- typically caused by a skull fracture
- arterial
- injury is usually less severe
- bleeds a lot
what are the characteristic of a subdural hemorrhage
- typically bridging viens
- brain moves within the skull, vessels don’t
- rapid decline, severe injury
- can be slow: 2-10 days later
what are the characteristics of a subarachnoid hemorrhage
- space between the outer arachnoid membrane and pia mater
- area filled with CSF
- rupture of a cerebral aneurysm or arterio-venous malformation at junction
why are berry aneurysms and why are they problematic
the are small but if they get big enough then they can rupture
- they often form on the brainstem which is not a good place for rupture
what is a arterio-venous malformation
clumping
one large vein instead of many small
what is the presentation of a hemorrhagic stroke
30-60 yo, high morbidity/mortality, serious disabilities
terrible headache
irritation of the meninges
- nuchal rigidity
- photophobia
what will be found in the CSF if there is a subarachnoid hemorrhage
blood
what is a risk with a subarachnoid hemorrhage
risk of rebleed within the first 24 hrs
what are the ways to remove an aneurysm
clip it
platinum coil
what is BE FAST
Balance: along with headache and dizzy
Eyes: sudden loss of vision (one or both)
Face: symmetry
Arm: weakness
Speech: difficulty
Time: time to call 911
what is the treatment evaluation for a stroke
3 hours is key
recognition of sx
ability to get to therapy
what is the class of alteplase
fibrinlytics
what is the moa of alteplase
promotes conversion of plasminogen to plasmin
what is alteplase used for
acute MI
PE
ischemic strokes
what is the route of alteplase
IV
what do you need to monitor after giving alteplase
BP and HR
what are the adverse effects of alteplase
inc risk of intracranial bleeding
what is the antidote for alteplase
aminocaproic acid –> anti thrombolytic
what are the functions of the left brain
logic, verbal, detail, science, names, math, strategies, order, thinking, write, communication, analytics
what are the functions of the right brain
pictures, stories, big picture, observations, shapes, music, patterns, beauty, imagination, possibilities, art
what are potential consequences of a stroke
dysphagia
motor and sensory deficits
flaccidity
spasticity
visual disturbances
- contralateral field blindness
- homonymous hemianopia
aphasia
depression
memory and behavioral problems
what is aphasia
some degree of inability to speak or to comprehend
what is dysphasia
impairment of speech
what is dysarthria
imperfect speech sounds
- word finding problems
- incorrect use of verbs
what is expressive aphasia
comprehension intact but cannot express
what is receptive aphasia
can communicate but cannot comprehend
- what is being said “can’t recieve”
what are the behavioral problems that can come up after a stroke
inc emotional response
may underestimate own abilities
slow rxn times
hesitant and cautious
may be apathetic, confused, disoriented
