stroke Flashcards by Unknown Unknown

what are the extracranial symptoms that affect stroke?

Systemic blood output (MAP)
Cardiac output
Viscosity of blood

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what are the intracranial factors that affect stroke?

INTRACRANIAL PRESSURE
atherosclerosis
blood vessels

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how many types of stroke are there?

2, ischemic and haemorrhagic.
TIA is under ischemic

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what are the causes of ischemic stroke?

thrombotic:
- htn
- atherosclerosis
-large vessel (MCA infarct)
- small vessel (lacunar infarct)

embolic
-dislodge of blood clots
>carotid plaque
>atrial fibrillation
>atherosclerotic plaque

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what is the difference between thrombotic and embolic clots?

thrombotic clots form in the arteries that supply the brain

embolic clots form elsewhere in the body and travels through the blood stream

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what are the causes of haemorrhagic stroke?

ICH- intracerebral
-HTN
-thrombolytic drugs

SAH- subarachnoid harmorrhage:
- aneurysm rupture

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what is ICH? what is its characteristics?

it is bleeding in the brain and it occurs without warning

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what is SAH and what is its characteristics?

bleeding in the subarachnoid space
severe headache- thunderclap headache. CT shows a star shaped image.
associated with activities

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What is FAST?

FACIAL DROOP
ARM WEAKNESS
SPEECH DIFFICULTY
TIME TO CALL 995

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what is MAP and what can u tell based on a MAP?
what is the normal value?

Mean arterial pressure - systemic blood pressure
it is a better indicator of perfusion to vital organs than systolic BP.
it should be maintained at MAP>65

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which arteries are involved in TIA?

carotid arteries and vertebrobasilar arteries

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what happens when the carotid arteries are affected in TIA? what symptoms will be presented?

transient loss of vision in 1 eye
hemiparesis
inability to speak

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what are carotid arteries?

they are major blood vessels that supply blood to head and brain. impt to maintain normal brain function

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what are vertebrobasilar arteries?

tehy are a pair of major blood vessels that supply to the posterior part of the brain and brainstem.

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what symptoms are presented when the vertebrobasilar arteries are affected?

tinnitus
verigo and blurring vision
hemiparesis

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what are the acute management in ED? (7)

1) assess ABCs and v/s
2) provide oxygen if hypoxemic
3) Obtain IV access and labs
4) Check CBG
5) Perform neurologic screening, GCS, NIHSS
6) Activate stroke team, STAT CT brain
7) 12 lead aECG

what are the diagnostic tests for stroke?

CT brain (hemorrhagic)
MRI (ischemic)
Angiogram (aneurysm)
Carotid u/s
2D echo (size, shape of heart, detect blockage)
EEG

what is the CT brain good for?

-identify haemorrhage and boney injury
it does not show early ischemia/ anoxia - absence of O2

What is MRI good for?

it is more useful than a CT scan to diagnose ischemic stroke within 12 hours of the first symptom

what is CT angiogram good for?

identify thrombus in major vessels or vascular malformations such as aneurysm

what does a spot sign in CT angiogram mean?

contrast extravasation into haematoma showing active bleed.

what is 1 con of CT Angiogram?

iodinated contrast can cause allergic reactions and kidney injury.

what is ischemia?

a reduction in blood flow that can last for several seconds to a few minutes

what is infarction

If there is cessation of flow for than a few minutes, infarction of brain tissue occurs
● Ischemia or infarction may be focal (brain vessels) or generalized

explain the pathophysiology of ischemia stroke

Reduce blood flow in the arteries can be thrombosis or embolism ● Reduction in blood flow deprives the cells of O2 and glucose ● Lack of energy causes membrane dysfunction and entry of ions ● Edema of cells occurs, followed by death of cells ● Vascular changes aggravate edema water follows ions hence causes edema

what is a core and penumbra?

Core: ischemic area Penumbra: hypoxia of cells near area of original insult over time hence need to protect penumbra by ↑ O2 transport to the danger zone, limit cell death

what are the causes of thrombosis?

Arterial disease ○ Atherosclerosis, arteritis ● Blood disorders ○ Thrombocytosis, polycythemia

explain the process of atherosclerosis

Fatty streaks in intima layer ○ Oxidation of LDL cholesterol by free radicals released by macrophages, endothelial cells, smooth muscle cells ○ Platelet & fibrin deposition as a result of endothelial injury ○ Accumulation of complex lipids, proteins, and carbohydrates, proliferation of cells in intimal layer of an artery ○ Plaque formation > rupture >thrombosis

what is stroke in evolution and how does it occur?

Increasing obstruction may involve a proximal branch of the artery and increase the deficit:. the damage can continue for several days

does resolution of edema after the acute stage help to restore function?

yes

list the common sites for ICH

basal ganglia, thalamus, pons cerebellum

symptoms of anterior cerebral artery stroke

prefrontal lobe: confusion, disorientation medial surface: paralysis, sensory loss in the opposite leg apraxia, abulia, urinary incontinence,

signs and symptoms of right side brain damage

- paralysis of left side - spatial perceptual deficits - quick and impulsive - performance memory deficit

signs and symptoms of left side brain damage

- paralysis of right side - speech language deficit - slow and cautious - language memory deficit

inclusion criteria for iv rtpa

18 years and above  Time from “last seen well” < 4.5 hours  Ischemic stroke with significant neurological deficit NIHSS > 4

exclusion criteria for iv rtpa

Evidence of ICH or SAH  Active internal bleeding  Stroke or HI within 3 mths  Platelet < 100,000  On anticoagulation (warfarin) or INR > 1.5 or PT > 15  Received heparin within 48hrs and aPTT elevated above normal range  BSL < 2.7 or > 22.2mmol/l Inclusion Exclusion