Stroke Flashcards
Definition of Stroke
Illness of brain with acute onset
Three Criteria of stroke
Sudden Onset
Focal Neurological Deficit
Cerebrovascular Cause
Does a stroke result in altered consciousness?
not usually
Stoke present bilateral/unilateral/both
Unilateral
Is fainting a sign of a stroke?
no… bc its bilateral
What are some warning signs of a stroke?
Hemifacial paralysis Vision loss Numbness on one side Loss of speech or Comprehension of speech Unsteady Gait
Most common cerebrovascular cause of stroke?
Ischemia~ 85% time
Less common cerebrovascular cause of stoke?
Hemmorhagic stroke~ 15%
What are two types of ischemic stoke?
Thrombotic and Embolic
Difference between thrombus and emobois
Thrombus is clot forming in brain dt fibrin strands clumping together
Embolis is a clot that forms somewhere else and is kicked out by the heart and travels up to brain
What are two types of Hemorrhagic stoke?
Intracerebral (Hypertension HTN)
Subarachnoid (aneurysm)
What is the least common type of stoke?
Hemorrhagic brought on by aneurysm
Where does a Hemorrhagic intracerebral stroke occur?
D/t high bp and is the blood within the parachyma–NOT in the subarachnoid space
Where does an aneurysm occur?
In the subarachnoid space–you are born with this and can rupture at any time and fill the fissures around brain.
What does ICH stand for?
Intracerebral Hemorrhage
On a CAT… what color is blood?
White
What are the two cause of a subarachnoid hemorrhage?
Aneurysm rupture and trauma… get patient history
What defines an Ischemic stroke?
Arterial occlusion with brain infarction = tissue in brain is dead
Stoke happens to …
the patient
infarct happens to…
the brain
Where does the PCA come from?
Vertebral arteries–> Basal Artery–> gives off PCA
Where does the ACA arise?
Internal carotids –> one of it’s terminal branches.. runs medially and anteriorly
Where does the MCA arise?
Internal carotids–> one of it’s terminal branches–> runs laterally in the sylvian fissure
Where do most strokes occur?
2/3 in MCA
What is the Penumbra
source of stroke… key area to fix when trying to deal with a stroke
During a stroke… where does collateral blood flow come from? Why?
from neighboring regions… d/t autoregulation
What do we look for on an MRI?
White tissue… shows where blood is located.
Where is an ACA stroke going to show up on MRI?
Midline in front
What does a perfusion scan tell us?
Where we aren’t getting any blood
What will our penumbra look like on perfusion scan?
RED
What colors represent decreased perfusion?
green/yellow/red
Why is a perfusion scan beneficial vs an MRI?
Gives us more information about specific location of infarct.. pinpoints region that needs to be salvaged to stop spread of tissue loss
What does a peneumbra look like on MRI?
bright white core
What will images look like for MCA occlusion?
angiograph?
MRI?
CAT?
angiograph will show occlusion of blood vessel lateral to circle of willis
MRI will help show dense core of penumbra
CAT scan will show us ride range are of low blood flow in bright white… usually to outside of hemi
What is a method of intervention for stroke?
catheter angiogram
Some examples of disease states that meet:
acute onset an focal neuro deficit but not cerebrovascular cause?
Parkinsons, some trauma, MS, migraines
Is postural dizziness a sign of stroke?
no
Patient with garbled, nonsensical speech, sudden onset… meet criteria for stroke?
yes
Patient with lateropulsion, dizziness and emesis meet criteria for stroke?
yes
What are Unmodifiable risk factors for stroke?
age, gender, race, heredity
Modifiable risk factors for stroke?
Hypertension Hyperlipidemia Heart disease Hyperhomocyteinemia Obesity Diabetes/inactive smoking/heavy alcohol use carotid disease
Why do people have stokes?
ALL about risk factors
3 stages of stroke management
Acute therapy
Recovery
Prevention of secondary stroke
Options for acute therapy
Thrombolysis–clot busting via drug intervention
TPA-tissue plasminogen activator; MUST BE DONE RIGHT AFTER STROKE
Key for recovery from stroke?
Limit neuro damage: prevent complications, rehab and education of new habits
Prevention of secondary stroke steps are:
Based on risk factor modification
And are specific to mechanism of stroke
Physical symptoms of Left PCA stroke?
Right body numbness
Right homonymous hemianopia (vision loss)
Physical symptoms of Left MCA stroke?
Right arm and face weakness
Aphasia : difficulty talking
Physical symptoms of Right MCA stroke?
Left arm and face weakness; no speech deficiets
Physical symptoms of right superior MCA stroke?
Weakness and/or sensory loss of LEFT face, hand, arm and trunk
Sensory loss from left face, hand and arm
Left hemineglect
Right inferior MCA stroke
Sensory loss from RIGHT face, hand and arm
Wernickes aphasia: posterior aspect of superior temporal gyru
Left inferior infarct of MCA
Left Superior infarct of MCA: symptoms
Weakness and/or sensory loss of RIGHT face, hand, arma and trunk
Brocas aphasia
Follwing symptoms describe: personal neglect—unaware of left half of body or environment: may not acknowledge that one half of body belongs to them or may only acknowldege half of environment
Cortical injury
Internal carotid artery has which two terminal branches?
ACA and MCA
Sing and Symptoms of Infarct of ACA on Left side
Right leg and foot weakess and behavioral changes d/t frontal lobe
precentral gyrus which is supplied by ACA is repsonsible for what?
contralateral leg and foot WEAKNESS if infarct
postcentral gyrus which is supplied by ACA is repsonsible for what?
Contralateral leg and foot SENSATION loss
