Stroke Flashcards
what is the leading cause of permanent disability in adults
stroke
what is the 3rd leading cause of death in North America
stroke!
what time do strokes normally occur
in the morning between 8AM and 10AM
age group most affected by strokes
over the age of 65
which sex is more affected by strokes
males
what race is affected more by strokes
African Americans more than Caucasians
Reson why strokes often occur in the morning
due to blood pressure
risk factors fro stroke
hypertension heart disease previous stroke or TIA carotid bruit diabetes mellitus smoking age
number for risk of stroke in hyptertension
6 X
number for risk of stroke in heart disease
2-6X
number for risk of stroke in previous stroke/TIA
10X
risk for stroke if carotid bruit
3x
risk of stroke for smoking
2x
age for stroke risk
doubles every 10 years after 55
number one risk factor for stroke
hypertension
examples of potential genetic risks factors for stroke
apolipoprotein e4
elevated homocysteine levels
factor V mutation
hemorrhagic stroke types
intracerebral and subarachnoid
types of ischemic strokes
atherothrombotic/embolic
cardioembolic
small vesel disease
cardiogenic emboli strokes are commonly caused by
atrial fibrillation
what type of emboli are usually larger, longer, lasting and MORE DAMAGING than other sources
atrial fibrillation emboli
what is nonbacterial thrombotic endocarditis
condition where you develop clots in the heart because you have cancer somewhere else
if both hemispheres are involved what should you look for
atrial fibrillation emboli
what is a transient ischemic attack
last less than 24 hours, a sudden FOCAL neurlogical deficit that is confined to an area of brain or eye perfused bya SPECIFIC artery
what is a RIND
reversible ischemic neurological decifit that lasts up to a week
Carotid TIA symptoms
unilateral weakness and numbness, aphasia, and monocular ision loss!
vertebrobasilar TIA symptoms
bilateral weakness, numbness and vision loss with a combination of diplopia, vertigo, ataxia, and dysphagia
partial or complete vision loss in one eye
amaurosis fugas
like a shade covered by eye
amaurosis fugax
how long does amaurosis fugas last
less than 5 minutes
embolic infract
seizure
focal deficit
sudden onset
hemorrhagic transformation
thrombotic infract
slowly progressive
preceded by TIA
symptoms of internal carotid occlusion
usually asymptomatic if circcle of willis is well developed
hemiplegia, hemianesthesia (leg more affected than face and arm, urinary symptoms, apathy)
ACA occlusion
apathy associated with
ACA occlusion
urinary symptoms associated more with
ACA occlusoin
homonomous hemianopia indicative of
MCA occlusion
aphasia if dominant hemispher affected
MCA occlusion
hemiplegia and hemianesthesia of face and arm more than leg
MCA occlusion
PCA occlusoin
homonomous hemianopia, hemiplegia, hemiparesis, affects the peduncles and brainstem
also known as nonfluent, expressive or anterior aphasia
brocas aphasia
characterized by broken difficulties producing speech but understanding is intact
brocas aphasia
also known as fluent, receptive or posterior aphasia
wernicke aphasia
characterized by impaired comprehension, paraphasia, neoglisms and gibberish
wenicke aphasia
lesion of posterior perisylvian region produces what type of aphasia
wernicke aphasia
lesion of the arcuate fasciculus leads to
conduction aphasia
common symptom of conduction aphasia
difficulty with reptition
type occlusion resulting in global aphasia
MCA occlusion
small vessel disease is also known as
lacunar infracts
presentation of lacunar infarcts
pure motor pure sensory pseudobulbar palsy clumbsy hand hemitaxic-hemiplegic
how are lacunar infarcts diagnosed
clinical syndrome
what are risk factors for small vessel disease
hypertension and diabetes
recurrence rate of lacunar infarcts is high if what
if blood pressure is NOT controlled
what is used to diagnose lacunar infarcts
MRI’s NOT CT SCAN!!!
how are lacunar infarcts treated
control blood pressure
antiplatelet agents
carotid endartectectomy
what are some common causes of a carotid dissection
migraines
oral contraceptive in smokers
cocaine and vasoactive agents
third nerve palsy and contralateral hemiplegia from midrain stroke
weber syndrome
occlusion of verteral or PICA resulting in ipsilateral facial numbness, ataxia, horners, dysphagia, hoarseness, loss of taste, numbness, and CONTRALATERAL pain and temperature
wallenberg syndrome
what should you do to prevent ischemic penumbra from growing
relative hypotention
hypoxia
hyperglycemia (over 200)
hyponaturemia
what are neuroprotetive agents for ischemic penumbra
NMDA, NO, GABA, calcium, and free radicals
examples of antiplatelet agents
aspirin
ticlopidine
clopidogrel
dipyridamole (modofied release)
which antiplatelt drug requires monitoring
ticlopidine (neutropenia and thrombocytopenia)
what drug is used to lower cholesterol
pravastatin
anticoagulative drugs
heparin
lowering cholesterol drugs
pravastatin (normal LDL<70)
patients with asymptomatic carotid stenosis
60% stenosis did better with surgery
symptomatic carottid stenosis
greater than 70% stenosis did beter with surgery
asymptomatic carotid stenosis approach
control risk factors
educate about TIA symptoms
cardiac workup
surgery if indicated
what are the indications for anticoagulation
progressive TIA
known source of emboli
Afib
hypercoagulable states
what are some contraindications of for haparin
sensitivity to heparin
bleeding
uncontrolled hypertension
large infracts
what are some complications of heparin therapy
hemorrhage excessive anticoagulation hypertension large infracts embolic infarcts thrombocytopenia
what is TPA
converts plasminogen to plasmin resulting in fibrinolysis and must be used within the first
what drug do you use first to control someones blood pressure before administrating TPA
labetalol
what are the features hypertensive encephalopathy
headache, confusion, seizure, and focal deficit
what is transient global amnesia
sudden loss of memory that occurs in middle age to elderly that’s cause ins most likely vascular in nature with a benign prognosis
what decades are associated with giant cell arteritis
6-8th decades
features of temporla arteritis
headache, fever, anorexia, blidness and tender artery and aching stuf muscles
treatment of temporal arteritis
self limited, steroids
what are the causes of idiopathic intracranial hypertension
pregnancy
sinus thrombosis
obesity
vitmain A, old tetracycline and steroids
features of IIH
headache, papiledema, Cranial Nerve 6 Palsy
spinal tap pressure greater than 250 indicates
increased pressure
how do you treat idiopathic intracranial hypertension
self limited, diruetics, surgerym succcessive spinal taps
venous thrombosis caused by
idiopathic, pregnancy, trauma, infection, tumors, oral contraceptives, malnutrition, hematological
features of venous thrombosis
papilledema, seizures, cranial nerve deficits, proptosis, chemosis, and focal deficits
located in the white matter and is associated with a tumor or hematoma
vasogenic edema
result of cellular swelling and involves both the gray and white matter and is associated with hypoxia and infraction
cytotoxic edema
how do you treat cerebral edema
hyperventilation
mannitol/glycerol
steroids
diruetics–pee off the fluid
what is the most common cause of intraparenchymal hemorrhage
hypertension due to rupture of small penetrating arteries
location of intraparenchymal hemorrhage
putamen, thalamus, pons cerebellar lobar
blood in CSF is indicative of
subarachnoid hemorrhage
95% of subarachnoid hemorrhages are located in the
anterior circulation
what two diseases are associated with subarachnoid hemorrhage
polycystic kidney disease and coarctation of the aorta
clinical features of subarachnoid hemorrhage
sudden worst headache of life, nuchal rigidity, alert to coma, focal deficits, and may have warning leak
Hess and Hunt grading scale type 1
asymptomatic, slight headache
Hess and Hunt grading scale type 2
moderate to severe headache; nuchal rigidity
Hess and Hunt grading scale type 3
drowsy, mild focal deficits
hess and hunt graiding type IV
semicomatose, posturing
hess and hunt grading type V
deep coma, decerebrate rigidity
complications to subarachnoid hemorrage
vasopasm
rebleeding
hydrocephalus
diagnosis of subarachnoid hemorrhage
H and P
CT scan
lumbar puncture
angiogram
nimodipine
calcium channel blocker that has been shown to prevent vasospasm from happening due to subarachnoid hemorage
treatment of subarachnoid hemaorrhage
nimodipine, bed rest, sedation, control bp, stool softener, pain, surgery, coiling
caused by septic emboli which lodges and weakens the blood vessel walls and is associated with bacterial endocarditis
mycotic aneurysms
what should you NOT DO WITH mycotic aneurysms
do NOT anticoagulate
features of areteriovenous malformation
headache, seizure, bruit, and hemorrhage
lucid interval
epidural hematoma
laceration of middle meningeal artery
epidurla hematoma
type of hemorrhage where are most often comatose from the start
acute subdural hematoma
tearing of briding veins
acuete subdural hematoma
signs of subdural hematoma
blown pupil, hemiplegia, cushingg’s reflex, and altered respirations
