Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Block 5 Week 4 Dani > Stroke > Flashcards

Stroke Flashcards

1
Q

What is the definition of a TIA?

A

A clinical syndrome characterized by an acute loss of focal brain or monocular function with symptoms lasting less than 24 hrs and which is thought to be due to inadequate cerebral or ocular blood supply, without ischemic changes in Diffusion Weighted Imaging (DWI)***actually something lasting less than 15 minutes (def less than 1 hr). **w/o evidence of acute infarction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is a stroke?

A

death of brain tissue b/c of lack of blood flow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the definition (technical) of stroke?

A

Clinical syndrome characterized by an acute loss of focal brain or monocular function with symptoms lasting greater than 24 hrs and which is thought to be due to inadequate cerebral or ocular blood supply.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the 2 main types of stroke?

A

Ischemic (thrombosis-narrowed bv & embolism-traveling clot)Hemorrhagic (intracerebral & subarachnoid aneurysm)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What % of strokes are ischemic? Hemorrhagic?

A

Ischemic (80%)Hemorrhagic (20%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Which % of ischemic strokes are thrombosis? Embolism?

A

Thrombosis: 50%Embolism: 30%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is a risk for an intracerebral stroke?

A

HTN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Where does stroke fall in terms of causes of death?

A

4th leading cause of deathleading cause of disability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What types of strokes do small vessels that are thrombosed v. large vessels that are thrombosed?

A

small vessels–smaller damage amount, called lacunar strokeslarger vessels–massive stroke more likely

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the non-modifiable risk factors for strokes?

A

Age Sex-M>F Race (e.g., African-Americans) Family history of stroke Prior stroke/TIA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the modifiable risk factors for strokes?

A

SmokingHypertension Alcohol abuseDiabetes ObesityHyperlipidemia Physical inactivityAtrial fibrillationHomocystemiaCarotid stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the most common cause of subarachnoid hemorrhage? Spontaneous cause?

A

All subarachnoid hemorrhage: traumaSpontaneous causes: aneurysm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

T/F Up to approximately 10% of people who suffer transient attacks (TIAs) will develop a stroke within 5 years.

A

False. 30% of people. Huge deal.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the risk of stroke post-TIA at 1 mo? 1 year? 5 years?

A

1 mo: 4-8%1 year: 12-13%5 years: 24-29%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

T/F Death rates from strokes are increasing since the 1900s.

A

False. the death rates are decreasing–we treat them better. But it will start to increase soon just b/c of the sheer number of people.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

T/F In the elderly population, strokes are as common in males as females.

A

True.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

If you supplement a patient w/ homocystemia with Vit B…are they at less risk for a stroke or MI?

A

No. sadly.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the stroke belt?

A

coordinates with the bible belt. Southern states.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What produces the death of the neurons in a stroke?

A

death of the sodium potassium pumptissue starts to die within minutesdamage is irreversible, can’t reverse this damage but can treat.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

T/F Time=Brain.

A

TRUE! Reason for stroke units.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

T/F The duration, severity, and location of focal cerebral ischemia determine the extent of brain function and thus the severity of stroke

A

True.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Lack of ______ and _____ deplete the cellular energy stores required to maintain electrical potentials and ion gradients.The membrane that surrounds each affected neuron becomes “leaky,” and the cell loses________ & _______ , the tissue’s medium for energy exchange

A

glucose & oxygenpotassium and adenosine triphosphate (ATP)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

There are several drugs on the market that treat things related to stroke that are a part of the coagulation cascade. Which parts of the coagulation cascade are targeted?

A

Factor 10-3 drugs targetThrombin Inhibitor–used for atrial fibrillation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

On contact with collagen, ______ become activated & aggregate at the site of injury. This surface is catalytic for several coagulation reactions that generate thrombin.

A

platelets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

How does atherosclerosis begin?

A

begins in response to chronic minimal injury to endothelium of blood vessel**involves many players: monocytes, lipoproteins, platelets, lymphocytes, smooth muscle cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

T/F with more plaque formation–the more likely to have a stroke.

A

True.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What does each of these levels of atherosclerosis consist of? Types I, II, III

A

Type I: minimal endothelial injuryType II: intimal injuryType III: thrombus formation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

If you have a migraine with an aura…you could have what?

A

endothelial cell dysfunctioncould put you at greater risk to have a stroke

29
Q

Plaque builds up in the _____ layer of the blood vessel & then ____ infiltrate.

A

intimal layer of bvinflammatory cells infiltrate

30
Q

Along with macrophages, _______ cells make up a lot of the bulk of atherogenesis.

A

Smooth muscle cells. they grow in atherosclerosis.

31
Q

T/F Some plaques ulcerate, leaving the deeper layers of the blood vessel open to blood cells.

A

True.

32
Q

What makes plaques vulnerable to rupture?

A

stress on plaque cap during systolereduction of collagen content with infiltration of foam cells

33
Q

What are the 3 ways that oxidized LDL-cholesterol contributes to atherogenesis?

A
  1. Cytotoxic properties that promote endothelial injury.2. chemoattractant for monocytes3. inhibits departure of macrophages from plaques
34
Q

Describe how an MI could lead to a stroke in time.

A

MI weakens ventricle of heart. blood falls in there & you get a clot.a piece of clot breaks off & travels into general circulationsome emboli go to brain & produce a stroke

35
Q

Where do cardiogenic emboli usu lodge?

A

80% of the time–middle cerebral artery10% of the time–posterior cerebral artery10% of the time–vertebral artery

36
Q

How do large vessels sometimes lead to strokes?

A

thrombosis w/i the large vessel. Plaque formation. Narrowing of lumen.

37
Q

How does small vessel occlusion usu happen?

A

via damage by HTNleads to thickening of b.v. mediadeposition of fibrinoid materialsmall vessels often give lacunar strokesCalled lipohyalinosis

38
Q

Where do lenticulostriate arteries go?

A

to the basal ganglia

39
Q

What’s something scary to keep in mind when I get my hair cut after school gets out?

A

um…be careful when you put your head back in the tub b/c if you bang your neck too hard you could get arterial dissection & stroke out.

40
Q

Aside from the things we have already talked about…what are some causes of stroke?

A

fibromuscular dysplasia: overgrowth of intima & mediaArteritis (Takayasu’s & Giant Cell)Arterial DissectionDecreased systemic perfusionFabry’s disease

41
Q

In muscular dysplasia..you can get bleeding of _____ blood vessels.

A

extra cranial blood vessels

42
Q

What are some important stroke warning signs?

A

Sudden weakness, paralysis, or numbness of the face, arm and the leg on one or both sides of the bodyLoss of speech, or difficulty speaking or understanding speechDimness or loss of vision, particularly in only one eyeUnexplained dizziness (especially when associated with other neurologic symptoms), unsteadiness, or sudden fallsSudden severe headache and/or loss of consciousness

43
Q

What are the things on your differential diagnosis when you see a patient with stroke symptoms?

A

Ischemic StrokeHemorrhagic StrokeCraniocerebral/cervical traumaMeningitis/ EncephalitisIntracranial MassSeizure with persistent neurological signsMigraine with persistent neurological signsMetabolic problem

44
Q

What are 2 types of intracranial mass on your differential diagnosis?

A

tumorsubdural hematoma

45
Q

What are some metabolic considerations when you see a patient with stroke symptoms?

A

Hyperglycemia Hypoglycemia Post-cardiac arrest ischemia Drug/narcotic overdose

46
Q

What do you associate with each of these stroke types? Atherothrombotic?Embolism?Primary small vessel disease?

A

Atherothrombotic: occlusion of larger arteriesEmbolism: cardiogenicPrimary small vessel disease: lipohyalonosis

47
Q

Which brain tissue are you trying to save with stroke treatment?

A

the penumbra

48
Q

When a person comes into the ER for stroke symptoms…which test do you usu order & why?

A

CT–good in times of emergency, won’t be able to see stroke right away…but can see if it is a hemorrhagic stroke. Then DON’T give anti-thrombolytic therapy to the pt!

49
Q

T/F Even in left-handed people the left hemisphere is often dominant.

A

True.

50
Q

What are some signs of a left hemisphere stroke?

A

Aphasia Right hemiparesis Right-sided sensory loss Right visual field defect Poor right conjugate gaze Dysarthria –slurred speechDifficulty reading, writing, or calculating

51
Q

What are some signs of a right hemisphere stroke?

A

Neglect of left visual field Extinction of left-sided stimuli-move 2 hands & they only see 1.Left hemiparesis Left-sided sensory loss Left visual field defect Poor left conjugate gaze Dysarthria Spatial disorientation Drowsy, sleep a lot. **sometimes these pts don’t realize that anything is wrong.

52
Q

What are some signs of a Posterior Circulation (Vertebrobasilar Territory) Stroke?

A

Ataxia, gait abnormalitiesDiplopia, oscillopsia, nystagmus, dysconjugate eye movementsNausea & vomiting (center is in area post-rema)Crossed hemiparesis, hemisensory deficitsHeadache more common

53
Q

What are some possible neurodeficits secondary to a lesion that you could see in the frontal lobe?

A

akinesiaapraxiaataxiabehavioral changes

54
Q

What are some possible neurodeficits secondary to a lesion that you could see in the parietal lobe?

A

sensory losshemianopiaapraxiaGerstmann’s syndrome

55
Q

What are some possible neurodeficits secondary to a lesion that you could see in the temporal lobe?

A

Pure word deafnessBehavioral disturbancesSuperior quadrant visual loss

56
Q

What are some possible neurodeficits secondary to a lesion that you could see in the occipital lobe?

A

vision loss

57
Q

Tests for the Emergent Evaluation of the Patient with Acute Ischemic Stroke?

A

CT of the brain without contrast Electrocardiogram Chest x-ray Hematologic studies Serum electrolytes Blood glucose Renal and hepatic chemical analyses National Institutes of Health Scale (NIHSS) score

58
Q

Under special circumstances extra tests that may be necessary?

A

Cervical spine x-rayArterial blood gasLumbar punctureElectroencephalogram (EEG)

59
Q

What are some things to make sure you do with stroke patients?

A

maintain adequate tissue oxygenation & O2 inhalationmaintain optimal BP b/c autoreg is faulty during a strokemaintain good blood glucose-hyperglycemia poorer outcomes.management of fever–hyperthermia worsens ischemia

60
Q

When should TPA be given?

A

hopefully w/i 1 hour.but can be given up to 4.5 hours after stroke symptoms began. **b/c of reperfusion injury

61
Q

What are some good anti-platelet agents?

A

Aspirin Plavix AggrenoxStatinsAtorvastatin

62
Q

What are some known factors that cause stroke progression?

A

HypotensionHyperglycemiaHyperthermiaInfectionCerebral hypoperfusion

63
Q

With brain edema, you see deviation of what?

A

the falx cerebri

64
Q

How do you (generally speaking) treat brain swelling?

A

fluid restrictionhyperventilation (lower PCO2) osmotic diureticsdrainage of CSF (ventriculostomy)surgery (lobectomy)peaks at 3-4 days following stroke

65
Q

So a stroke patient had super high BP & they lowered it artificially to 130/80 mmHg. Then his stroke symptoms did not resolve after TPA. Why?

A

b/c his autoreg is out of whack b/c of stroke & lower his BP that drastically cause lack of perfusion to his brain tissue. Lost the penumbra. **in stroke patients cerebral pressure directly related to cerebral blood flow

66
Q

Med student who skiied & fell & then had stroke symptoms later on…what happened?

A

they had dissection of left vertebral artery

67
Q

T/F No patient should be given dextrose solution who has had a stroke.

A

True. Could cause hyperglycemia if a diabetes pt too & could worsen stroke.

68
Q

Why do you need to take a CT of a patient 24 hours after the stroke?

A

to see if the TPA has caused a hemorrhage

69
Q

When can you use VTE prophylaxis?

A

36 hours after a stroke

Block 5 Week 4 Dani (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions