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stroke Flashcards

1
Q

def. acute stroke

A
  • sudden loss of brain function
  • interuption of blood flow
  • loss of O2 and glucose to brain
  • ischemic of hemmoragic
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2
Q

def. TIA

A

self-limited episode of neuro dysfunction

- not associated with cerebral infarction

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3
Q

biggest risk for stroke

A

age

- stroke rate doubles each decade after 55

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4
Q

how has aging and deaths due to strokes changed over time

A

age of pop going up, but deaths going down (better care)

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5
Q

how will this change in future

A

interventions will plateau and deaths up again

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6
Q

impact of stroke

A

1% of canadians

3% of heath $

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7
Q

how are stroke and TIA localized

A

to a single vascular territory

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8
Q

2 keys to understanding stroke localization

A
  1. 4 major arterial territories

2. understanding underlying anatomy

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9
Q

what is origin of all cerebral blood supply

A

A arch

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10
Q

2 main branches

A
  1. internal carotid

2. vertebral

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11
Q

3 main vascular territories and the supply vessels

A
  1. brainstem
    - basilar and vert. arts.
  2. cerebellum
    - PICA
    - AICA
    - SCA
  3. main cerebral
    - MCA
    - ACA
    - PCA
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12
Q

2 deep brain structures and what supplies them

A
  1. basal ganglia - MCA and perf.

2. thalamus - top of basilar and PCA perforating

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13
Q

what is ACA territory and effect of ischemia

A
  • medial frontal and parietal lobes

- contralateral hemiparesis and anathesia- leg more

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14
Q

what is MCA territory and effect of ischemia

A

supply: lateral frontal and parietal + superior temporal
ischemia:
- contralateral hemiparersia and anasthesia face, arm>leg
- contra homonymous hemianopsia
- conta hemineglect and ipsi gazw deviation
- lagnuage impairment if on dominant side

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15
Q

what is PCA territory and effect of ischemia

A

supply - inferior temporal and occipital
ischemia
- contraleteral homonymous hemianopsia

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16
Q

what is basilar territory and effect of ischemia

A

supply - pons and midbrain
ischemia
- tracts to contrlateral
- nuclei to ipsilateral

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17
Q

what is brainstem territory and effect of ischemia

A
  • both tracts and nuclei - crossed face/body deficits
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18
Q

what are 2 cerebellar syndromes

A
  1. vermis (central) - gait ataxia and truncal instability

2. lateral - ipis limb ataxia

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19
Q

what is effect of small vessel

A
  • perfuse deeper structures

- result in small discrete lesions causing classic syndromes

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20
Q

lacunar affects of internal capsule, basal ganglia

A

all contra

  • pure hemi-motor
  • pure hemi- sense
  • hemi sensimotor
  • ataxic hemiparesis
  • dysarthia/clumsy hand syndrome
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21
Q

lacunar thalmic effects

A

contra sensory loss

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22
Q

mech of ischemia

A

insufficient blood flow leading to irreversible damage

23
Q

4 main etiologlies of ischemia

A
  1. thrmobosis
  2. embolism
  3. hemmorage
  4. hypoperfusion
24
Q

def. thrombosis

A

formation of clot or throbus in artery - triggered by pathological endothelium

25
Q

most common location of atherscleosis causing stroke

A

internal carotid

26
Q

def. embolsim

A

formation of clot in another area that breaks off and travels to brain

27
Q

2 common sources of embolism

A
  1. artery-to- artery - atherosclerosis

2. cadiac to artery - A fib, valvular disease

28
Q

2 common causes of hemm

A
  1. uncontrolled or spike in HT

2. amyloid angiopathy - weakens vessel walls

29
Q

proportion of stroke etiology

A

hemm 12-15% , rest is ischemia

30
Q

2 main ischemia etiologies

A
  1. atheroscleoris - 45%

2. cardiogenic - 20%

31
Q

modifable risk factors

A
  • HT
  • diabetes
  • hyperlipid
  • smoking
  • obesity
  • sedentary
    diet
    CAD
  • heart disease
32
Q

non-modifiable risk factors

A
  • ages
  • male
  • fam Hx
  • genes
33
Q

most important modifiable risk factor

A

HT

34
Q

what are HT targets

A

140/90 or 130/80 for diabetes

35
Q

what is blood target in diabetes

A

A1C

36
Q

2 treatments of lipids and their effects

A

fibrate - reduce chol, but no effect on stroke

statins - reduce LDL and most effective

37
Q

what is effect of statins

A
  • 25% RRR

- each 10% redcuction in LDL = 13% reduction in stroke

38
Q

what are primary and secondary targets for stroke prevention

A

primary - framingham

secondary - LDL

39
Q

what is major cardiac risk factor

A

A fib - more severe strokes

40
Q

what is use of anticoag

A

reduces stroke risk in A fib

41
Q

what to use for anticoag

A

warfarin - 66% RRR

ASA - 19%

42
Q

what is doing of warfarin

A

keep INR @ 2-3

43
Q

what is advantages to new anticoags

A
  • no INR to monitor
  • standard dosing
  • need good renal funct
44
Q

what is risk of TIA

A

high risk for stroke in next 90 days

45
Q

5 things to do after TIA

A
  1. treat HT
  2. start statin
  3. screen for diabetes
  4. antocoag
  5. lifestyle mods
46
Q

what to do to prevent thrombus formation

A

antiplatelets - ASA

  • absolute benefit small
  • but cheap and minimal adverse effects
47
Q

what is standard dose of ASA

A

anything over 30mgis good - standard is 81

48
Q

2 other options

A
  1. aggrenox

2. plavix

49
Q

what is first and second line anitplatelet therapy

A

1st - ASA
2nd - plavix daily or aggrenox BID
- used if had stroke or TIA on ASA

50
Q

2 treatments for carotid disease

A
  1. endartectomy

2. stent

51
Q

when to do endartectomy

A

stenosis > 70% - any time will benefit

50–59% - need to do in 2 weeks

52
Q

what is diff. between endartectomy and stent

A

no diff up to age 70, then end is better

53
Q

what is time for thrombolysis

A

4.5H of stroke onset

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