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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
most common location of atherscleosis causing stroke
internal carotid
26
def. embolsim
formation of clot in another area that breaks off and travels to brain
27
2 common sources of embolism
1. artery-to- artery - atherosclerosis | 2. cadiac to artery - A fib, valvular disease
28
2 common causes of hemm
1. uncontrolled or spike in HT | 2. amyloid angiopathy - weakens vessel walls
29
proportion of stroke etiology
hemm 12-15% , rest is ischemia
30
2 main ischemia etiologies
1. atheroscleoris - 45% | 2. cardiogenic - 20%
31
modifable risk factors
- HT - diabetes - hyperlipid - smoking - obesity - sedentary diet CAD - heart disease
32
non-modifiable risk factors
- ages - male - fam Hx - genes
33
most important modifiable risk factor
HT
34
what are HT targets
140/90 or 130/80 for diabetes
35
what is blood target in diabetes
A1C
36
2 treatments of lipids and their effects
fibrate - reduce chol, but no effect on stroke | statins - reduce LDL and most effective
37
what is effect of statins
- 25% RRR | - each 10% redcuction in LDL = 13% reduction in stroke
38
what are primary and secondary targets for stroke prevention
primary - framingham | secondary - LDL
39
what is major cardiac risk factor
A fib - more severe strokes
40
what is use of anticoag
reduces stroke risk in A fib
41
what to use for anticoag
warfarin - 66% RRR | ASA - 19%
42
what is doing of warfarin
keep INR @ 2-3
43
what is advantages to new anticoags
- no INR to monitor - standard dosing - need good renal funct
44
what is risk of TIA
high risk for stroke in next 90 days
45
5 things to do after TIA
1. treat HT 2. start statin 3. screen for diabetes 4. antocoag 5. lifestyle mods
46
what to do to prevent thrombus formation
antiplatelets - ASA - absolute benefit small - but cheap and minimal adverse effects
47
what is standard dose of ASA
anything over 30mgis good - standard is 81
48
2 other options
1. aggrenox | 2. plavix
49
what is first and second line anitplatelet therapy
1st - ASA 2nd - plavix daily or aggrenox BID - used if had stroke or TIA on ASA
50
2 treatments for carotid disease
1. endartectomy | 2. stent
51
when to do endartectomy
stenosis > 70% - any time will benefit | 50--59% - need to do in 2 weeks
52
what is diff. between endartectomy and stent
no diff up to age 70, then end is better
53
what is time for thrombolysis
4.5H of stroke onset

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