Stroke Flashcards
Neurologic deficits Ischemic or hemorrhagic Neurologic deficits vary; 3rd leading cause of death in North America Survivors have some degree of impairment Highest incidence in people more than 65
Stroke or Brain Attack
Brain is 2% of body wt but requires 20% of Cardiac output and requires 20% of body’s oxygen consumption
- Cerebral blood flow is self regulated (Autoregulation)
- Maintains a constant blood flow despite changes in systemic blood pressure.
- Autoregulation is lost when
- systemic BP less than 50 mmHg or above 160 mmHg
- Cerebral Blood flow increases with increase CO2 concentration, increased hydrogen ion concentration and decreased oxygen conc.
Perfusion required/ stroke
Blood flow and oxygenation decreased
- to cerebral neurons
- cellular metabolism ceases
- cells swell
- Dead/dying cells surrounded by Penumbra
- neurologic deficits used to identify location
- contralateral deficits
Pathophysiology and Etiology stroke
- Ischemic but still viable cerebral tissue
- This region will die if reperfusion is not established during the early hours.
- The penumbra is where pharmacologic interventions are most likely to be effective.
sm. time frame given for TPA (3 to 4.5 hrs)
Penumbra; the partially shaded outer region of the shadow cast by an opaque object.
Ischemic strokes; blood clots, stenosis
- transient ischemic attack (TIA)
- mini stroke
- Thrombotic stroke
- occlusion of large vessel by thrombus; plaque build up over years.
- Embolic stroke
- blood clot or matter through cerebral vessels
A fib; emoblic stroke clots in atrium and embolizes
Pathophysiology and Etiology; Stroke
Hemorrhagic stroke *Intracranial hemorrhage; worst headache of my life. pass out *Ruptured cerebral blood vessel *form that is most fatal -Types: Intracerebral Subarachnoid #1 cause HTN
Pathophysiology and Etiology; Stroke
Hypertension Heart disease Diabetes mellitus Sleep apnea Blood Cholesterol levels Smoking Sickle Cell disease Substance abuse Living in stroke belt; southeastern US. greasy foods; soul foods
Risk Factors of Stroke
Fam hx Obesity Sedentary lifestyle Recent infections Hx of TIA's Oral contraceptives Pregnancy Childbirth Menopause Migraines with aura Autoimmune disorders Clotting disorders Previous stroke
Other Risk Factors for Stroke
Cerebral artery involved; varies
Area of brain affected; varies
Focal; one-sided
Stroke clinical manifestations
Weakness of face, arm, leg Numbness of one side Loss of vision Speech difficulties Sudden severe headace Difficulty balancing
FAST; face, arm drop, speech, time
**Quicker TPA better they will do. 3-4.5 hr window
Clinical Manifestations of Stroke
Call 911 immediately
Sensory Perceptual deficits:
- Hemianopsia; 1/2 visual field
- Agnosia; can’t recognize objects
- Apraxia; clumsiness. romberg test
- Neglect syndrome; right sided CVA; don’t recognize left side of body is theirs.
- Pain
Complications of stroke
Cognitive and behavioral changes;
- changes in consciousness
- emotional lability
- loss of self-control
- decreased tolerance for stress
- intellectual changes
Complications of stroke cont.
Communication disorders:
- Result of stroke affecting dominant hemisphere. Left side/language
- Aphasia;
- expressive; can’t express
- receptive; hearing
- mixed or global
- dysarthria; movement
Complications of stroke
Motor deficits: *mild weakness to severe limitation *weakness, paralysis, spasticity *Specific deficits; -hemiplegia, -hemiparesis -flaccidity -spasticity Elimination disorders; -partial loss of sensations that trigger elimination; Contractures from old strokes Flaccidity from new strokes
Complications of stroke
Motor deficits on right side Right visual field deficits Language deficits; aphasia, agraphia or alexia Slow and cautious behavior style Anxiety before new skills attempt Frustration, anger, depression, worrisome Sense of guilt or worthlessness Difficulties with memory Chewing or swallowing problems
Left sided CVA
