What are symptoms associated with Stroke? 9

- Hemiparesis, monoparesis: paralysis of half or one part of the body - Hemisensory deficits: Loss of sensation - Visual field deficits: Decreased and or double vision - Facial droop: Face literally droops - Ataxia: Loss of coordination - Vertigo: Dizziness - Aphasia: Loss of speech - Headache: Sudden and Severe - Decrease in level of consciousness

What are early management guidelines? 5

- 911, EMS protocols, stroke assessment - Non-contrast-enhanced CT or MRI - Blood glucose: Checked because hypoglycemia can mimic some symptoms of a stroke - Stroke rating scale (NIHSS) - ECG and other tests, but should not delay treatment

Stroke Flashcards by Bryan Smith

What is CVA stand for?

CVA: Cerebral Vascular Accidents aka stroke

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What is the official definition of a CVA?

Neurological deficit attributed to acute focal injury of the CNS by a vascular cause

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Difference between TIA and a stroke?

A transient ischemic attack (TIA) happens when blood flow to part of the brain is blocked or reduced , often by a blood clot. After a short time, blood flows again and the symptoms go away.

With a stroke, the blood flow stays blocked, and the brain has permanent damage.

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What are the 5 main types of stroke?

Ischemic stroke ~85% of strokes
Intracerebral hemorrhage
Subarachnoid hemorrhage
Cerebral venous thrombosis
Not otherwise specified (NOS)

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Stroke is the ____ leading cause of death.

Fourth

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Morbidity

refers to the unhealthy state of an individual

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Stroke is the most__________cause of morbidity

prevalent

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1 out of ___ deaths in the U.S. are from a stroke

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Ischemia

an inadequate blood supply to an organ or part of the body, especially the heart muscles.

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What does Ischemia cause?

5 steps

Deprivation of oxygen and glucose
Causes depletion of ATP
Loss of membrane potential
Cytoplasmic Calcium Levels
Enzymatic Processes and cellular injury

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What is infarction?

tissue necrosis (CELL death)

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What are two types of Ischemic Stroke?

What % of strokes are Ischemic?

Embolus and Thrombus Ischemic Strokes

85% of strokes

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What is an Embolic Ischemic Stroke?

What is most frequently affected?

These are caused by a blood clot or plaque debris that develops elsewhere in the body and then travels to 1 of the blood vessels in the brain via the bloodstream.

Middle cerebral artery most frequently affected

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What is a Thrombotic Ischemic Stroke?

What is effected?

These are caused by a blood clot that develops in the blood vessels inside the brain.

carotid bifurcation, origin of the middle cerebral artery, end of basilar artery

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What are common sources for Embolic Ischemic Stroke?

Cardiac: MI, valvular disease, atrial fibrillation

Carotid artery: atherometous plaques

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What are symptoms associated with Stroke?

Hemiparesis, monoparesis: paralysis of half or one part of the body
Hemisensory deficits: Loss of sensation
Visual field deficits: Decreased and or double vision
Facial droop: Face literally droops
Ataxia: Loss of coordination
Vertigo: Dizziness
Aphasia: Loss of speech
Headache: Sudden and Severe
Decrease in level of consciousness

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What are early management guidelines?

911, EMS protocols, stroke assessment*
Non-contrast-enhanced CT or MRI
Blood glucose: Checked because hypoglycemia can mimic some symptoms of a stroke
Stroke rating scale (NIHSS)
ECG and other tests, but should not delay treatment

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What is the best way to treat an Ischemic Stroke?

Tissue plasminogen activator (tPA)

Enzyme that binds to fibrin in a thrombus
Converts plasminogen to plasmin
fibrinolysis (CLOT BUSTER)

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What timing intervals are necessary for good treatment of Ischemic strokes?

Imaging within 45 minutes of arrival
tPA administration within 60 minutes of arrival
tPA within 3 hours of stroke onset

What is important to remember about TPA

Only use with Ischemic Stroke!!

What are other strategies to treat Ischemic Stroke?

Control blood pressure
Control blood glucose
Maintain oxygenation
Avoid hyperthermia (fever)
Thrombectomy - involves removal of thrombi (blood clots)
Surgery – Besides Thrombectomy what is there?
Aspirin 325 mg within 24 to 48 hours

how can one recover from a Ischemic stroke?

Physical therapy
Occupational therapy
Speech therapy
Manage risk factors
May take months, may not be complete

What risk factors can be managed to help prevent Ischemic stroke?
Name 5

Hypertension
Diabetes
Atherosclerosis
Metabolic syndrome
Atrial fibrillation
Sleep apnea
Carotid disease
Cardiomyopathy
MI, ventricular thrombus
Mitral disease
Not Smoking
LimitingAlcohol use
Not being Obesity
Na intake

What is important to note when using medication to help treat a Ischemic stroke?

Depends on nature of risk (intracranial atherosclerosis, a-fib, MI, LV thrombus, cardiomyopathy,etc)

What are 4 types of medications that can be used to help prevent Ischemic stroke

- Antiplatelets - Vitamin K antagonists - Direct Thrombin Inhibitor - Factor Xa inhibitors

What are examples of Antiplatelet drugs?

Aspirin Clopidogrel Dipyridamole

What are examples of Vitamin K antagonist?

Warfarin

What are examples of Direct Thrombin Inhibitor?

Dabigatrin

What are examples of Factor Xa Inhibitors

Rivaroxiban | Apixiban

Hemorrhagic stroke

a blood vessel ruptures and blood accumulates in the tissue around the rupture. This produces pressure on the brain and a loss of blood to certain areas.

What % of strokes does Hemorrhagic make up?

-Approximately 8-18% of all strokes

What are the fatality rates within 30 days of a hemorrhagic stroke?

-35-45% fatality rate within 30 days

What are symptoms of a hemorrhagic stroke? | 5

- Headache - Altered mental status - Seizures - Nausea, vomiting - Depends on area involved – can be similar to ischemic presentation

What are the two types of hemorrhagic stroke?

Intracerebral hemorrhages and Subarachnoid

What are Intracerebral hemorrhages Where do they occurs? What could cause them?

- Focal bleeding within the brain parenchyma or ventricular system - Often occurs in putamen, thalamus, pons, cerebellum - Can be caused by AVN, Saccular Aneurysm

What is AVN? | How much of population does it effect?

Arteriovenous malformation An abnormal connection between arteries and veins, usually in the brain or spine. AVM occurs in 1% of population

What are Subarachnoid hemorrhages Where do they occur What could cause them?

bleeding in the area between the brain and the tissue covering the brain subarachnoid space AVN, medications, Saccular Aneurysm

What is a Saccular aneurysm? | How much of population does it effect?

Rupture of saccular (“berry”) aneurysm in cerebral artery | Saccular aneurysm found in about 2% of population

Things to do for a Hemorrhagic Stroke | 5

``` Non-contrast CT or MRI Other labs and diagnostics Control blood pressure Vitals and oxygenation Surgical and endovascular methods ```

Thing to be mindful of after a Hemorrhagic Stroke | 4

Vasospasm (constriction) and delayed ischemia (clot) Intracranial pressure Seizures Complications

Ways to prevent Hemorrhagic Stroke? | 4

Manage hypertension Avoid tobacco and alcohol misuse DASH diet Exercise

Transient ischemic attacks

An episode of acute neurological dysfunction caused by focal brain, spinal cord, or retinal ischemia without acute infarction -Usually last under an hour

What is the problem with Transient Ischemic Attacks?

Means risk of ischemic stroke

How to prevent a Transient ischemic attack? | 3

- Similar to preventing a stroke - Manage risk factors - Antiplatelet or anticoagulant as appr

What is the FAST Assesment?

Face: ask the person to smile. Does one side droop? Arms: ask the person to raise both arms. Does one arm drift downward? Speech: ask the person to repeat a single sentence. Is speech slurred or strange? Time: if you observe any of these signs, call 9-1-1

What is the clinical presentation of a stroke? | 5

numbness or weakness of face, arm or leg - especially on one side of the body confusion, trouble speaking or understanding. trouble seeing in one or both eyes trouble walking, dizziness, loss of balance or coordination. severe headache with no known cause.