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PATHO 2 > Stroke > Flashcards

Stroke Flashcards

1
Q

Stroke definition

A

Sudden loss of neurological function as the result of a disruption to blood flow resulting in tissue death

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2
Q

2 Types of Stroke

A
  1. Ischemic

2. Hemorrhagic

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3
Q

5th leading cause of death

A

STROKE

Leading cause of serious long term disability

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4
Q

Modifiable risk factors

A
  • HYPERTENSION
  • SMOKING
  • HYPERLIPIDEMIA
  • Cardiac disease
  • Diabetes
  • Obesity (abdominal)
  • Sedentary lifestyle
  • Excessive alcohol consumption
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5
Q

Non-modifiable risk factors

A
  • Age (increases with age)
  • Sex (Females less likely than men)
  • Hereditary
  • Race (African Americans > Hispanics > Caucasian)
  • Geography — highest death rate in the Southeast US
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6
Q

Warning signs of a stroke

A
  • Sudden numbness/ weakness of the face
  • Sudden difficulty with speech/ understanding speech
  • Sudden trouble seeing in one or both eyes
  • Sudden trouble walking, dizziness, loss of balance, or coordination
  • Sudden severe headache with no known cause
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7
Q

Time frame to get to emergency department

A

Within 3 hours of start of symptoms– tend to have less disability 3 months post CVA

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8
Q

What does FAST stand for?

A 
F= facial drop
A= arm drop
S= speech difficulty
T= time

+ TONGUE (See if tongue deviates)

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9
Q

Purpose of diagnostic testing

A

Finding the source of ischemic event

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10
Q

Non-contrast CAT scan

A

Fast, convenient

Ischemic vs. hemorrhagic stroke vs. other pathologies (tumor/ aneurysm)

IF ISCHEMIC, then tPA or Merci procedure potential

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11
Q

MRI

A

done a few days later to assess the size and extent of infarct

Can pick up tissue death within 2-6 hours

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12
Q

MRA

A

Magnetic resonance angiogram

Assesses arterial stenosis or presence of aneurysm

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13
Q

EKG

A

afib major risk factor for stroke

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14
Q

Echo

A

Assesses heart ventricular and valve function

- brain requires 17% cardiac output

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15
Q

Echo with bubble

A

to rule out patent foramen ovalus (PFO)

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16
Q

TEE

A

Trans Esophageal Echocardiogram

- more sensitive to echo to further determine source of infarct

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17
Q

Telemetry

A

minimum of 24 hours

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18
Q

Carotid Doppler

A

stenosis due to plaque accumulation

- 70% occlusion indicates endarterectomy

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19
Q

tPA

A

Tissue plasminogen activator– results in lysis of fibrin
- used for ischemic strokes

“Golden three hour tPA window”

  • 8/ 18 CVA patients given tPA are without disability 3 months post event
  • 1/18 will have hemorrhagic conversion with 45% mortality rate
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20
Q

Merci procedure

A

Mechanical Embolus Retrieval for Cerebral Ischemia

8 hour window— for larger arteries

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21
Q

University of Oxford ABCD Scale

A

Predictor of stroke after TIA

performed by MD

A= age (>60)
B= blood pressure (above 140/90)
C= clinical features (one sided weakness/ speech)
D= Duration (>60 min)

Predicts chances of stroke

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22
Q

NIH Stroke Scale

A

Assesses impairment and if tPA is warranted

Performed at:

  • baseline
  • 2 hours post treatment
  • 24 hours from symtom onset
  • 7-10 days later
  • 3 months

Max score of 42

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23
Q

Items assessed in NIH

A

11 items assessed:

  • level of consciousness
  • horizontal eye movement
  • visual field
  • facial palsy
  • motor arm
  • limb ataxia
  • sensory
  • language
  • speech
  • extinction and inattention
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24
Q

NIH Stroke Scale Scoring

A

Best range: 10-20

Higher score: significant deficits, poor recovery
Max score: 42

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25
Ischemic stroke
Decreased blood flow resulting in tissue death 80% of all CVAs FOUR Types: 1. Thrombotic 2. Embolic 3. Lacunar Infarct 4. TIA
26
Thrombotic stroke (ischemic)
Big clot breaking away and collecting in the artery, piece of the thrombus - Aggregation of fibrin and platelets in a cerebral artery resulting in occlusion gradual onset - often awaken with symptoms
27
Embolic stroke (ischemic)
Foreign body-- thrombus that originate elsewhere that is carried through bloodstream to narrowing region - abrupt and often with activity - most common area of origin: cardiac, post op
28
Lacunar infarct (ischemic)
Tiny infarcts, mild deficits Occlusion of small vessels, may be gradual onset, associated with HTN/ diabetes
29
TIA (ischemic)
Short period of disrupted blood flow - symptoms recover within 24 hours - 15 % CVAs reported TIA
30
Ischemic tissue death
excessive production of neurotransmitters
31
Ischemic penumbra
Rim of mild to moderately ischemic tissue around the area of infarction is evolving - remains viable for several hours due to collateral arteries - tissue death if not reperfusion is not establishe during the early hours - brain tissue requires 20-25% of regular blood flow to survive
32
Hemorrhagic stroke
Sudden onset, closely linked to HTM Decreased level of consciousness, headache, nausea and vomiting Includes: - intracerebral hemorrhage - subarachnoid hemorrhage - subdural hematoma - epidural hematoma
33
Intracerebral hemorrhage (ICH)
Arterial bleeding into the brain parenchyma- intraparenchymal hemorrhage - 15% of all strokes - high mortality rate
34
ICH Etiology
Primary - Artherosclerosis - Sudden increase in BP - over the age of 65 doubles with each decade Secondary - trauma - coagulopathies - toxin exposure - anatomic anomaly - cerebral amyloid aniopathy - excessive alcohol use - cocaine/ ampethemines - adverse effect thrombolytic therapy
35
ICH clinical manifestations
Specific to reiogn Symptoms increase as hematoma enlarges Seizure activity possible, esp in cerebral cortex Results in: - distortion of structures - rise in ICP - development of severe edema, causing midline shift
36
Subarachnoid hemorrhage
Blood in subarachnoid space - sudden onset with severe headache - prognosis is good (<3 cm)
37
Subarachnoid medical management
Evacuation of hematoma with resection of aneurysm or coiling
38
Subdural hematoma
Trauma results in tearing of the bridging veins between the brain surface and dural sinus - chronic onset (slow leakage) - decline in cognitive/ functional status
39
Small subdural hematoma
absorbed by body
40
Large subdural hematoma
becomes space occupying, requires evacuation
41
Epidural hematoma
Traumatic tearing of the meningeal arteries that supply the periosteal layer of the dura Medical emergeency requires evacuation IMMEDIATELY as can cause compression of the brainstem
42
Aphasia
difficulties in speaking, listening, reading, and writing, but does not affect intelligence Types: - Broca's: expressive - Wernicke's : receptive - Global: receptive/ expressive
43
Alexia
impairment in readings--- know they are letters, but cannot decode
44
Agraphia
impairment in writing
45
Apraxia
the inability to execute voluntary motor movement despite being able to demonstrate muscle function
46
Agnosia
loss of the ability to perceive auditory, visual, and tactile input though sensory systems are intact
47
Anosognosia
lack of awareness of illness (parietal lobe lesion)
48
Dysarthria
motor speech disorder
49
Dysphagia
inability/ difficulty in swallowing due to CN involvement
50
Visual perception
ability to process incoming sensory information
51
spatial perception
ability to sense the size, shape, movement, distance, and orientation of objects and awareness of oneself in space and its relation to other objects
52
Flexor synergy (UE)
``` Scap retraction/ elevation Shoulder abduction elbow flexion forearm supination wrist/ finger flexion ```
53
Flexor synergy (LE)
Hip flex/ abd/ ER Knee flexion Ankle DF/ inv Toe DF
54
Extensor synergy (UE)
``` scap retraction should add/ IR elbow extension forearm pronation wrist finger flexion ```
55
Extensor synergy (LE)
Hip ext/ IR Knee extension Ankle PF/ INV Toe PF
56
MOST COMMON REGION OF CVA
Middle cerebral artery
57
COMMON CAUSE OF INTERNAL CAROTID THROMBUS
Middle cerebral artery
58
2 Divisions of MCA
1. Superior division involvement | 2. Inferior Division Involvement
59
Complete occlusion of MCA
``` Global aphasia hemiplegia-- UE/ face>> LE hemisensory loss left neglect or inattention visual- perceptual and spatial-perceptual defecits perseveration anosognosia ```
60
Right hemisphere
learned behaviors that require voluntary initiation, planning, spatial perceptual judgement
61
Left hemisphere
Responsible for learning and using language symbols
62
Pusher syndrome
Equitable split between right and left brain Perceive their "midline" as 18 degrees to ipsilesional side
63
What side will a pt. with Pusher syndrome push to?
uninvolved side due to change in their midline
64
Cerebellar artery syndrome
``` Ipsilateral ataxia loss of pain. temp in contralateral ext./ torso/ face dysmetria UE>> LE dysarthria nausea/ vomitting vertigo ```
65
Vertebrobasilar artery syndromes
Wallenberg syndrome | Horner's syndrome
66
Locked in syndrome
Complete basilar artery syndrome - high mortality syndrome - those that survive severely disabled - tetraplegia - cognition spared - BL cranial nerve palsy ( no horixontal eye movement) - mute, but can still understand everything

PATHO 2 (4 decks)

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