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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
Q

Ischemic stroke

A

Decreased blood flow resulting in tissue death
80% of all CVAs

FOUR Types:

  1. Thrombotic
  2. Embolic
  3. Lacunar Infarct
  4. TIA
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26
Q

Thrombotic stroke (ischemic)

A

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
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27
Q

Embolic stroke (ischemic)

A

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
Q

Lacunar infarct (ischemic)

A

Tiny infarcts, mild deficits

Occlusion of small vessels, may be gradual onset, associated with HTN/ diabetes

29
Q

TIA (ischemic)

A

Short period of disrupted blood flow

  • symptoms recover within 24 hours
  • 15 % CVAs reported TIA
30
Q

Ischemic tissue death

A

excessive production of neurotransmitters

31
Q

Ischemic penumbra

A

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
Q

Hemorrhagic stroke

A

Sudden onset, closely linked to HTM
Decreased level of consciousness, headache, nausea and vomiting

Includes:

  • intracerebral hemorrhage
  • subarachnoid hemorrhage
  • subdural hematoma
  • epidural hematoma
33
Q

Intracerebral hemorrhage (ICH)

A

Arterial bleeding into the brain parenchyma- intraparenchymal hemorrhage

  • 15% of all strokes
  • high mortality rate
34
Q

ICH Etiology

A

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
Q

ICH clinical manifestations

A

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
Q

Subarachnoid hemorrhage

A

Blood in subarachnoid space

  • sudden onset with severe headache
  • prognosis is good (<3 cm)
37
Q

Subarachnoid medical management

A

Evacuation of hematoma with resection of aneurysm or coiling

38
Q

Subdural hematoma

A

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
Q

Small subdural hematoma

A

absorbed by body

40
Q

Large subdural hematoma

A

becomes space occupying, requires evacuation

41
Q

Epidural hematoma

A

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
Q

Aphasia

A

difficulties in speaking, listening, reading, and writing, but does not affect intelligence

Types:

  • Broca’s: expressive
  • Wernicke’s : receptive
  • Global: receptive/ expressive
43
Q

Alexia

A

impairment in readings— know they are letters, but cannot decode

44
Q

Agraphia

A

impairment in writing

45
Q

Apraxia

A

the inability to execute voluntary motor movement despite being able to demonstrate muscle function

46
Q

Agnosia

A

loss of the ability to perceive auditory, visual, and tactile input though sensory systems are intact

47
Q

Anosognosia

A

lack of awareness of illness (parietal lobe lesion)

48
Q

Dysarthria

A

motor speech disorder

49
Q

Dysphagia

A

inability/ difficulty in swallowing due to CN involvement

50
Q

Visual perception

A

ability to process incoming sensory information

51
Q

spatial perception

A

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
Q

Flexor synergy (UE)

A 
Scap retraction/ elevation
Shoulder abduction
elbow flexion
forearm supination
wrist/ finger flexion
53
Q

Flexor synergy (LE)

A

Hip flex/ abd/ ER
Knee flexion
Ankle DF/ inv
Toe DF

54
Q

Extensor synergy (UE)

A 
scap retraction
should add/ IR
elbow extension
forearm pronation
wrist finger flexion
55
Q

Extensor synergy (LE)

A

Hip ext/ IR
Knee extension
Ankle PF/ INV
Toe PF

56
Q

MOST COMMON REGION OF CVA

A

Middle cerebral artery

57
Q

COMMON CAUSE OF INTERNAL CAROTID THROMBUS

A

Middle cerebral artery

58
Q

2 Divisions of MCA

A
  1. Superior division involvement

2. Inferior Division Involvement

59
Q

Complete occlusion of MCA

A 
Global aphasia
hemiplegia-- UE/ face>> LE
hemisensory loss
left neglect or inattention
visual- perceptual and spatial-perceptual defecits
perseveration
anosognosia
60
Q

Right hemisphere

A

learned behaviors that require voluntary initiation, planning, spatial perceptual judgement

61
Q

Left hemisphere

A

Responsible for learning and using language symbols

62
Q

Pusher syndrome

A

Equitable split between right and left brain

Perceive their “midline” as 18 degrees to ipsilesional side

63
Q

What side will a pt. with Pusher syndrome push to?

A

uninvolved side due to change in their midline

64
Q

Cerebellar artery syndrome

A 
Ipsilateral ataxia
loss of pain. temp in contralateral ext./ torso/ face
dysmetria UE>> LE
dysarthria 
nausea/ vomitting
vertigo
65
Q

Vertebrobasilar artery syndromes

A

Wallenberg syndrome

Horner’s syndrome

66
Q

Locked in syndrome

A

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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