Stroke Flashcards
includes an assortment of disorders that affect the blood vessels of the CNS; Inadequate blood flow (ischemia) or hemorrage (bleeding) leads to neurologic dysfunction
Cerebrovascualr disease
abrupt-temporary focal neurologic deficit (slurred speech, aphasia, limb paralysis/weakness) that lasts ≤ 24 hours and usually < 30 minutes with complete resolution of symptoms
TIA
bleeding in spaces in or around the brain that results in very similar symptoms as TIA/Infarct and the damage is due to lack of blood flow and direct irritation of blood in contact with brain tissue; blood pools and increases pressure inside the brain
Cerebral hemorrhage
permanent form because the damage is fixed due to neuronal cell death, usually vascular in origin, symptoms last ≥ 24 hours, and can be stable/ improving/ progressive
Stroke (cerebral infarction)
What are the ischemic stroke mechanisms?
- Atherosclerotic (carotid/ cerebral artery)
- Cardiogenic embolism (A.Fib.)
- Penetrating Artery disease (lacunar)
- Cryptogenic (hidden cause)
- Other - Drug abuse, vasospasm, many more
What are the hemorrhagic stroke mechanisms?
- Subarachnoid (blood in CSF) - blood vessel that breaks is usually an artery
- Intracerebral (HTN/ antithrobotic therapy) - blood vessel that breaks is usually an artery
- Subdural (Trauma) - blood vessel that breaks is usually a vein
What are nonmodifiable risk factors for strokes?
- Age (doubles every decade after 55)
- ¾ over age 65
- Men > Women
- African Americans, Asian-Pacific Islanders, Hispanics > Caucasians
- Hereditary
- Geography – SE US
What are modifiable risk factors for strokes?
- HTN – most important
- Smoking 2X
- Heart Disease
- Atrial Fib – 5X
- Diabetes
- Previous TIA – 17% in 90 d
- Dyslipidemia
- Alcohol
- Illicit Drug Use
- Obesity
- Diet
- Physical Activity
accumulation of lipids and inflammatory cells in the arterial wall, combined with hypertrophy of arterial wall smooth muscle, results in plaque formation. It may remain in vessel causing local occlusion or travel distally as an embolism to the cerebral vessels
Carotid Atherosclerosis
- etiologic factor for eschemic stroke
pooling of blood in the atrium/ventricles allows the formation of a clot that can be dislodged and travel to cerebral circulation
Cardiogenic Embolism
- etiologic factor for eschemic stroke
What are the diagnostic strategies for a stroke?
- CT scan- will reveal area of infarct
- MRI- shows if ischemic or hemorrhagic
- Carotid Doppler- determine if patient has a high degree of stenosis in carotid arteries supplying blood to the brain
- ECG- Detects Atrial Fibrillation (Etiologic Factor)
- Transthoracic Echocardiogram (TTE) – determines if there are any valve/wall motion abnormalities
- Transesophageal Echocardiogram (TEE)- test for thrombus in left atrium
- Transcranial Doppler (TCD) – tells if pt is likely to have intracranial arterial sclerosis
- lab tests - hypercoaguable states
What are the desired outcomes of tx for stroke?
- Reduce ongoing neurologic injury
- Decrease mortality and long-term disability
- Prevent complications secondary to immobility and neurologic dysfunction
- Prevent stroke recurrences
What are nonpharmacologic tx of ischemic stroke?
- Craniectomy to release some of the pressure from edema (benefits unclear)
- Carotid endarterectomy of ulcerated/stenotic caroid artery (very effective)
- In patients where carotid endarterectomy is excessive, carotid stenting may be effective
What are nonpharmacologic tx of hemmoragic stroke?
- subarachnoid - surgical intervention to either clip or coil offending vascular abnormality
- intracerebral - not studied well, benefits of surgery to remove hematoma is less documented
- Insertion of extraventricular drain (EVD) and subsequent monitoring of intracranial pressure
- Maint tx is aimed at controlling ICP**
How are ischemic strokes treated acutely?
- Rule out hemorrhage stroke
- tx (tPA, or aspirin w/in 48 hrs if tPA cannot be administered) can be initiated within 3 hours of start of sx
- HTN is not treated initially