Stroke Flashcards
Early warning signs
sudden: weakness/numbness, change in vision (1 eye),
difficulty speaking/understanding, severe HA
unexplained: dizziness, falls, unsteadiness
Transient Ischemic Attack
preceeds 15% of strokes
similar to a stroke, same etiology, BUT resolves within 24 hours
early management: blood thinners, imaging
Risk factors: modifiable
cardiovascular disease High cholesterol Type II DM HTN >140/90 obesity/dec physical activity diet alcohol/cocaine/cig nicotine
Risk factors: non-modifiable
age (>50 yo, each decade risk doubles)
race (Afro/Mexican)
gender
family hx: genetic predisposition, sickle cell, family member with stroke
Ischemic Stroke etiology
loss of blood supply–>vascular change (swelling)
either reduced blood flow= ischemic penumbra
or no blood flow=neuronal death:
contents of neuron spill out, excitotoxicity leading to increase Ca and swelling/eventual pop, free radicals
Ischemic Stroke Major Artery occlusion
large vessel disease
athelerosclerotic cerebrovascular disease- plaques blocking vessels of carotid/verebrobasilar system
Thrombosis (clot)
Embolism (mobile clot)- 1)most commonly in heart with atrial fibrillation (insufficient atrial emptying 2) plaques in atheleroscleratic arteries carotid/vertebrobasilar BV
Ischemic Stroke Penetrating artery disease
small vessel disease
HTN + DM –> promotes lipohyalinosis
thickening/narrowing of lumen of small BV
located: pons, Internal capsule, basal ganglia
Small BV infarct: cyst, ischemic neurons, gliosis
Hemorrhagic Stroke Intracerebral
HTN–> microvascular disease (weak BV walls=prone to rupture)= Charccot Bouchard disease, microaneurysm
BV at risk: distal, small, arterioles, small penetrating arteries
acute increase in BP can precipitate event
Hemorrhagic Stroke subarachnoid
berry aneurysm A-V malformation congenital distention at bifurcation direct arteries to veins without capillary beds COW
Hemorrhagic Stroke subdural
tearing of bridging veins
Hemorrhagic stroke chronic subdural
elderly
cerebral atrophy= inc space between brain and skull
trauma/falls
MCA stroke
UE>LE hemiplegia/hemianesthesia Dominant hemisphere=global aphasia partial syndrome brachial weakness facial weakness/Brocas area aphasia Inferior division-Wernicke's area
ACA stroke
LE>LE hemiplegia/hemianesthesia
occlusion proximal to anterior communicating artery =minimal dysfunction due to collateral support
Internal carotid artery Stroke
MCA + ACA symptoms
Lacunar stroke
internal capsule insult
posterior limb- motor involvement
anterior limb- facial weakness, dysarthria
Thalamus
posterolateral
pure sensory
Lateral medullary syndrome (PICA occlusion)
vertigo, naseua, dysphagia, hoarseness
Ipsilateral: ptosis, ataxia, facial weakness
Contralateral: torso/trunk sensory loss
Medial medullary syndrome (PICA occlusion)
Contralateral: arm/leg hemiparesis, decreased proprioception
Ipsilateral: tongue weakness
Basilar artery occlusion
locked in syndrome
quadriplegia, mutism, lower bulbar palsy
spares: vertical eye movement, cognition
Cerebellar syndrome
PICA- lateral medullary syndrome
AICA- axtaxia, vertigo
superior cerebellar artery- ipsilateral ataxia
Left dominant hemisphere syndrome
R hemiparesis
Aphasia:
receptive (language/memory) Wernicke’s area
expressive Brocas’ area
global
dysphagia
slow/cautious/disorganized to unfamiliar movements
easily frustrated from communication problems
aware of impairments
difficulty recognizing objects/words
requires more time to process and respond
responds well to non verbal instructions
repetition due to retaining info
Right non dominant hemisphere syndrome
L hemiparesis
L sided neglect
disjointed thinking
safety awareness is diminished
overestimates ability impulsive movements/doesn't follow cue unaware of impairments high distractibility impaired judgement
repetition is important
1 step at a time cue
verbal is better than non verbal instruction
Diagnosis
Hx (timing, course, pattern)
CT (r/o hemorrhage)
MRI (can detect ischemic stroke within 2-6 hours)
doppler US
PET scan ( high sensitivity, earlier detection)
Cerebral angiography
invasive injection of opaque into BV
series of x-ray taken to inspect stenosis/obstruction
Management of stroke
Cerebral perfusion
greater than 240/120, decrease the BP
if acute, may need to increase BP
TPA if within 3 hours
Mechanical thrombolectomy
antihypotension drugs
managment ICP/edema
surgical drainage
Prognosis
LOC= poor prognosis
risk of recurrent stroke
90% recovery within first 3 months, recovery of movement patterns by 5th month
Summary of Ischemic stroke
onset: sudden
BV: arterial
s/s: sudden and progressive focal deficit
prognosis: better than hemorraghic
Summary of Hemorrhagic intracerebral stroke
onset: sudden or gradual
BV: microvasculature
s/s: Focal HA, seizures, ICP
prognosis: high mortality, survivors have good recovery
Summary of Hemorrhagic subarachnoid stroke
onset: gradual
BV arterial
s/s: HA, vomiting, confusion
prognosis: high mortality, elders have poor recovery
Summary of Hemorrhagic subdural stroke
onset: gradual
BV: bridging veins
s/s: HA, change in mental status
prognosis: acute worse than chronic
Summary of epidural hemorrahgic stroke
onset: sudden trauma
BV: aterial meninges
s/s: compression of brain causes symptoms
prognosis: medical emergency, risk of death
Prophylaxis management of ischemic stroke
anticoagulant drug
control HTN
Lipid lowering drug
neuroprotection
sugery for stenotic vessel (carotid endarterectomy if stenosis in internal carotid is >70%)
Posterior cerebral artery syndrome
Thalamic: abnormal sensation (ligh touch=painful)
Occipital: homonymous hemianopsia, visual agnosia
Temporal: memory loss
cerebral peduncle involvement= contralateral presention
