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Clin med II Patho > Stroke > Flashcards

Stroke Flashcards

1
Q

Early warning signs

A

sudden: weakness/numbness, change in vision (1 eye),
difficulty speaking/understanding, severe HA

unexplained: dizziness, falls, unsteadiness

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2
Q

Transient Ischemic Attack

A

preceeds 15% of strokes

similar to a stroke, same etiology, BUT resolves within 24 hours

early management: blood thinners, imaging

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3
Q

Risk factors: modifiable

A 
cardiovascular disease
High cholesterol
Type II DM
HTN >140/90
obesity/dec physical activity
diet
alcohol/cocaine/cig nicotine
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4
Q

Risk factors: non-modifiable

A

age (>50 yo, each decade risk doubles)

race (Afro/Mexican)

gender

family hx: genetic predisposition, sickle cell, family member with stroke

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5
Q

Ischemic Stroke etiology

A

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

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6
Q

Ischemic Stroke Major Artery occlusion

A

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

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7
Q

Ischemic Stroke Penetrating artery disease

A

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

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8
Q

Hemorrhagic Stroke Intracerebral

A

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

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9
Q

Hemorrhagic Stroke subarachnoid

A 
berry aneurysm
A-V malformation
congenital distention at bifurcation
direct arteries to veins without capillary beds
COW
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10
Q

Hemorrhagic Stroke subdural

A

tearing of bridging veins

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11
Q

Hemorrhagic stroke chronic subdural

A

elderly
cerebral atrophy= inc space between brain and skull
trauma/falls

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12
Q

MCA stroke

A 
UE>LE hemiplegia/hemianesthesia
Dominant hemisphere=global aphasia
partial syndrome
brachial weakness
facial weakness/Brocas area aphasia
Inferior division-Wernicke's area
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13
Q

ACA stroke

A

LE>LE hemiplegia/hemianesthesia

occlusion proximal to anterior communicating artery =minimal dysfunction due to collateral support

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14
Q

Internal carotid artery Stroke

A

MCA + ACA symptoms

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15
Q

Lacunar stroke

A

internal capsule insult

posterior limb- motor involvement
anterior limb- facial weakness, dysarthria

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16
Q

Thalamus

A

posterolateral

pure sensory

17
Q

Lateral medullary syndrome (PICA occlusion)

A

vertigo, naseua, dysphagia, hoarseness
Ipsilateral: ptosis, ataxia, facial weakness
Contralateral: torso/trunk sensory loss

18
Q

Medial medullary syndrome (PICA occlusion)

A

Contralateral: arm/leg hemiparesis, decreased proprioception

Ipsilateral: tongue weakness

19
Q

Basilar artery occlusion

A

locked in syndrome

quadriplegia, mutism, lower bulbar palsy

spares: vertical eye movement, cognition

20
Q

Cerebellar syndrome

A

PICA- lateral medullary syndrome
AICA- axtaxia, vertigo
superior cerebellar artery- ipsilateral ataxia

21
Q

Left dominant hemisphere syndrome

A

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

22
Q

Right non dominant hemisphere syndrome

A

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

23
Q

Diagnosis

A

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

24
Q

Management of stroke

A

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

25
Q

Prognosis

A

LOC= poor prognosis
risk of recurrent stroke
90% recovery within first 3 months, recovery of movement patterns by 5th month

26
Q

Summary of Ischemic stroke

A

onset: sudden

BV: arterial

s/s: sudden and progressive focal deficit

prognosis: better than hemorraghic

27
Q

Summary of Hemorrhagic intracerebral stroke

A

onset: sudden or gradual

BV: microvasculature

s/s: Focal HA, seizures, ICP

prognosis: high mortality, survivors have good recovery

28
Q

Summary of Hemorrhagic subarachnoid stroke

A

onset: gradual

BV arterial

s/s: HA, vomiting, confusion

prognosis: high mortality, elders have poor recovery

29
Q

Summary of Hemorrhagic subdural stroke

A

onset: gradual

BV: bridging veins

s/s: HA, change in mental status

prognosis: acute worse than chronic

30
Q

Summary of epidural hemorrahgic stroke

A

onset: sudden trauma

BV: aterial meninges

s/s: compression of brain causes symptoms

prognosis: medical emergency, risk of death

31
Q

Prophylaxis management of ischemic stroke

A

anticoagulant drug
control HTN
Lipid lowering drug

neuroprotection
sugery for stenotic vessel (carotid endarterectomy if stenosis in internal carotid is >70%)

32
Q

Posterior cerebral artery syndrome

A

Thalamic: abnormal sensation (ligh touch=painful)

Occipital: homonymous hemianopsia, visual agnosia

Temporal: memory loss

cerebral peduncle involvement= contralateral presention

Clin med II Patho (11 decks)

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