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Clin Med-Neuro > stroke > Flashcards

stroke Flashcards

1
Q

stroke

A

occurs when the blood supply to part of the brain is suddenly interrupted or when a BV in the brain ruptures

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2
Q

how long does it take for cerebral edema to reach its maximum

A

72 hours and takes about 2 weeks to subside

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3
Q

arterial occlusion (ischemic)

A

thrombus-clot in situ

embolus-loose clot

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4
Q

rupture of blood vessel (hemorrhagic stroke)

A

arterial defect or trauma

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5
Q

non-modifiable risk factors for stroke

A 
heredity
age (increases with age)
gender- women
ethnicity- AA
previous stroke or TIA
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6
Q

modifiable risk factors

A 
HTN
Heart disease
DM (control of BP contributes to prevention more than blood sugar)
smoking
alcohol
viscosity of blood
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7
Q

how long do TIA’s last

A

less than 24 hours

- most last 5 minutes

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8
Q

what are residual ischemic neruo deficits

A

reversible ischemic events lasting more than 24 hours

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9
Q

pathophys of TIA

A

in situ platelet agg or showering of tiny emboli–> blockage of circulation or vasospasm caused by releases of vasoactive substances

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10
Q

what is the prognosis of TIA is not treated

A

80% will have recurrance

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11
Q

prediction of stroke within 48 hours of a TIA

A 
"ABCDD" scoring system
Age (greater than 60)
BP (140/90)
Clinical features (weakness, speech)
Duration of TIA symptoms (greater than 60 2 points)
Diabetes
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12
Q

risk assessment after scoring

A

6-7= 8% risk

use as a warning to the patient to let them know they need to change their habits/lifestyle

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13
Q

subtypes of ischemic stroke

A

thrombotic
embolic
lacunar (special subtype)

other..
hypotensive
vasospastic
various and sundry

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14
Q

thrombotic due to large vessel disease

A
  • includes both extracranial and intracranial blood supply to the brain (athero-thrombosis most comomon)
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15
Q

thrombotic due to small vessel disease

A

-involves smaller penetrating arteries of the brain that can result in small, deep infarcts referred to as lacunar infarcts or subcortical strokes
(lipohyalinosis)

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16
Q

features of a thrombotic stroke

A
  • proceeded by TIA
  • during sleep
  • step wise progression “stroke of evolution”
  • completed stroke- CVA that has completed its progress and has resulted in some amount of permanent,irreversible damage to the brain tissue
17
Q

what is the role of an early brain CT?

A

r/o intracranial bleeding, abscess, and tumor

18
Q

signs of carotid artery disease

A
  • transient monocular blindness (TIA of ophthalmic artery)

- hemispheric deficit

19
Q

lacunar disease

A

associated with chronic HTN, DM, hyperlipidemia

  • can occur indepen or concurrently with large vessel cerebrovascular disease
  • can be due to disease in estuaries of the internal carotid artery or in the vertebrobasilar artery distribution
20
Q

lacunar (subcortical) stroke

A
  • associated with vascular lesions in the posterior circulation (vertebral and basilar) resulting in cranial nerve impairment or dysfunction of the motor an sensory tracts
21
Q

signs of vertebrobasilar arterial disease

A

horners syndrome

22
Q

syndromes related to lacunar stroke

A 
pure motor
pure sensory
sensorimotor
ataxic-hemiparesis
clumsy hand dysarthria
multi infarct dementia
23
Q

prophylactic treatment of lacunar strokes

A

aspirin has not been show to prevent

-most effective treatment s to manage risk factors

24
Q

cardiac causes of embolic stroke

A
  • a.fibb
  • MI
  • endocarditis
  • rheumatic heart disease
  • valvular prostheses
  • ASD/VSD “paradoxical embolism”
25
Q

arterial causes of embolic stroke

A

anomalies of the:

  • aorta
  • carotids
  • vertebrobasilar circulation
26
Q

emboli of non-arterial origin

A 
fat emboli
air emboli
tumor emboli
hardware emboli
paradoxical emboli
septic emboli
27
Q

features of embolic stroke

A
  • sudden onset
  • rapid progression
  • might present with syncope or seizure
  • maximal deficit at time of presentation
28
Q

watershed infarcts

A
  • during hypotensive episodes

- most common location is between the anterior and middle cerebral artery areas (on the surface or deep within)

Clin Med-Neuro (8 decks)

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