Stroke

Question 1

who is more at risk for having a stroke?

Answer 1

1. men, except in age groups 35 - 44 and > 85 years

2. African americans and hispanics > whites

Question 2

intracerebral hemorrhage vs subarachnoid hemorrhaged

Answer 2

1. intracerebral: within the cerebrum, blood can expand through the brain, do not c/o worst HA
2. subarachnoid: blood within the meninges surrounding the brain, the skull/dura prevents the blood from expanding, c/o worst HA of their life

Question 3

two zones of injury for ischemic stroke

Answer 3

1. ) core ischemic zone: area of severe ischemia where blood flow falls below 10-25%. Cells die and won’t regenerate
2. ) Ischemic penumbra: region surrounding the ischemic zone, mild to moderate ischemia, target area for pharmacological management and neuroplasticity. Goal is to minimize cell death here so cells can compensate for cells lost in the core ischemic zone. Positron Emission Tomography is used to identify ischemic penumbra

Question 4

three types of causes for ischemic stroke

Answer 4

1. Cerebral thrombosis: atherosclerotic plaque in the brain
2. Cerebral embolus: clot travels to the brain
3. Conditions resulting in low systemic perfusion pressure (IE cardiac arrest, shock, )

Question 5

symptoms of subarachnoid hemorrhage

Answer 5

sudden and intense

c/o worst HA, neck pain, nausea and vomiting

Question 6

percentage of strokes that are ischemic vs hemorrhagic

Answer 6

ischemic = 87%
Hemorrhagic = 13%

Question 7

definition of TIA

Answer 7

small ischemic stroke where the symptoms completely resolve within 24 hours

Question 8

definition of crescendo TIA

Answer 8

• series of TIAs that build over time and can result in full blown ischemic stroke
• 2 TIAs within 24 hours
• 3 TIAs within 3 days
• 4 TIAs within 2 weeks

Question 9

what is the ABCD prediction rule?

Answer 9

• The score predicts how likely someone is to have a stroke in 30 days and 90 days after a TIA.
• Higher score = increased chance of having a stroke
• score 0-7 (higher = WORSE)
• Points for: > /= 60 yo, BP > /= 140/90, has DM, duration of sx >/+ 60 minutes (2 pts) or 10 -59 mins (1 point) , weakness with (2pts) or without (1 pt) speech impairments

Question 10

Common causes of intracerebral hemorrhage

Answer 10

HTN
ETOH
Drug abuse
Anticoagulant use

Question 11

What are the etiologies of hemorrhagic strokes?

Answer 11

1. Intracerebral hemorrhage
2. Subarachnoid hemorrhage
3. Succular aneurysm
4. Arteriovenous malformation

Question 12

What are the etiology of ischemic strokes?

Answer 12

1. Cerebral thrombosis
2. Cerebral emobolus
3. Conditions resulting in low system perfusion pressure

Question 13

Most common sites for aneurysm

Answer 13

Anterior communicating artery, internal carotid/posterior communicating artery, and MCA

Question 14

Aneurysms that are at critical risk of rupturing

Answer 14

Diameter greater than or equal to 10 mm