Stroke Flashcards
What are the 2 subtypes of stroke?
Hemorrhagic (20%)
Ischemic (80%
can have secondary hemorrhage)
Describe types of hemorrhagic stroke
if in brain tissue (intracerebral): cortical or subcortical
subarachnoid hemorrhage (outside brain tissue)
Describe types of ischemic stroke
large artery atherosclerosis with thromboembolism
small vessel/lacunar disease
cardioembolism
nonatherosclerotic vasculopathies
hypergoag states (sticky blood)
RF for stroke
age
previous TIA/stroke
atherosclerosis caused by:
- -> HTN
- -> smoking
- -> DM
- -> HLD
cardiac disorders
- -> valvular (dysfxn or prosthetic valve)
- -> dysrhythmia (A-FIB)
- -> mural thrombus
- -> endocarditis
- -> atrial myxoma
- -> interatrial septal abnormalities (paradoxical embolism)
drug abuse (IV, cocaine, meth)
oral contraceptives (cause hypercoag)
pregnancy/postpartum
fibromuscular dysplasia
inflammatory disorders (SLE, arteritis, AIDS)
migraine (with aura, debated)
Sx of stroke in left hemisphere
apahsia
right sided sensory and motor sx
right visual field cut
Sx of stroke in right hemisphere
left hemineglect
left sensory and motor sx
left visual field cut
Sx of stroke in cerebellum
ipsilateral ataxia
vertigo
nystagmus
Sx of stroke in brainstem
CN findings
contralateral hemisensory or hemimotor sx
vertigo
What does the brain so in response to injury (generally)?
swell
bleed
seize
What accounts for 50% of deaths attributable to stroke?
being immobile:
pneumonia, DVT, PE, UTI, decubitus ulcers
Emergent diagnosis and tmt of stroke
ABCs
BP, pulse, cardiac monitor, EKG, O2 sat
raise head of bed by 30% to decrease ICP
IV access (NO GLUCOSE: hyperglycemia--> worse neuro outcomes) --> if tPA, get 2 IV sites
neuro exam
CAT scan
labs (CBC, PT and PTT, full chem, UA, chest xray)
NIH stroke scale
treat fever if present (a/w worse CNS outcomes)
Should acute HTN in ischemic stroke be treated?
NO (unless hypertensive emergency)
might be too high for the area of infarction, but the normal tissue around it might turn ischemic if you lower the blood pressure
When to get NIH stroke scale?
if tPA or intra-arterial intervention is considered
less than 10: small risk of hemorrhage if give clot buster
over 20: 17% risk of hemorrhage
score ranges from 0 (nml) to 42 (coma)
How long can it take for ischemia to show up on CT?
3 days/72 hours
What are some things that can present with focal neuro deficits/stroke sx?
seizure
migraine
hypoglycemia
hepatic problems (encephalopathy d/t ammonia)
