Stroke Flashcards
What’s Stroke?
A stroke can be defined as a sudden global or focal Neurological deficit resulting from spontaneous hemorrhage or infarction of the CNS with objective evidence of infarction irrespective of duration of clinical symptoms.
(According to WHO)
Stroke is also called Cerebrovascular accident.
what’s the classification of Stroke?
And which is more common?
Hemorrhagic
Ischemic
Ischemic stroke; Embolic , Thrombotic
Hemorrhagic stroke: Intracranial hemorrhage, Subarachnoid hemorrhage.
Ischemic is the most common while Hemorrhagic is more severe!!
Risk factors for Stroke (modifiable)
Modifiable includes
Alcohol DM Smoking Hyperlipidemia Obesity Atrial fibrillation OCP - oral contraceptives Drugs Hyperviscosity syndrome Carotid artery stenosis Etc
Non modifiable risk factors for Stroke
Non Modifiable risk factors include Race(blacks) Age(advanced) Sex(male) Genetics(CADASIL) Family hx Previous hx Gender
Hemorrhagic stroke occurs at the rest. T/F?
F
Ischemic stroke occurs with history of TIA? T/F
T
There’s severe headache in ischemic stroke T/F?
F
Cause of severe headache in hemorrhagic stroke
Ruptured berry aneurysm at the peak of physical activity will lead to Subarachnoid hemorrhage and sudden onset of THUNDER CLAP HEADACHE.
Risk factors for hemorrhagic Stroke
Severe hypertension Bleeding disorders Prolonged antiplatelet use Arteriovenous malformation APS
Monroe Kelly rule
Monroe Kelly’s rule states that the pressure in the skull cavity is always constant as the skull is a rigid structure. It comprises of the following 1. Cerebrospinal fluid 2. Brain mass 3. Blood(bleeding)
Ischemic Stroke Syndtomes according to affected artery
Ischemic stroke syndromes 1- middle cerebral artery occlusion Signs and symptoms -Hemiparesis -hemisensory deficit -motor aphasia -central aphasia -quadrantanopia -eye deviation to side of lesion
2-Anterior Cerebral Artery
- contralateral weakness of lowerlimb more than upper
- mood and cognition impairments
- urinary incontinence
- gait apraxia
3- posterior cerebral artery
- memory deficit - cortical blondness - dense sensory loss,dysethesias - cortical blindness - homonymous hemianopia
the most common site affected in the brain is? (Stroke)
Internal capsule
AREA of dead tissue that is irreversibly damaged IN THE BRAIN is called?
Umbra
Penumbra is the area around it.
So which type of necrosis occurs in Stroke???
It’s LIQUEFACTIVE or COLLIQUATIVE NECROSIS
Investigation for Stroke
Specific: non contrast CT scan of the brain ~> Hypodense lesion
CT is normal in first 24 - 72 hrs
Signs of cerebral edema( flattened gyri, effaced sulci)
Non specific:
Management of Stroke
ADMIT PATIENT
•RESUSCITATE USING ABC PROTOCOL
•PERFORM HEAD CT
•IF ISCHEMIC, INITIATE THROMBOLYTICS(tPA) IF < 4,5 HOURS OF ONSET or INTRA-ARTERIAL REPERFUSION
•GIVE ANTIPLATELETS (ASPIRIN), LMW HEPARIN AND STATIN AS PROPHYLAXIS
•MECHANICAL THROMBOECTOMY
•CONTROL BP ONLY IF MAP > 145mmHg or SBP > 220mmHg or DBP > 120mmHg
•CONTROL CEREBRAL EDEMA WITH MANNITOL
•TURN PATIENT REGULARLY TO PREVENT BED SORES
•EARLY PHYSIOTHERAPY IS ESSENTIAL TO REGAIN FUNCTIONS
•GIVE ANTIOXIDANTS Vitamins A,C,E
•In HEMORRHAGIC STROKE, THROMBOLYTIC THERAPY AND ASPIRIN ARE CONTRAINDICATED!!!!
What is ‘Permissive Hypertension’ in management of Stroke ?
Allowing a SBP OF LESS THAN 220, DBP LESS THAN 120
We do this to allow perfusion to the area of PENUMBRA.
If we quickly crash the BP, the UMBRA are will widen due to poor perfusion of blood.
Complications of Stroke
Trauma from falling Loss of bowel function Loss of sphincter function Paralysis Decubitus ulcers Paresis
Acute complications >7days
Cerebral edema Increased ICP Seizures Hypoxia Cardiac arrythmias
Chronic complications
Dementia
Epilepsy
Speech difficulty
Gait problems
