Stroke and Neurological disorders Flashcards
What are ways in which we can determine if a stroke is hemorrhagic or ischemic?
DWI (diffusion weighted mri), CT scan (stat), ECG, carotid doppler, PET scan
(if you were to remember anything, it is a CT scan and the diffusion weighted MRI)
What is the major cause of stroke?
Atherosclerosis
What are the three most common causes of death in Canadians?
Heart disease, cancer, stroke
Stroke is the layman’s term, what is it called medically?
What is a new layman term being used to help non-medically educated individuals understand the severity?
CVA - cerebrovascular accident
Brain attack
What are the two stroke types? Which is more common?
Ischemic (80%) or hemorrhagic (20%)
TIA = ?
- temporary ______ loss of neurological function
- caused by _______, lasting less than _____, often less than ______
- TIAs are a ________ _____ of progressive cerebrovascular disease
Transient ischemic attack
focal
ischemia, 24 hours, 15 minutes
warning sign
What is a TIA not?
Not a mini stroke
Stroke risk factors - non-modifiable: - Age - Gender - Ethnicity - Heredity Describe the impact of each.
Age - after 55, risk doubles q10 years; 2/3rds of all strokes occur over the age of 65
Men > women (however, since women live longer the absolute number is the same)
Blacks are 2x as likely to die from strokes and suffer more extensive physical impairments
Cannot change your genetics
Describe the treatment/impact of the following, modifiable risk factors for stroke:
- HTN
- heart disease
- high cholesterol
- Obesity/sedentary lifestyle
- Elevated hematocrit
HTN - meds
Heart disease - meds
Cholesterol - often in 200s - modify with diet first, then meds
- lose weight, exercise
- Hematocrit - want to lower - i.e. dilate blood
Describe the treatment/impact of the following, modifiable risk factors for stroke:
- diabetes
- (sickle cell anemia)
- oral contraceptives
- smoking
- periodontal disease
diabetes - keep blood sugar consistently below 10, and between 4-7 for fasting
- oral contraceptives and smoking can predispose
- good oral hygiene is important to prevent bacteremia
What does the fast acronym stand for?
Face (Drooping)
Arms (one arm drifts downwards)
Speech (repeating, slurred, strange)
time (to call 911)
If a patient in London has TIA symptoms, they will be screened right away. What do HCPs look for?
Look at patency of the carotid arteries - usually quite occluded - may perform a carotid endarterectomy.
Describe the ischemic cascade.
Vessel becomes occluded leading to hypoxia.
This causes cells to perform anaerobic respiration, thereby increasing lactic acid, and acidifying the pH.
Anaerobic respiration cannot meet the ATP demands, and cells begin to die
The resulting neurological deficits of a (ischemic) stroke are dependent on what 3 factors?
The location of the obstruction
The size of the area of inadequate perfusion
the amount of collateral blood flow
Describe the resulting manifestation of stroke in the following areas:
- Broca’s
- Wernicke’s
Broca’s - the patient will have difficult producing speech/language
Wernicke’s - the patient will have difficulty understanding speech/language
Which is more severe, an ischemic or hemorrhagic stroke?
Hemorrhagic
Describe the effect of collateral blood flow/circulation in dictating the severity of a stroke.
In the case of an ischemic stroke, if a person has a good collateral circulation, the lack of blood flow can be compensated by the secondary blood flow to that same area.
Ability to branch off when needed and grow into an area of blood flow decline or deficit
Collateral circulation
Slowed or slurred speech that is difficult to understand.
Medical term for double vision
Decreased vision or blindness in one eye.
Dysarthria
Diploplia
hemianopsia
If the cerebral infarct is on the right side of the brain, the resulting neurological deficit will manifest on the ____ side of the body.
left
If a person develops emotional lability following a stroke, where did the stroke most likely attack.
Frontal lo`e
In some stroke patients, they completely neglect one side of their body. Which brain region was affected?
Parietal lobe