Stroke and Transient Ischemic Attack Flashcards
Differences between ischemic and hemorrhagic strokes
ischemic- thrombosis, embolism, systemic hypoperfusion, occurs in developed countries more often
hemorrrhagic- intracerebral hemorrhage, subarachnoid hemorrhage, occurs in less developed countries
Thrombotic ischemic stroke def., clinical
d/t occlusions on artherosclerotic lesions
evolve in stepwise fashion, progressively gets worse, may be preceded by TIAs
Embolic ischemic stroke def, clinical, where it can come from
d/t embolus migrating distally that blocks blood flow
occurs suddenly without warning and symptoms maximal at onset
Mid and post cetebral arteries most commonly affected
emboli usually come from artery-to-artery or cardiac
What is the difference between lacunar and watershed ischemic strokes
Lacunar- small vessel disease in branches of MCA, d/t untreated HTN, more rapid and complete recovery
Watershed- a border zone infarct, can occur w/ prolonged hypoTN (risk of over tx elderly pts for chronic HTN), usually diffuse sx
TIA onset, clinical, scoring
sudden onset of focal neurological deficit d/t disturbance of circulation in brain, spinal cord, or retina that is transient
last few min to less than an hour; even brief ischemia can cause permanent injury
scored by ABCD2 to asses risk of stroke after TIA
*amaurosis fugax=transient visual loss if retinal artery involved
Difference in stroke sx between anterior circulation, middle cerebral artery, and post. circulation
Ant= contralateral sensorimotor deficit affecting leg, urinary incontinence, impaired memory, emotional disturbances MCA= MC location, contralateral sensorimotor deficit often affecting arm, homonymous hemianopia, language deficit Post = coma, drop attacks, vertigo, nausea, vomiting, ataxia, crossed sx
What is lateral medullary syndrome
aka Wallenberg’s syndrome
d/t occlusion of vertebral artery but can be d/t PICA occlusion
causes ipsilateral facial numbness and truncal ataxia, weakness of the palate, pharynx, vocal cords, contralateral loss of pain and temp
What is locked-in syndrome
quadriplegia, aphonia, impairment of horiz eye movements, can blink and move eyes vertically, awake d/t sparing of reticular formation
What is intracerebral hemorrhagic stroke, sx, and tx
direct bleed into brain that forms hematoma
sx usually gradually increase- focal neuro sx/deficits, HA, N/V, seizures, decreased consciousness d/t increased cranial pressure
Tx: close monitoring of BP, reverse coagulopathy therapy if on it, tx intracranial pressure if too high,
30-50% die within 30 days
What is cerebral aneurysm
outpouching of cerebral artery wall
rupture can lead to bleed in subarachnoid space
MC artery is the anterior communicating artery
What is subarachnoid hemorrhage, sx, and tx
Rupture of aneurysm at base of the brain that releases blood into CSF causing increased intracranial pressure which leads to vasoconstriction of arteries
Sx: “worst HA of my life”, N/V, seizure, altered mental status, fever, coma, meningeal irritation signs, increased BP
Tx: get CT, if CT is (-) get a lumbar puncture and look for a consistent amt of blood in tubes, can get a cerebral angiography or digital subtraction angiography, bedrest, monitoring, surgery to clip aneurysms
How long before you can’t tx someone with a thrombolytic
<4.5 hours since onset of sx
What are the most predictive findings of a stroke
facial paralysis
arm drift/weakness
abnormal speech
What is the first diagnostic test you should get done
Non-contrast CT: r/o hemorrhage, usually normal in acute ischemic stroke
What are the other diagnostic procedures you can run
CTA, CTP (perfusion), blood glucose, CBC, PT/PTT/INR, BMP, trop, MRI, cerebral angiography, transcranial doppler, carotid/vertebral duplex US
