Stroke COPY Flashcards
Non-modifiable risk factors for stroke
- age
- gender
- ethnicity or race
- family hx
- heredity
Modifiable risk factors for stroke
- HTN
- heart disease
- diabetes mellitus
- smoking
- excessive alcohol consumption
- obesity
- sleep apnea
- metabolic syndrome
- lack of exercise
- poor diet
- drug abuse
Characteristics of transient ischemic attack (TIA):
Carotid system
- temporary loss of vision in one eye
- transient hemiparesis
- numbness or loss of sensation
- sudden inability to speak
Characteristics of transient ischemic attack (TIA):
Vertibrobasilar system
- tinnitus
- vertigo
- darkened or blurred vision
- diplopia
- ptosis
- dysarthria
- dysphagia
- ataxia
- unilateral or bilateral numbness or weakness
Ischemic strokes
- thrombotic
- embolic
Hemorrhagic strokes
- intracerebral
- subarachnoid
Thrombotic stroke
- results from injury to blood vessel and blood clot formation
- warning: TIA (30-50% of cases)
- onset: often during or after sleep
- S&S develop slowly, usually some improvement, recurrence in 20-25% of survivors
Embolic stroke
- occurs when an embolus lodges and occludes a cerebral artery
- warning: TIA (uncommon)
- onset: lack of relationship to activity, sudden onset!
- single event, D&S develop quickly, usually some improvement, recurrence common without aggressive tx of underlying disease
Intracerebral stroke
- bleeding within the brain caused by a rupture of a vessel (most important cause-HTN)
- warning: headache (25% of cases)
- onset: activity (often)
- progression over 24 hour
- poor prognosis, fatality more likely with presence of coma
Subarachnoid stroke
- intracranial bleeding into CSF-filled space between arachnoid and pia mater
- warning: headache (common)
- onset: activity (often), sudden onset, most commonly related to head trauma
- usually single event, fatality more likely with presence of coma
Clinical manifestations for pt who have had a stroke
Motor function impairment:
- mobility
- respiratory function
- swallowing and speech
- gag reflex
- self-care abilities
Right-brain stroke
- paralyzed left side: hemiplagia
- left-sided neglect
- spatial-perceptual deficits
- tends to deny or minimize problems
- rapid performance, short attention span
- impulsive, safety problems
- impaired judgement
- impaired time concepts
Left-brain stroke
- paralyzed right side: hemiplagia
- impaired speech/language aphasia
- impaired right/left discrimination
- slow performance, cautious
- aware of deficits: depression, anxiety
- impaired comprehension related to language, math
Drug tx for pts with ischemic strokes
- thrombolytic (fibrinolytic) therapy
- TPA within 3-4.5 hours of onset of stroke
- Anticoag therapy
Surgical tx for pts with ischemic strokes
- stent retrievers-way to open blocked arteries
- mechanical embolus removal in cerebral ischemia (MERCI) retriever
Drug tx for pts with hemorrhagic stroke
-drugs to manage HTN
(oral and IV agents to keep BP in normal limits)
-seizure prophylaxis in acute period after (situation specific)
Surgical tx for pts with hemorrhagic stroke
- immediate evacuation of aneurysm-induced/cerebral hematomas >3 cm
- arteriovenous malformation (AVM)-resection and/or radiosurgery (gamma knife)
- “clipping” aneurysm
