Stroke Lecture Powerpoint Flashcards
Cerebrovascular disease
A collective term for a range of conditions that affect and decrease blood flow to brain such as carotid stenosis, aneurysms, vascular malformations, stroke, etc.
Risk factors for CVD (also which is MOST important?) (8)
- HTN (MOST important)
- atherosclerosis
- hyperlipidemia
- diabetes
- smoking
- diet
- obesity
- increasing age/male/african americans
Carotid stenosis definition, when is it symptomatic, diagnostic studies (3), treatment options
- A type of cerebral vascular disease caused by atherosclerosis plaque in the arteries that are main supply to brain
- Often asymptomatic until a TIA
- PE might find carotid bruit, doppler ultrasound, or cerebral angiography
- In less than 50% occlusion treated conservatively with antihypertensives, statins, anticoags while >50% require stenting but NOT endarterectomy (too risky)
Cerebral aneurysm causes (4), epidemiology, types, signs/symptoms, diagnosis
- Caused by hypertension, atherosclerosis, trauma, congenital defect
- most prevalent in ages 50-60 and more common in women
- 2 types: saccular (rounded outpouching containing blood also called berry) and fusiform (balloons or bulges out on all sides of artery)
- Signs and symptoms unruptured are asymptomatic but occasionally have cranial nerve palsy, dilated pupils, double vision, or pain - ruptured have localized headache, nausea and vomiting, stiff neck
- Diagnosed via MRA and carotid angiogram, rupture can also be detected by CT or lumbar puncture then cerebral angiography
Vertebrobasilar insufficiency cause, signs/symptoms, diagnosis (2), treatment options (3)
- Caused by decreased blood flow to vertebral and basilar arteries, affects the brainstem, occipital lobes, and cerebellum
- vision loss, diplopia, vertigo, dysarthria, ataxia, confusion
- MRA or angiography
- lifestyle modifications, meds, surgery
Arteriovenous malformations definition, cause, signs/symptoms (2), diagnosis (2), treatment (1)
- Groups of abnormal/poorly formed blood vessels resulting in increased rate of bleeding
- typically congenital found incidentally
- seizure and headache (4/100 people will hemorrhage per year)
- MRI and angiography
- Treated by neurosurgery
Stroke definition, how does it clinically present?
- Abrupt onset of neurological deficit attributable to focal vascular disease, acute brain injury caused by decreased blood supply (ischemia) or hemorrhage
- clinical manifestations are variable because of the complex anatomy of the brain and its vasculature
Stroke is a ____ diagnosis
clinical
Stroke pathophysiology
- Brain is 2% of body weight but takes 17% of cardiac output and 20% o2
- ischemia is caused by decrease in blood flow that lasts longer than a few seconds
- neurons lack glycogen so energy failure is rapid and necrosis occurs faster than in other tissue
Stroke epidemiology
Stroke is the leading cause of what?
- 5th leading cause of death, 87% are ischemic rather than hemorrhagic,
- leading cause of serious long term disability
2 types of stroke based on dysfunction and their subclasses
- focal brain dysfunction (ischemic and intracerebral hemorrhage)
- diffusion brain dysfunction (subarachnoid hemorrhage)
80% of ischemic strokes occur from occlusion of ____ caused by _____.
Majority of strokes are ____ rather than ____
- large or small vessels
- thrombosis (clot), embolism (dislodged flowing object), or systemic hypoperfusion (circulatory problem of whole brain)
- ischemic, hemorrhagic
Ischemic stroke vs TIA
Ischemic stroke is infarction with sequelae (symptoms don’t completely go away while body tries to compensate) vs TIA has no infarction and no sequelae but is a transient “mini stroke”
Transient ischemic attack (TIA)
Transient episode of focal ischemic cerebral neurologic deficits without infarction, symptoms typically less than 1 hour but varies, risk of stroke rises if not treated early enough
Transient ischemic attack clinical presentation (3) and which set of symptoms does carotid TIA belong to and which does vertibrobasilar ischemic belong to?
- abrupt and rapid recovery
- weakness and heaviness of contralateral arm, leg, or face with possible numbness (carotid)
- vertigo, ataxia, diplopia, dysarthria, changes in vision (vertebrobasilar ischemic)
TIA diagnostic studies (5)
- CT of head
- echo
- EKG (afib)
- CBC (infection)
- blood glucose (hypoglycemia)
TIA treatment options (4)
- carotid endarterectomy if surgery accessible stenosis
- anticoagulants
- aspirin 325mg po daily
- clopidogrel (plavix)
Penumbra
Zone of reversible ischemia around core of irreversible infarct, salvageable in first few hours after ischemic stroke onset and goal to save with treatment to reverse and minimize permanent damage
Lacunar infarct ischemic stroke definition and presentation (3)
- A common type of ischemic stroke usually caused by small lesions often in patients with no memory of CVA found incidentally, usually progress over 24 hours then stabilize
- Present with contralateral motor and sensory deficits, ipsalateral ataxia, and dysarthria
Carotid circulation ischemic stroke definition and presentation (1)
-A common type of ischemic stroke that is usually asymptomatic but can present with amaurosis fugax (collateral circulation brings vision back)
LEFT sided MCA ischemic stroke should raise worry for….
….broca’s or wernicke’s aphasia
anterior cerebral artery ischemic stroke key points (2)
- emotional symptoms
- unilateral occlusion well tolerated because of collateral blood flow
middle cerebral artery ischemic stroke key point (1)
-wernicke and broca’s aphasia if on left side of brain
posterior cerebral artery ischemic stroke key points (2)
- thalamic syndrome: contralateral hemisensory disturbance followed by spontaneous pain and increased sensation
- memory loss
