Stroke Module Flashcards
Major risk factors of stroke (modifiable)
Hypertension (most important; control the HTN to prevent stroke) Metabolic syndromes (diabetes) Heart disease (atherosclerosis)(CAD) Heavy ETOH consumption Poor diet Drug abuse Sleep apnea Obesity Physical inactivity Smoking
What is the most significant modifiable risk factor for stroke?
Hypertension
Ischemic stroke
Ischemic strokes result from Inadequate blood flow to the brain from partial or complete occlusion of an artery 80% of all strokes are ischemic strokes Ischemic strokes can be A. Thrombotic (arthrosclerosis) B. Embolic (traveling blood clot)
Hemorrhagic stroke
Account for approximately 15% of all strokes
Result from bleeding into the brain tissue itself or into the subarachnoid space or ventricles
Intracerebral hemorrhage
Bleeding within the brain caused by rupture of a vessel
HYPERTENSION is the most important cause
Hemorrhage commonly occurs during periods of physical activity (sex, exercise)
Non modifiable risk factors for stroke
Age,
Gender,
Race,
Genetics/family history
What is a TIA?
Transient Ischemic Attack (TIA) is a temporary focal loss of neurologic function caused by ischemia.
Most TIAs resolve within 3 hours; beyond 3 hours is a stroke
TIAs may be due to microemboli that temporarily block the blood flow
TIAs are a warning sign of progressive cerebrovascular disease
Thrombotic stroke (Ischemic)
Thrombotic stroke
Thrombosis occurs in relation to injury to a blood vessel wall and formation of a blood clot
Result of thrombosis or narrowing of the blood vessel
Most common cause of stroke
Two-thirds are associated with hypertension and diabetes mellitus
Often preceded by a TIA
Embolic stoke (Ischemic)
Embolic stroke
Occurs when an embolus lodges in and occludes a cerebral artery
Results in infarction and edema of the area supplied by the involved vessel
Second most common cause of stroke
Majority of emboli originate in the inside layer of the heart, with plaque breaking off from the endocardium and entering the circulation
Patient with an embolic stroke commonly has a rapid occurrence of severe clinical symptoms
MANIFESTATIONS: Intercerabral hemorrhage d/t hemorrhagic stroke
Often a sudden onset of symptoms, with progression over minutes to hours because of ongoing bleeding MANIFESTATIONS Neurologic deficits Headache Nausea and/or vomiting Decreased levels of consciousness Hypertension
Subarachnoid hemorrhage
Intracranial bleeding into cerebrospinal fluid–filled space between the arachnoid and pia mater
Commonly caused by rupture of a cerebral aneurysm
An aneurysm may be saccular or berry
Majority of aneurysms are in the circle
of Willis
“Worst headache of one’s life”
Most frequent surgical procedure to prevent rebleeding is clipping of the aneurysm
Coiling is another procedure
Stroke Features: Thrombotic
ONSET: Gradual, in minutes to hours
LOC: Preserved
Neuro: Deficits Headache, speech, visual, confusion
Duration: Improvements over weeks to months
Stroke Features: Embolic
ONSET: Sudden
LOC: Preserved
Neuro Deficits: Paralysis, aphasia
Duration: Rapid but may be persistent if embolism is not absorbed
Stroke Features: Hemorrhagic
ONSET: Usually sudden
LOC: Stuporous, coma
Neuro Deficits: Focal deficits
Duration: Variable, permanent deficits possible
Clinical manifestations of stroke: Cognitive changes
Cognitive changes
- increased ICP, confusion
- right sided = vision/spatial, personality changes
- left sided = aphasia, decreased analytical skills
Clinical manifestations of stroke: Motor changes
Motor changes - hemiplegia, hemiparesis - hypotonia, flaccidity - incontinence - seizures, unequal pupils, facial drooping
