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Stroke & TIA Flashcards

1
Q

Define Stroke

A

Alteration of cerebral blood flow

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2
Q

Types of Stroke

A

Ischemic

Hemorrhagic

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3
Q

Reasons for Ischemic Stroke

A

Thrombosis
Embolism
Systemic hypoperfusion

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4
Q

Types of Hemorrhagic Stroke

A

Intracerebral hemorrhage

Subarachnoid hemorrhage

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5
Q

Internal carotid give way to which vessels?

A

Anterior cerebral artery

Middle cerebral artery

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6
Q

Posterior cerebral artery originates from which vessels?

A

Vertebral

Basilar

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7
Q

Etiologies of Ischemic Stroke

A 
A-fib
Atrial septal defect
Ventricular septal defect
Endocarditis
Cardiac tumor
Valvular disorder
Atherosclerotic plaques
Vasculitis
Prothrombotic State
Cerebral Hemorrhage
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8
Q

Etiology: A-fib

A

Embolization of intracardiac thrombi
Anticoagulation decreases risk by 70%
Aspirin decreases risk by 20-25%

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9
Q

Etiology: Atrial Septal Defect

A

Only if associated with a R to L shunt

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10
Q

Etiology: Ventricular Septal Defect

A

Only if associated with a R to L shunt

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11
Q

Etiology: MI

A

Most common after an anterior wall infarction

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12
Q

Etiology: Endocarditis

A

Emboli from vegetations

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13
Q

Etiology: Cardiac Tumor

A

Obstruction of blood flow
Can lead to arrhythmias
Embolization of tumor fragments

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14
Q

Etiologies: Valvular Disorders

A

Rheumatic MS: most commonly associated with stroke
Mitral valve prolapse: fibrinous deposits on valve
Prosthetic valve: require lifelong anticoagulation
Repaired valves: require anticoagulation short term

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15
Q

Percent of all strokes are hemorrhagic

A

20%

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16
Q

Causes of Spontaneous Intracerebral Hemorrhage

A

Poorly controlled HTN
Bleeding disorders
Amyloid angiopathy

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17
Q

Causes of subarachnoid hemorrhage

A 
Trauma
Spontaneous subarachnoid
Abnormal vascular composition
Illicit drug use
Intracranial arterial dissections
No identifiable cause
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18
Q

Intracranial Aneurysm

A

Located in Circle of Willis (most common)

Size and location determine risk of rupture

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19
Q

Arteriovenous Malformations

A

Abnormal connection
Venous side develop high pressures
Associated with risk of seizure

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20
Q

Types of Ischemic Stroke

A

Anterior circulation
Posterior circulation
Lacunar

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21
Q

Intracerebral Hemorrhage

A

Arterial bleeding directly into the brain
Accumulation over minutes to hours
Symptoms increase over time

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22
Q

Major causes of intracerebral hemorrhage

A 
HTN
Trauma
Bleeding disorder
Amyloid angiopathy
Illicit drug use
Arteriovenous malformations
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23
Q

Goal of treatment of intracerebral hemorrhage

A

Contain and limit the bleeding to prevent herniation

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24
Q

Major causes of Subarachnoid Hemorrhage

A

Ruptured aneurysm

Atriovenous malformation

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25
What is a Subarachnoid Hemorrhage?
Bleeding into the CSF and the space surrounding the brain | Increases ICP
26
Treatment for Subarachnoid Hemorrhage
Identification of source of bleeding | Prevent brain damage
27
Ischemic Stroke: Anterior Circulation
Most are middle cerebral artery occlusions due to direct flow from internal carotid
28
Ischemic Stroke: Posterior Circulation
Have terrible outcomes | Affects occipital lobes, cerebellum, and brainstem
29
Ischemic Stroke: Lacunar Infarcts
Lesions that occur in the penetrating arterioles off of the MCA "Punched out hypodense areas" Less morbidity/mortality
30
Stroke Risk Factors
``` HTN DM Hyperlipidemia Cigarette Smoking Cardiac Disease Elevated blood homocysteine levels AIDS Recreational drug abuse Alcoholism Family hx of stroke Overweight Ischemic heart disease PVD Sedentary lifestyle Men >45 & Women >55 Oral contraceptives +smoking Hypercoagulopathy Polycythemia Prior Stroke Sleep Apnea Bleeding disorders ```
31
Stroke Symptoms
Facial droop Arm droop Speech difficulty Time to call 911
32
Define Aphasia
Acquired communication disorder | Input or output disorder
33
4 Types of Aphasia
Global Anomic Broca's Wernicke's
34
Global Aphasia
``` Most severe INPUT AND OUTPUT Few recognizable words Understands minimal spoken speech Can't read or write ```
35
Anomic Aphasia
``` Person who are left with a persistent inability to supply words for the things that they want to talk about OUTPUT DISORDER Understands speech Reads adequately Poor writing ability ```
36
Broca's Aphasia (Expressive)
Supplied by left MCA OUTPUT DISORDER Speech output severely reduced Reading/writing affected
37
Wernicke's Aphasia (Receptive)
``` Supplied by left MCA Meaningless speech iNPUT DISORDER Comprehension poor Writing/reading affected ```
38
Define Dysarthria
Problem with the muscles that produce speech
39
Define Dysconjugate Gaze
Failure of the eyes to turn together in the same direction
40
Apraxia
Difficulty with the motor planning to perform tasks or movements when asked Patient may not know where to start
41
Define Dystaxia
Lack of muscle coordination
42
Define Agnosia
Inability to process sensory information | Loss of ability to recognize objects, persons, sounds, shapes, or smells
43
Symptoms of Subarachnoid Hemorrhage
``` Symptoms begin abruptly Sudden increase in ICP "Thunderclap" headache No focal neurologic signs Signs of meningeal irritation Symptoms preceded by heavy physical exertion or sex ```
44
Symptoms of Intracerebral Hemorrhage
Symptoms slower in onset Symptoms worsen as hematoma enlarges Headache/vomiting Symptoms preceded by heavy physical exertion or sex Symptoms will vary depending on location/size of bleed
45
Stroke Symptoms
Brain damage one side, deficits on contralateral side
46
General Symptoms of Anterior Circulation Stroke
Face-hand-arm-leg contralateral hemiparesis Aphasia Dysarthria
47
Anterior Cerebral Artery Occlusion may cause:
Contralateral leg weakness/sensory loss Contralateral arm weakness/sensory loss Urinary incontinence
48
Middle Cerebral Artery Occlusion May Cause:
Contralateral hemiplegia Homonymous hemianopsia Apraxia
49
Left Dominant Hemisphere MCA Occlusion
Aphasia Wernicke's (receptive) Broca's (expressive)
50
Nondominant Right Hemisphere MCA Occlusion
Confusion Spatial Disorientation Sensory Neglect Emotional Neglect
51
Posterior Circulation Stroke Symptoms
Vertigo Diplopia, dysconjugate gaze, ocular palsy, hemonymous hemianopsia Sensorimotor- IPSILATERAL face and CONTRALATERAL limbs Dysarthria Ataxia
52
5 D's of Posterior Stroke Symptoms
``` Dizziness Diplopia Dysarthria Dysphagia Dystaxia ```
53
Lacunar Stroke Symptoms
Pure motor or sensory loss Sensorimotor stroke Ataxic hemiparesis
54
Acute Evaluation of Stroke
Timing of onset Assessment of risk factors Look for stroke sources
55
Blood Work for Evaluation of Stroke
``` Lipid Profile CBC CMP PT/PTT Cardiac biomarkers ```
56
Diagnostic Work Up for Evaluation of Stroke
``` Noncontrast CT EKG Ultrasound of carotids Echo MRI or MRA ```
57
Key Window for Treating Stroke
3-4.5 hours
58
Medical Tool Bag for Strokes
ASA Heparin or Lovenox Fibrinolytics Percutaneous Intracerebral Intervention
59
Treatment of Stroke
Continuous monitoring | Medical support as needed
60
Tissue Plasminogen Activator (tPA)
Clot busting drug Dissolve clot in ischemic stroke ONLY FOR ISCHEMIC STROKES
61
Inclusion Criteria for tPA
Ischemic Stroke | Onset of symptoms 18
62
Exclusion Criteria for tPA
Significant stroke/head trauma in previous 3 months Previous intracranial hemorrhage Intracranial neoplasm, arteriovenous malformation, or aneurysm Recent intracranial or intraspinal surgery Arterial puncture 1.7 or PT >15 secs Heparin use within 48 hours Current use of direct thrombin inhibitor
63
Relative Exclusion Criteria for tPA
Minor/isolated neurologic signs TIA Major surgery/trauma
64
Discharge Medications for Stroke
``` Aspirin Statin Anticoagulation? Plavix? Antihypertensives Blood sugar control in DM ```
65
Residual Effects of Strokes
Emotional Lability Difficulty recognizing, understanding familiar objects Difficulty planning/carrying out simple tasks Loss of awareness Dysphagia and aspiration
66
Medical Complications of Stroke
``` Bladder dysfunction Bowel dysfunction Pressure ulcers Malnutrition Dehydration Falls/injuries Recurrent strokes Venous thromboembolism Dysphagia Aspiration pneumonia Seizures Spasticity ```
67
Define TIA
Stroke like event lasting less than 24 hours that occurs secondary to cerebral ischemia
68
Etiology for TIA
``` A-fib Atrial septal defect Ventricular septal defect Endocarditis Cardiac tumor Valvular disorder Atherosclerotic plaques Vasculitis Prothrombotic State Cerebral Hemorrhage ```
69
Risk Factors for TIA
``` HTN DM Hyperlipidemia Cigarette Smoking Cardiac Disease Elevated blood homocysteine levels AIDS Recreational drug abuse Alcoholism Family hx of stroke Overweight Ischemic heart disease PVD Sedentary lifestyle Men >45 & Women >55 Oral contraceptives +smoking Hypercoagulopathy Polycythemia Prior Stroke Sleep Apnea Bleeding disorders ```
70
TIA Subtypes
Amarosis fugax Low Flow Embolic Thrombotic
71
TIA Work Up
CT or MRI Carotid ultrasound Evaluation for source of embolic/thrombus
72
TIA Treatment
Consider hospital admission (

Neurology (10 decks)

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