Test 2 Flashcards
Warning Signs of a Stroke
Face Drooping
Arm Weakness
Speech Difficulty
Time to Call 911
Sudden numbness or weakness of the leg
Sudden confusion or trouble understanding
Sudden trouble seeing in one or both eyes
Sudden trouble walking, dizziness, loss of balance or coordination
Sudden severe headache with no known cause
Nauseous
Vomiting
Time period that a person having a stroke should get to the hospital by
Ideal is less than 2 hours but less than 3 hours is critical
Modifiable Risks for Stroke
HTN BP > 160/95 Reducing Diastolic by 5-6 mmHg reduces risk by 40% Smoking Weight Atrial Fibrillation increases risk by 6x Decreased Physical Activity CAD- cholesterol Apnea Alcohol
American Heart Association Life’s Simple 7
Get Active Control Cholesterol Eat Better Manage BP Lose Weight Reduce Blood Sugar Stop Smoking
Types of Strokes
Ischemic (87%):
Embolic
Thrombotic
Lacunar
Hemorrhagic
TIA (not a stroke, a warning sign)
Ischemic Stroke`
A clot blocks blood flow to an area of the brain reducing oxygen
3-4 minutes of hypoxia is when brain cells die
Embolic Ischemic Stroke
Most common type of ischemic stroke
Blood clot forms somewhere else and travels to the brain
Cardiac origin (carotids and aorta) most common and 80% of emboli occlude the MCA
Other forms: paradoxical, congenital (foramen oval), DVT
Thrombotic (Ischemic) Stoke
Thrombosis (obstruction of a blood vessel by a blood clot forming locally)
Typically related to abnormalities within the vessel wall such as atherosclerosis, arteritis, dissections and external compression of the vessels
HTN is the common precusor
Large vessel thrombosis that occurs in extrracranial vessels (carotid, vertebral a) can lead to severe strokes
Lacunar (Ischemic) Stroke
Lacunar stroke or lacunar infarct (LACI) is a type of stroke that results from occlusion of one of the penetrating arteries that provides blood to the brain’s deep structures. Infarct is 2mm to 3cm in size
Typically associated with chronic HTN and diabetic microvascular disease
25% of ischemic strokes
Types of Lacunar Strokes
Only Sensory Only motor Sensorimotor Ataxic hemiparesis (mild form, less than cerebellar) Dysarthria (trouble swallowing) Clumsy-hand syndrome
Hemorrhagic Stroke
Account for approx 13% of strokes
Common causes:
HTN bleed
ICH due to AVM or tumor
Ruptured aneurysm
Cellular destruction caused by ischemia 2ndary to trauma. Mechanical injury caused by edema and pressure of blood collection
75% of ppl with Hemorrhagic stroke due to HTN
Anterior Cerebral Artery (ACA) supplies…
Medial aspect of the frontal and parietal lobes, and subcortical structures like Basal Ganglia
Middle Cerebral Artery (MCA)
Entire lateral aspect of cerebral hemisphere (frontal, temporal, parietal)
Posterior Cerebral Artery (PCA)
Occipital Lobe, medial/inferir temporal lobe, UPPER BRAIN STEM, Midbrain, Thalamus
Transient Ischemic Attack (TIA)
Symptoms include focal deficits of an ischemic stroke and typically follow a vascular pattern
Are REVERSIBLE, NO Infarct of the tissue
Within 5 yrs 35% of ppl with a TIA have a stroke
Workup necessary for prevention of future stroke
Pt will be monitored for 24 hours
Hemorrhagic Conversion
Ischemic infarct that converts to a hemorrhagic lesion
Thrombi/Emboli can migrate, lyse and reperfuse into an ischemic area, leading to small hemorrhages
Damaged capillaries and small blood vessels no longer maintain their integrity
More common in large infarcts like an occluded MCA
Tissue Plasminogen Activator (TPA)-strong thrombolysis med-Guidelines
Must rule out hemorrhagic stroke
Must have clinical diagnosis of ischemic stroke
No recent trauma, surgery, bleeds
If TIA, rapidly improving sx will occur, do NOT give TPA
BP <185/110
Must be within 3 hours of onset
CT without ICH or major early infarct signs
Normal glucose and platelet counts
Temporal Lobe Fxns
Personality, Behavior, Emotions, Judgement, Planning, Problem Solving, Intelligence, Speaking, Writing, Concentration, and Self Awareness
Parietal Lobe Fxns
Interpretation of Language, Sensation of Touch Pain, and Temperature, Vision, Hearing, Memory, and Visual/Spatial Perception
Temporal Lobe Fxns
Understanding Language, Memory, Hearing, Sequencing, and Organizing
Occipital Lobe Fxns
Interprets Vision (Light, Color, Movement)
Left sided Strokes
Right Sided Weakness Right Sided Sensory Deficits Speech and Language Deficits Slow, Cautious Behavior Style Memory Deficits
Right Sided Strokes
Left Sided Weakness
Left Sided Sensory Deficits
Spatial Perceptual Deficits
Quick, Impulsive Behaviors Style
Brain Stem Strokes
Changes in breathing, movement, sensation, eye movement, heart rate, blood pressure
Cerebellar Strokes
Abnormal reflexes of the head and torso
Impaired Coordination, Ataxic Movement/Gait, Balance Issues, Dizzyness, Vomiting
Signs and Sx of Occlusion of the ACA
Contralateral hemiparesis involving mainly LE
Contralateral hemisensory loss involving mainly LE
Urinary Incontinenece
Slowness, Delay, Motor Inaction
Signs and Sx of Occlusion of the MCA
Contralateral hemisensory loss & hemiparesis (mainly UE & face)
Motor Speech Impairment (Broca’s or nonfluent aphasia with slow speech impairment)
Receptive Speech Impairment (Wernicke’s or fluent aphasia)
Global Aphasia
Perceptual Deficits and limb kinetic apraxia
Ataxia of Contralateral limbs
Signs and Sx of Occlusion of the Vertebral Arteries- Medial Medullary Syndrome or”Dejerine Syndrome”
Ipsilateral impairments of:
Paralysis with atrophy of 1/2 of tongue with deviation to the paralyzed side
Contralateral Impairments of:
Paralysis of UE and LE
Impaired tactile and proprioceptive sense
Signs of Occlusion of the Posterior Cerebellar Artery or Vertebral Artery- Lateral Medullary Syndrome or “Wallenburg’s Syndrome”
Ipsilateral impairments: Decreased pain/temperature sensation to face Cerebellar Ataxia Vertigo/Nausea Nystagmus Dysphagia
Contralateral Impairments:
Impaired pain and thermal sense over 50% of the body
Signs of Occlusion of Basilar Artery or “Locked in Syndrome”
Hemiparesis-Quadriplegia
Bilateral Cranial Nerve Palsy
Consciousness and Sensation are spared
Pt can not move or speak but remains alert & oriented
Occlusion of Paramedian Branch of Basilar Artery or “Foville’s Syndrome”
Ipsilateral Impairments Paralysis of conjugate gaze to side of lesion Nystagmus Ataxic Gait Double Vision with Lateral Gaze
Contralateral impairments:
Pareis of face, UE, LE
Impaired tactile and proprioceptive sense over 50% of the body
Occlusion of the Anterior Inferior Cerebellar Artery
Ipsilateral Impairments: Horizontal & Vertical Nystagmus, vertigo, nausea, vomiting Facial Paralysis Deafness/Tinnitus Ataxia Impaired sensation over the face
Contralateral Impairments:
Impaired pain & thermal sense over 1/2 the body
