TIA and Stroke Flashcards
What is a Transient Ischemic Attack?
An acute, focal cerebral insufficiency that lasts less than 24 hours but it usually less than 60 minutes and leaves no residual effects. It is a brief episode of neurological dysfunction resulting from an interruption in the blood supply to the brain or the eye, sometimes as a precursor of a stroke.
When is stroke risk the highest following a Transient Ischemic Attack
1st month
What does someone with a TIA look like?
1-sided facial droop that is forehead-sparing
What does a carotid TIA/stroke look like?
weak and heavy contralateral arm + leg and face, numbness, dysphagia, ipsilateral one-eye visual loss
What does a vertebrobasilar TIA/stroke look like?
dim/blurry vision, vertigo, dysphagia, ataxia on the body contralaterally and on the face ipsilaterally
How is a TIA/stroke diagnosed?
history and physical, CT, MRI, MRA, carotid doppler, or an ECHOcardiogram
How is a TIA/stroke treated?
anticoagulants (ASA), anti-platelets (clopidogrel), carotid endarterectomy with > 70% stenosis
What are the leading risk factors for a stroke
Hypertension (Hemorrhagic), Hyperlipidemia (Ischemic), and tobacco use
What are the secondary risk factors for a stroke?
African American, Age, men, Atrial Fibrillation
What are the less likely risk factors for a stroke?
DM, obesity, alcohol, family history, birth control, sickle cell anemia, physical inactivity, arterial diseases, TIA history, Cocaine, Heart Failure
What is an Ischemic Stroke?
occlusion of a cerebral artery by a thrombus or ane embolus that causes O2 deprivation, irreversible damage, and neuro deficits
What is a Thrombotic Stroke (ischemic)?
A thrombus forms due to atherosclerosis in a vessel or a hypercoagulable state (Birth Control). This is usually seen in older individuals with high cholesterol, atherosclerosis, or DM
What is an Embolic stroke (Ischemic)?
Occurs when a clot or debris (embolus) travels from one part of the body and lodges in a narrower brain artery, blocking blood flow to the brain.
What would cause an embolic stroke?
thrombus, valve vegetation, a venous clot in atrial septal defect or PFO, carotid plaque, A.Fib, mitral valve vegetation
What is a Penumbra?
the area surrounding an ischemic event such as a thrombotic or embolic stroke. This ischemic area is viable for 3 hours
What is a Hemorrhagic Stroke?
bleeding within the brain parenchyma (tissue) that is associated with long-standing, severe, untreated Hypertension
What comes as a direct result of a hemorrhagic stroke?
increased intracranial pressure, herniation, death
What are the two types of intracranial hemorrhages?
epidural and subdural
Where does an epidural intracranial hemorrhage take place?
between the skull and the dura mater
Where does a subdural intracranial hemorrhage take place?
between the dura mater and the arachnoid matter
How does an epidural intracranial hemorrhage occur?
skull fractures tear an underlying blood vessel (arteries)
Is a subdural or epidural intracranial hemorrhage worse?
subdural
How does an subdural intracranial hemorrhage occur?
a type of bleeding that occurs outside the brain as a result of a severe head injury. It takes place when blood vessels burst between the brain and the leather-like membrane that wraps around the brain (the dura mater). the brain moves within the skull but the vessels don’t (bridging veins)
How fast does decline occur with a subdural hemorrhage?
can be very rapid or very slow (2-10 days)
Where does a Subarachnoid hemorrhage take place?
between the outer arachnoid and pia mater
How does a subarachnoid hemorrhage occur?
rupture of a cerebral Berry aneurysm or arterio-venous malformation that usually occurs in 30-60-year-olds
What is a hallmark sign of a subarachnoid hemorrhage?
blood in the Cerebrospinal fluid (CSF)
How fast must you treat a stroke?
3 hours
How would someone present with a hemorrhagic stroke?
rapid level of consciousness change, meninges irritation in the form of nuchal rigidity, photophobia
What does it mean if someone claims they have “the worst headache of my life”?
HEMORRHAGIC STROKE!
How long is there a re-bleeding risk?
first 24 hours
Will an MRI detect an intracranial hemorrhage?
NO
what does “BE FAST” stand for?
Balance loss
Eyes
Face uneven
Arm weakness
Speech
Time to call 911
What can you do to treat a patient with a possible stroke?
ABC’s, CT scan W/o contrast, penumbra procedure to try and save the area
What are the left-brain consequences of a stroke?
loss of logic, verbal, details, science, names, math, thinking, writing, slow/cautious behavior, memory loss, organizational impairment
What are the right-brain consequences of a stroke?
loss of pictures, stories, music, patterns, big picture, imagination, denies problems, impaired judgment, impulsivity, safety problems, short attention span
What are the consequences of a stroke?
aspiration risk, motor and sensory deficits, flaccidity on the contralateral side, spasticity in 6 weeks, contralateral field blindness, homonymous hemianopsia (vision), dysphasia, aphasia, dysarthria, expressive and receptive aphasia, depression, memory problems
What are some Altered personality effects of a stroke?
increased emotional responses, slow reactions, hesitant, cautious, confused, disoriented
