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Patho 2 > TIA and Stroke > Flashcards

TIA and Stroke Flashcards

1
Q

TIA

A

Transient ischemic attack; acute focal cerebral insufficiency lasting under 24h (often under 60min)

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2
Q

Do TIAs have residual effects?

A

NO - and no acute infarction

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3
Q

Who gets TIAs

A

more males than females

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4
Q

Does TIA cause increased risk of stroke?

A

Yes - inc risk after one within 1 month

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5
Q

Do TIAs recur often?

A

Yes - often with the same symptoms

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6
Q

TIA CM

A

depend on the affected vessel and follows a vascular “line”

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7
Q

TIA CM (specifics)

A

Like Bell’s palsy
- droopy face, like stroke
- carotid area–weak, numb, heaviness in the contralat arm, leg, face, dysphagia and ipsilateral monocular vision loss
- vertebrobasilar–blurry vision, vertigo, dysphasia, motor or sensory changes, ipsilateral face, contralateral body

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8
Q

TIA care

A
  • hx and physical for pattern or vasc problem
  • CT, MRI, MRA 1st to r/p hemorr, lacunar infarct or aneurysm
  • Carotid doppler study for carotid stenosis
  • echo for cardiac causes
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9
Q

TIA tx

A
  • anticoag–ASA or clopidogrel or hep/warf if cardiac
  • carotid endarectomy w/ over 70% stenosis
  • edu on lifestyle meds
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10
Q

Names for strokes

A

CVA aka stroke aka brain attack

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11
Q

Risk fx for stroke

A

HTN, HLD (inc chol), endothelial damage–tobacco and DM, obese, alc, fam, race (AfAm), oral contraceptives, old, men, SCA, physically inactive, arterial disease, hx TIA, a-fib, IV, coke use, HF (EF <25%)

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12
Q

Stroke CM

A

numb/weak unilaterally in face, arm, leg, confuse, trouble speaking, slurred speech (dysarythria), ataxia, severe HA w/o cause (esp hemorr)

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13
Q

What to do first after a stroke

A

CT w/o contrast
- bright white shows hemorrhaging blood
- darkness shows damaged tissue

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14
Q

Ischemic stroke

A

Vessel occlusions stop blood distal to brain occlusion
- occluded cerebral artery
- thrombus or embolus

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15
Q

How to treat an ischemic stroke best?

A

Known the best cause

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16
Q

Hemorrhagic stroke

A

Ruptured vessel in brain parenchyma

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17
Q

Hemorrhagic conversion

A

happens post-stroke, extravasation of blood from peripheral circulation across a disrupted BBB
- occurs after reperfusion is established
- natural or with therapy

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18
Q

Stroke patho

A

dec blood supply, o2 dec, neuro def and sx w/i 1 min, cont loss of supply, irreversible damage

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19
Q

Thrombotic stroke

A

from arterial obstruction from thrombus
- often athero that ruptures
- or clot
- or hypercoag state–cancer, oral cont, COVID

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20
Q

Embolic stroke

A
  • often cardiac source like a-fib, mural thrombus
  • often arterial on L side
  • venous if atrial septal defect or patent foramen ovale
  • thrombus of vegetation of valves from mitral valve (IE) and valve replace
  • carotid plaque rupture (hear bruit)
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21
Q

What is a mural thrombus

A

in L ventricle a part breaks off

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22
Q

penumbra

A

injured but salvagable tissue around dead area

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23
Q

Goal of stroke tx

A

Tx w/i 3h to save
- maintain perfusion–BP <180/105 w/ TPA; BP <220/120 w/o TPA

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24
Q

What are hemorrhagic strokes associated with

A
  • long standing, severe HTN–inc pressure weakens the vessel
  • aneurysms
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25
Q

Mortality of hemorrhagic stroke

A

quick–minutes to hours or w/i seconds in the brainstem

26
Q

With a hemorrhagic stroke, ICP…

A

Increases with inflammation
- herniation can occur
- tissue death
- cranium defines the space

27
Q

Age range for hemorrhagic stroke

A

30-60Y (younger than ischemic)

28
Q

What does hemorrhagic stroke prognosis depend on

A

Age (older is better), location and size, how rapid the brain shifts occur

29
Q

Midline shift

A

blood forces the brain past the cranial midline

30
Q

Where does a hemorrhagic stroke occur?

A

Below the pia mater

31
Q

Epidural bleed

A
  • skull fracture
  • arterial bleeds
  • less severe injury
32
Q

subdural bleeds

A

injury in bridging veins that carry blood from outer region to larger brain vessels
- if severe, rapid decline
- brain moves but vessels don’t
- can be slow–2-10d later (bc venous)
- need to relieve pressure

33
Q

Where does a subarachnoid hemorrhage occur?

A

In the CSF
- often due to cerebral aneurysm or AVM
- may see blood in the CSF during a lumbar puncture

34
Q

Which bleed will NOT be treated by evacuating the blood build up?

A

Bleeds in the tissue

35
Q

Hemorrhagic stroke presentation

A
  • worst HA ever
  • rapid chx in LOC
  • irritation of the meninges–nuchal rigidity and photophobia (subarachnoid)
36
Q

AVM

A

abnormal junction with blood flow direct from artery to vein without slowing thru caps
- puts at risk of intracranial hemorrhage

37
Q

When is a lumbar puncture most sensitive for detecting a subarachnoid bleed?

A

12 hours after onset of sx

38
Q

Subarachnoid hemorrhage management

A
  • keep BP steady (withing borders)
  • bed rest
  • surgery ASAP for aneurysm–clip or coil
  • anticonvulsant maybe
  • CCB post-surg to “narrow BVs to slow BF”
  • triple H therapy for perfusion–HTN (pressors), hypervolemia, hemodilution
39
Q

When is the risk of rebleed highest?

A

24 hours after

40
Q

Fibrinolytics

A

Destroy an already formed clot

41
Q

BE FAST

A

Balance, HA, dizzy
Eyes (vis loss)

Face (symmetry)
Arm (weak)
Speech
Time to call 911

42
Q

Endovascular embolization

A

Insert cath in groin and thread to aneurysm and coil metal inside to block blood flow in aneurysm

43
Q

What is important to know for a stroke?

A

Last known normal

44
Q

GCS < 8

A

Intubate–worry about protecting airway

45
Q

Stroke protocol

A
  • ABCs
  • Glucose and labs
  • CT
46
Q

How do you r/o hemorr or ischemic?

A

CT scan w/o contrast

47
Q

tx for hemorrhagic stroke

A
  • Reverse anticoags
  • Control HTN
  • Manage ICP
  • raise HOB, antipyretics, head neutral
48
Q

tx for ischemic stroke

A

Anticoags or thrombolytics to dec penumbra

49
Q

MRI vs CT for stroke

A

MRI more detailed but not first choice in emergencies

50
Q

L side head stroke complications

A

Logic, math, communication

51
Q

R side stroke comps

A

Pictures, stories, music, art

52
Q

Alteplase class and MOA

A
  • fibrinolytic therapy
  • Converts plasminogen to plasmin to dissolve clots
53
Q

Alteplase SE and NC

A

Biggest risk is intracranial bleeding, dysrhythmias with reperfusion, hypotension
- give w/i 30-70 min for sx of MI
- can give with Hep and clopidogrel
- CI with brain bleed
- IV
- antidote is aminocaproic acid (anti-thrombolytic)–stops the bleed

54
Q

Surgical tx for ischemic stroke

A

Penumbra procedure–mechanical thrombectomy

55
Q

Other comps of stroke

A
  • dysphagia–need swallow study
  • motor and sensory
  • flaccid on contralat side
  • spasticity w/i 6W and contractures
  • Contralat vision changes
  • aphasia–probs with lang reception of reading, speaking
56
Q

Homonymous hemianopia

A

Lose the r or l side of both visual fields

57
Q

Receptive aphasia

A

Difficulty understanding but can communicate

58
Q

Dysarthria

A

Impaired speech

59
Q

Expressive aphasia

A

Can’t express language but can comprehend

60
Q

Cognitive stroke effects

A
  • memory
  • behavioral–apathetic, emotional, slow rxn time, cautious, underestimate own abilities
  • depression

Patho 2 (16 decks)

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