Transient Ischemic Attack and Cerebral Vascular Accident Flashcards
Cerebral Circulation
blood supplied to the brain in internal carotid arteries and vertebral arteries which needs to be 750 to 1000mL/min for normal brain function
Ischemic Cascade
inadequate adenosine triphosphate production leads to loss of ion homeostasis, the release of excitatory amino acids, free radical formation and cell death
Stroke
lack of blood flow to the brain with multiple causes results in cell death within the brain
Ischemic Stroke
stroke from partial or complete occlusion of the artery. Most common stroke that can cause thrombotic and embolic effects
Affect of Brain
If the stroke is on the left side of the brain, the right side of the body is affected and vice versa
Transient Ischemic Stroke
temp neurological dysfunction from the focal brain, spinal cord, or retinal ischemia without acute infarction of the brain, essentially a mini-stroke. It May develop into a full stroke if not treated
Thrombotic Stroke
cerebral thrombosis or narrowing of the lumen on the arteries in the brain from fatty plaque or trauma to the artery wall that causes a blood clot formation. 30-50% of all strokes. Typically no changes to LOC unless it is severe. Risk factors are hypertension and DM
Lactunar Stroke
stroke form occlusion of a small penetrating artery that supplies blood to the deep tissues of the brain.
S&S of Lactunar Stroke
Typically more severe paralysis of one side of the brain purse sensory stroke loss of consciousness decrease in vascular functioning
Embolic Stroke
embolus or blood clot or other debris causing a blockage in a narrow artery that blocks blood flow resulting in infarction and edema of the area with severe rapid progression, 24% of stroke and typically ends with cardiovascular complications as well
Embolic Stroke S&S
headache that typically does not cause a LOC
Hemorrhage Stroke
burst blood vessel or vessels that causes internal bleeding to occur in the brain and damage to the tissues until coagulation occurs, 15% of all strokes
Intracerebral Hemorrhage Stroke
10% of all strokes, occurs in the brain due to some type of trauma with sudden onset of symptoms that is typically caused by hypertension
Subarachnoid Stroke
intracranial bleeding into the cerebral spinal fluid space between the arachnoid space and pia mater that is commonly caused by a brain aneurysm. Mortality rates are 25% and 1/2 of survivors have severe permanent neurological damage. SILENT BUT DEADLY
Risk Factors of Strokes
Hypertension, which is also the most common cause DM due to the systemic inflammation, atrial fibrillation, endothelial dysfunction CAD and other cardiovascular diseases heavy alcohol consumption oral contraceptives smoking physical inactivity obesity older age ethnicity hereditary so familial history of low birth weight
S&S of Strokes
decreased mobility decreases senses, numbness or paralysis loss of speech and swallowing decreased rep loss of voluntary movement drooping face amnesia of movements lack of or decreased reflexes monotone voice and inability/difficulty expressing emotions decreased judgement and intellectual status poor perception of self poor elimination headache LOC depending on the type of stroke fixed pupils or pupils unequally reactive Homonymous Hemianospice - blindness equal on both sides in a specific area of vision that can lead to double vision, loss of corneal reflex and ptosis (drooping eyelid) dysphagia dysarthria altered spatial perception
Left Side Stroke S&S
communication problems hemiplegia hyperaware of deficits causing depression and anxiety impaired wrath language impairment facial drooping
Right Side Stroke S&S
vision problems
Left side neglect
tend to minimize or deny effects of stroke
rapid performance
decreased attention span
impulsive or posing safety concerns to self
impaired time concepts
Ischemic Stroke S&S
loss of sight in one eye vertigo dysphagia double vision or blurriness unilateral control of movement problems speaking
Intracerebral Hemorrhage Stroke S&S
hemiplegia internal bleeding and bruising balance off abnormal body posture paralysis
Gender Differences in Strokes
1/3 more women die from strokes, with worse outcomes and less likely to be admitted into a rehab program. 85 women a day have a stroke and 18 of them will die
Diagnosis of Stroke
CT CAT MRI MRA Carotid angiography carotid duplex scanning cerebral angiography digital subtraction angiography transcranial doppler ultrasonography cardiac markers and other cardiac diagnostics if cardiovascular involvement is suspected coagulation studies CSF analysis CBC aPTT Renal and hepatic studies
TX of Strokes
CABs IV with NS NPO and NG tube ASA, Plavix, apixaban, dabigatran, rivaroxaban surgery physio and movement rehab monitoring neuro exam results, elimination, skin integrity, and nutritional status focus on emotions and coping tPA
tPA Recombinant Tissue Plasminogen Activator
naturally occurring endothelial protein that activated conversion of plasminogen to plasmin that breakdown clots and is used to re-establish blood flow to the brain. Need to be within 3.5-4 hours of onset and cannot have blood thinners prior. Requires foley catheter,, NG tube and multiple IVs
Rehab for Strokes
stabilized for 12-72 h is the beginning
attaining optimal functioning with physio may be transported to outpatient neuro wards and neuro exam is KEY
