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Year 2: Clinical medicine > Week 3 > Flashcards

Week 3 Flashcards

1
Q

where does stroke fall in the ranking of death/disability in the US

A

5th leading cause of death (used to be 3rd)

leading cause of long term diability and long term hospitalization

795000 Americans have a stroke each year (1/4 are recurrent)

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2
Q

what ethnicities are more prone to strokes

A

black americans and hispanic population

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3
Q

common risk factors for stroke

A

atherosclerosis

lifestyle factors

HBP

smoking

obesity

“brain attack”

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4
Q

what region of the US has the highest prevalence of stroke

A

southeastern states

“stroke belt”

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5
Q

hypothesis for why the southeastern region has a high % of stokes

A

poor nutrition; high in fat

greater smoking rates/hx tobacco farms

untreated HTN; greater barriers to health care access

socioeconomic and race factors; high poverty and minority population

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6
Q

prevalence of stroke based on age and gender

A

steady incline between 45 and 85

males are more common until 75 (females live longer)

rare below 45

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7
Q

non-modifiable risk factors for stroke

A

Age
Gender
Family hx
Race
hx of stroke
certain blood disorders (i.e. sickle cell)

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8
Q

modifiable risk factors for strokes

A

HTN
smokin g
diabetes
high cholesterol
inactivity/obesity
arteriosclerosis
history of TIA
atrial fib
excessive alcohol intake
illegal drug use
oral contraceptives

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9
Q

job as PT in terms of stroke prevention

A

stress to patients the modifiable changes that can make

especially following a prior stroke

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10
Q

what are the symptoms and warning signs of a stroke

A

Sudden weakness/numbness of face/arm/body, especially one sided

sudden confusion/trouble speaking/understanding

sudden trouble walking/dizziness/loss of balance/coordination

sudden severe headaches w/o cause

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11
Q

acronym for stroke signs

A

FAST

Face drooping
Arm weakness
Speech difficulty
Time to call 911

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12
Q

what is the technical definition of a stroke

A

sudden loss of neuro function caused by INTERRUPTION OF BLOOD FLOW TO BRAIN

aka CVA

can result from bloackage or rupture of the vessel

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13
Q

what type of stroke is most common

A

ischemic > hemorrhagic

87% of strokes

hemorrhagic produce greater consequences though

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14
Q

what are the types of strokes/subtypes

A

ischemic
hemorrhagic
-intracerebral ~10%
-subarachnoid ~5%
transient ischemic attack

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15
Q

what is an infarct

A

small localized area of dead tissue resulting from loss of blood supply

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16
Q

how does an ischemic stroke occur

A

obstructed vessels result in poor blood flow to brain

20-25% of regular blood flow is required for the cells to survive

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17
Q

what is TPA

A

clot buster

can be given in 3-4 hours of stroke onset and can remove clot

decreases length of ischemia

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18
Q

embolism vs thrombosis

A

thrombosis = static clot; results in artherosclerosis plaques that form in the brain over time and block blood flow

embolism = floating clot that travels to brain and blocks blood flow

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19
Q

common sources of emboli

A

heart is most common; usually due to afib or other valvular disease

ICA; clot originates at bifurcation of common carotid

20
Q

what are the subtypes of thrombotic strokes

A

large vessel; i.e. MCA/carotid

small vessel (lacunar); due to blockage of lenticulostriate arteries, medullary arteries, or other small vessels that branch off of main vessels; these “mini strokes” can lead to dementia

21
Q

what can caise conditional cerebral ischemia

A

low systemic perfusion pressure (LBP)

anoxia (arteries dont get perfused due to poor pressure and absence of O2)

diaschisis = system shock; stroke like temporary loss of function within a region not directly affected by the original stroke or neurologic injury that occurs due to system shock not edema or direct damage to structures

22
Q

describe a hemorragic stroke

A

reuptured blood vessel results in bleeding in brain

10-15% of strokes

caused by weak vessels

blood accumulates and compresses brain tissue

23
Q

what is an intracerebral hemorrhage

A

hemorrhage within the brain

24
Q

what is a subarachnoid hemorrhage

A

between inner and outer layers of tissue covering brain

occurs when blood vessel on the surface of the brain ruptures and bleeds into the space between the brain and skull

25
Q

what are the 2 types of weakened blood vessels that cause a hemorrhagic stroke

A

aneurysms (25% of people with cerebral aneurysm rupture don’t survive 24 hours)

arteriovenous malformation (AVMs)

TPA not appropriate for this type of stroke; no clot to bust

26
Q

common reasons for a hemorrhagic stroke

A

uncontrolled HTN

AVM (congenital)

aneurysm

cavernous malformation
vasculitis
amyloid angiopathy
venous thrombosis/infart
tumor

27
Q

symptoms of a hemorrhagic stroke

A

sudden intense HA (b/c blood has no where to go)

neck pain

N&V (b/c pressure on brainstem)

Raised intracranial pressure (ICP)

28
Q

what is a TIA

A

temporary blockage of blood flow to brain

warning stroke/temporary

symptoms last 24 hours or less

medical emergency with same symptoms as ischemic and hemorrhagic stroke

“warning sign”

29
Q

how does TIA act as a warning sign for strokes

A

often procede full strokes or other CV problems later

1/5 people who have TIA will have a stroke within 90 days

often not taken seriously, but with medical help pts can get early intervention and reduce risk of actual stroke

30
Q

what is a silent stroke

A

undetected; blood vessels die but no warning signs or symptoms are present

small vessel (“lacunar”) strokes

NOT TIA, just poor outward presentation

can be seen in advanced brain imaging techniques such as MRI and CT

31
Q

how are silent strokes linked to vascular dementia

A

linked to subtle problems in mobement/mental processing

common with older individuals and people who smoke or have hx of vascular disease

1/4 people over 80 had at least one area of tissue death in brain w/o knowledge of occurence due to lack of residual deficits

32
Q

what is the primary ischemic zone

A

area primarily affected by blood being cut off

death of several neural cells not being perfused with blood

cells die and dont regenerate

severe = blood flow below 10-25%

33
Q

what is ischemic penumbra

A

secondary area affected by ischemic stroke

region surrounding primary zone; mild to moderate ischemia

not directly affected by embolism/thrombosis and direct loss of blood supply

subject to ischemic cascade and cerebral edema

area where early spontaneous recovery occurs in neural repair

34
Q

what is an ischemic cascade

A

release of excess neurotransmitters causes disturbance of energy metabolism and anoxic depolarization

inability of brain cells to produce ATP

35
Q

what is diaschisis

A

temporary transient loss of function in areas of the brain not directly affected by injury due to reduction of blood flow or system shock

36
Q

what is cerebral edema

A

accumulation of fluids in brain due to tissue necrosis and widespread rupture of cell membranes

begins w/i minutes of ischemia but peaks at 3-4 days

TIME MATTERS: neuroplasticity principle

can have spontaneous recovery where swelling subsides/resolves in 2-3 weeks

can elevate intracranial pressure

37
Q

how can elevated ICP present

A

cheyne-stokes respiration

irregular HB

impaired arousal/consciousness

38
Q

significance of circle of willis

A

redundancy in circulation

blood rerouted to continue perfusion of brain even with blockages

delays ischemic cell death

still need 20-25% perfusion

39
Q

what is tissue plasminogen activator

A

“clot buster”

gold standard for treatment of ischemic stroke

administered with 3 hours of symptom onset

protein that catalyzes conversion to plasmin breaking down clot

ischemic stroke only

pts with tPA 33% more likely to have minimal or no disability at 3 months post stroke

40
Q

types of anticoagulation therapy

A

heparin (lovenox)
warfarin (coumadin) - for pts with afib

short term treatment

41
Q

tyoes of antiplatelet therapy

A

asprin

platelets form clots, thus these prevent clots

recommended for prevention of secondary strokes

long term treatment

42
Q

how is blood pressure managed for ischemic strokes

A

permissive hypertension

BO is allowed to remain hypertensive to keep brain perfused

43
Q

how is blood pressure controlled for hemorrhagic stroke

A

usually caused by uncontrolled hypertension

BP is normalized to prevent futher hemorrhage

cease antiplatelet adn anticoagulant therapies to stop bleed and regulate pressure

hemodynamically unstable

44
Q

what risk factors should be agressively treated for medical management of strokes

A

cessation of smoking; reduce ischemic risk by half

anticoagulant meds to reduce afib risk

manage HTN

stay active; reduced risk by 18% if exercise 5x/wk

45
Q

PT role for stroke pt

A

return to function/life

increase participation in society

prevent secondary complications/future strokes

establish POC

46
Q
A

Year 2: Clinical medicine (3 decks)

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