Week 7 Stroke Flashcards
what are two ways we can get a stroke (CVA)
hemorrhage, or a broken vessel or a blockage and then a burst.
how often do people have strokes, and how often does someone die of a stroke
40 seconds, dies every 4 minutes
how many people have new and recurrent strokes every year
first: 610,000
recurrent: 185,000
how has more strokes at younger ages
men
in total, do men or women have more strokes per year
women
T/F: almost 2x risk of first stroke every in africans vs whites.
true
stroke is the ___ or ____ leading cause of death, according to different sources
5th or 3rd
every ___ minutes, some one dies from a stroke
3-4 minutes
what is the estimated indirect or direct cost of stroke
36.5 billion
what is he stroke belt
down like in the Bible Belt
25% of people age ___ and younger have a stroke
55y/o
only ___% of people under 40 have a stroke
5%
are the rate of hospitalization, rate of strokes in younger people and rates of stroke in white and blacks increasing
yes to all, all of these rates are increasing
why do we care that the age of stroke is getting younger
people are living longer with disability.
what is the leading risk factor for stroke
HTN is the leading
what are other risk factors for stroke
DM, heart rhythm things (A-fib increases risk stroke 5 fold, and is undetected), high cholesterol, smoking, tobacco use, physical inactivity, nutrition, family history and genetics, and chronic kidney disease.
are the risk factors modifiable or non modifiable. Why does this help us
they are modifiable, so we can do something to try and prevent stroke, or decrease the risk of a recurring stroke.
what are the signs and symptoms of stroke
- sudden numbness and weakness (faces, arm and leg)
- sudden confusion or difficulty speaking or understanding others
- sudden difficulty with vision
- sudden dizzy, difficulty walking, loss balance and coordination
- sudden severe HA (worst ever)
what does FAST mean, and what do we use it for
to spot a stroke face dropping arm weakness speech difficulty time to call
can we educate patients using the FAST method
yes, educate them, and inform them that if they get these S and S to call 911 immediately
what is a stroke
damage to the brain from ischemic or hemorrhagic loss
what is the primary pathology of a stroke
reduced arterial blood flow, cell death due to ischemia
what is the secondary pathology of a stroke
cell death, edema, increased ICP, more cell death
edema can lead to herniation
if symptoms last more than 24 hours what is it considered. less then 24 hours
more: CVA (Cerebrovascular accident)
less: TIA (transient ischemic attack)
how much of the normal CO goes to the brain
17-20%
what happens to blood flow in the brain with changes in the BP
increase BP, stretch the arterial wall, then it contracts, decreases flow and decreases BP in the brain
what is normal cerebral blood flow
autoregulation, do chemical regulation, O2 vs CO2, pH, viscosity and ICP, and changes in BP
if you increase ICP, what happens to blood flow
you decrease blood flow
if autoregulation is disrupted, what are some S and S
dizziness and other signs
what do we respond to more, changes in O2 or CO2
CO2
what two things fall under the ischemic stroke category. what percent of strokes are these ischemic ones
87%
cerebral thrombus and cerebral embolus
hemorrhage accounts for 13% of strokes. There are two types of these, what are they
inter cranial (10%) subarachnoid (3%)
a clot (Cerebral thrombus) leads to occlusion which leads to…
hypoxia, ischemia, infarction and tissue death
what is a transient ischemic attack (TIA)
deficit lasting less than 24 hours
what % of strokes are preceded by TIA
15%
what is the medial management of the cerebral thrombus
increased circulation, HOB down, normalize BP and thrombolytics
what do thrombolytics do
destroy the clot, while having a TIA
what must you manage with a cerebral thrombus
cerebral edema
what are common sites for plaque build up and a thrombus
at bifurcations, like the carotid, brachiocephalic trunk, internal cerebral arteries and vertebral arteries
what is a cerebral embolus
a traveling blockage, like thrombus, fat, air or bacteria that will cork the vessel
what is the medical management of the cerebral embolus
anticoagulants and DVT prophylaxis
why does A-fib put you at a higher risk for embolus
the atria doesn’t empty as well, and the blood with pool and thicken in the atria, then it clots, and travels
what are the 2 types of hemorrhage
intracerebral and subarachnoid
what are the potential causes of a hemorrhage
aneurism, arteriovenous malformation (AVM) and HTN
what is arteriovenous malformation (AVM)
capillary beds are leaky
what is hemorrhagic conversion
a complication of acute stroke. you have the tPA administered. the clotted vessels die, which weaken the surrounding vessels and then they break and leak, so you get a second hemorrhage
what are the two types of hemorrhagic conversion
hemorrhagic infarction and parenchyma hematoma
what are the predictors of hemorrhagic conversion
large infarct
A-fib and cerebral embolism
hyperglycemia
thrombolysis
what are the causes of cerebral edema dan increased ICP
bleeding in to the brain or fluid around the brain
swelling in the brain (by ischemia)
what are the signs and symptoms of cerebral edema and increased ICP
behavior changes, decrease consciousness, HA, lethargy, decline in neuro status, vomiting, seizures.
what are the treatments for cerebral edema and increased ICP
osmotherapy, corticosteroids, and surgical decompression
what are the determinants for CVA severity
location of lesion, size or extent, early acute management, amount of collateral blood flow, and amount of brain swelling.
