Week 8 stroke Flashcards
Stroke drugs
Atorvistatin (HmG-CoA reductase inhibitor)
Labetalol (Trandate) - beta blocker
ASA - antiplatelet
Heparin: unfractioned heparins
t-PA: Fibrinolytic therapy
What is atorvistatin used for
Lower LDL and prevent plaque
What is Labetalol (trandate) used for
Post stroke
lower BP
what is ASA, Heparin and t-PA used for
Prevent/dissolve blood clots
What does the Cerebellum do
Fine motor movement
Balance
Determines limb movement
What does the brain stem do
Breathing
Heart rate
Blood Pressure
Alertness (A&O)
Temp
Swallowing
What does the occipital lobe do
Vision
Colour perception
What does Parietal lobe do
Knows left from right
Sensation
Reading
Body orientation
What does frontal lobe do
Higher level thinking
Problem solve
Emotional traits
Reasoning (judgement)
Speaking
Voluntary motor activity
What does the temporal lobe do
Language
Behaviour
Memory
Hearing
Pressure, 5 senses and pain go to this part of the brain
Thalamus
Smooth muscle sends signals to this part of the brain
Hypothalamus
What are the menengies (types and purpose)
3 layers that protect the brain and spinal cord
1. Dura mater
2. Arachnoid
3. Pia mater
How long does it take to see metabolic changes when oxygen is cut off such as strangulation
30 seconds
How long does it take for lactic acid to be produced when oxygen is restricted
2 min
How many min will cells start to die without oxygen
5 min
If PaCo2 is high blood vessels in the brain do what
relax: dilation
To increase blood flow
If PaO2 is too low blood vessels in the brain do what
relax: dilation
To increase blood flow
If PaCo2 is too low the blood vessels in the brain do what
constrict
To decrease blood flow so that Co2 can build more
If PaO2 is too high the blood vessels in the brain do what
constrict
To decrease blood flow so that O2 can slow down and levels lessen
When there is not enough O2 then lactic acid is produced. This causes pH to do what
lower (too many H+)
Acidic environment
When pH drops the blood vessels do this
Dilate
To get more O2 so that lactic acid production will slow down and stop creating too much H+
What is a stroke
- Not enough blood flow to the brain (ischemia)
- Hemorrhage into the brain spaces (bleeding)
What is the leading cause of disability in Canada
Stroke
what are the 3 types of Ischemic stroke
- TIA (transient ischemic attack)
- Thrombotic
- Embolic
What are the 3 causes of an Ischemic stroke
Inadequate blood flow to the brain
Artery occulsion (partial or full)
heart failure/shock - systemic
What is Ischemic penumbra
The zone around the core of ischemia but is still reversable if treated in time
How many hours do we have to protect the penumbra area?
3 hours from the start of symptoms
How many hours after ischemia will we see brain colour changes?
6-12 horus
How many hours after an ischemic stroke do you see all the damage that has occured?
72 hours (3 days)
What happens the few weeks after an ischemic stroke?
Macrophages get rid of dead tissue
This causes scarring in the brain
What are the three causes of TIA
- carotid stenosis - narrow or occluded carotid artery
- Atherolsclerosis - dislodged plaque travels
- Atrial fibrillation - blood stasis - clot, travels to brain
Aphasia
trouble with speech and/or language
Dysarthria
slurred speech
What are the main signs of TIA
- Visual changes
- Mobility issues
- Sensory issues
- Speech issues
What is the associated cause of a thrombotic stroke?
atherosclerosis
What are the associated causes of Embolic stroke ?
All Systemic and sudden
1. valvular heart disease
2. MI
3. infective endocarditis
4. rheumatic heart disease
5. congential heart defect
6. a-fib
Examples of embolus responsible for Embolic stroke
- fat embolus
- air embolus
- Tumour embolus
- bacterial clumps
- foreign bodies
What is the most common cause of Ischemic stroke?
Atherosclerosis
What are the 2 types of hemorrhagic stroke?
- Intercerebral Hemorrhage
- Sub arachnoid Hemorrhage
What is intercerebral hemorrhage caused by?
ruptured arterial vessel
what are the 2 associated causes of intercerebral hemorrhage
- HTN * #1
- Aterio-venous malformation
What is a main symptom of intercerebral hemorrhage
Worst headache ever
What is a subarachnoid hemorrhage caused by?
intercranial bleeding in to the space that is between the Pia mater (close to skull) and arachnoid layers (closer to brain)
Subarachnoid hemorrahage is associated with
ruptured aneurysm
What stroke type is most common in females?
Subarachnoid hemorrhage due to aneurysm
Which type of stroke has the worst outcomes and what does it depend on?
Subarachnoid hemorrhage
location in the brain is key
Clinical manifestations of stroke
- Sudden numb/weak on left side of body
- Sudden confusion (LOC)
- Speech difficulty and slurring
- Vision issues
- Ataxia
- Sudden severe headache
What are the typical deficits associated with stroke
- motor function * most obvious
- Communication
- Cognition
- Spacial- perceptual alterations
- Elimination
What are the complications of stroke we assess for?
- Aspiration PN
- DVT
- UTI
- Falls/injury
- Dehydration
- Constipation
- Depression
- Seizures
What is the saying for stoke complications?
A Dirty Dog Danced Under Falling Star Constellations
Anosognosia
not knowing (gnosia) anything is wrong (ano)
Homonymous hemianopia
Field of vision loss on both eyes (so if left side of the right eye and left side of the left eye)
Agnosia
Can’t recognize what objects or people are
Apraxia
Know what they want to do but can’t (A) perform (praxia) the movement.
Dysarthria
Slurring words
Stuporous/stupor
Very deep sleep
need repetitive vigourous stimulation
Obtunded
Can’t wake up very easily
need less repetitive vigourous stimulation
Lethargy
Drowsy but will wake up
Mentation
What is their LOC - metal status
Canadian Neurologic scale
Evalulation and monitoring of neurological status for stroke patients
Acute stage (1-7 days)
8 items
High number is good (less deficits)
National Institute of Health Stroke Scale
15-item impairment scale
evaluate neurologic outcome and degree of recovery for patients with stroke
High # is bad - severe
CT or MRI in stroke helps us determine
location of injury
size of injury
hemorrhagic or ischemic stroke
Blood work in hyper acute stroke
CBC - hemoglobin
INR/PTT/Platelets
Blood sugar
Renal/liver function - creatinine, urea, liver enzymes
Lipid profile - try to prevent stroke
Acute stroke priorities
- When did it happen (time is brain)
- Airway - RR, O2, protectives (cranial 9&10)
- RR - is the brain driving breathing
- circulation
- Rapid neuro assess
- LOC
- GCS
- FAST
- Pupils (PERRLA)
- speech/motor - hand grips/push pedals (cranials 9, 10, 12) - Blood sugar
- 2nd neuro check
How many days do we still see brain changes after ischemic stroke?
2-3 days
