- Cerebral vascular accident - Sudden vascular event leading to disruption of blood flow to part of the brain and destruction of surrounding brain tissue

Stroke Flashcards by Shyanne Howard

What is a stroke?

Cerebral vascular accident
Sudden vascular event leading to disruption of blood flow to part of the brain and destruction of surrounding brain tissue

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T/F: After a stroke there is a rapid onset of neurological deficit

True
- Leading cause of serious long term disability

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What is a Transient Ischemic Attack?

Focal neurological symptoms, similar to stroke, but with resolution of neurological symptoms within 24 hours

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The etiology for Transient Ischemic Attack is same as what disorder? And what may it be confused with?

Etiology is the same as stroke
May be confused with minor ischemic stroke

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15% of all stroke are preceded by what?

Transient Ischemic Attack

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What is the early management of Transient Ischemic Attack?

Imaging
Close observation
Blood thinners

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What are some potentially modifiable risk factors of stroke?

HTN
Cardiovascular disease
Atrial Fibrillation
DM (Type II)
Smoking
Alcohol / Cocaine use
Medication
Physical inactivity
Obesity
Diet

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What is the greatest non-modifiable risk factor for stroke?

-Age
- Risk double each decade after 55 yr

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What are some non-modifiable risk factor for stroke?

Race
Gender
Family history (stroke, sickle cell disease, genetic predisposition)

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What are the early warning signs for stroke?

BE FAST
Loss of BALANCE, headache, dizziness
EYES: blurred vision
one side of the FACE is drooping
ARM or leg weakness
SPEECH difficulty
TIME to call for ambulance immediately

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In regards to pathogenesis of Ischemic Stroke there is a loss of blood supply so what happens as a result of:
- No blood flow?
- Reduced blood flow?

No blood flow can lead to neuronal cell death (core/infarct)
Reduced blood flow can lead to ischemic penumbra

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What is an ischemic penumbra?

An area of damaged tissue surrounding the area of infarct

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Inflammatory processes in the penumbra can expand what?

initial lesion

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T/F: Even if blood flow is restored to ischemic area the damaged tissue can not recover

False
- If blood flow is restored to the ischemic area before irreversible damage occurs the tissue may recover

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What are the inflammatory processes that occur in the penumbra?

Change to blood brain barrier causes leukocyte infiltration
Activated glial and endothelial cells cause free radicals to be released, cytokines, chemokine & enzymes

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Inflammatory processes that occur in the penumbra lead to what?

Neuronal cell death within the ischemic penumbra

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Pathogenesis: Ischemic Stroke
What is Atherosclerotic Cerebrovascular Disease?

Major Artery Occlusion
Plaque forms in vessel walls

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What happens physiologically due Atherosclerotic Cerebrovascular Disease?

Carotid & Vertebrobasilar system involved
Decreased compliance & flow
May form thrombus –> occlusion or embolism

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What is the most common source of embolism?

heart

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Pathogenesis: Ischemic Stroke

Atrial fibrillation can lead to what?

Clot formation

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Embolism form from what type of arteries?

Atherosclerotic
(Carotid & Vertebrobasilar)

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(BLANK) and (BLANK) can promote thickening of small vessel walls leading to Lacunar infarcts.

HTN and DM

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Small vessel infarct can be due to what?

Ischemic necrosis
Cysts
Gliosis

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What areas can Lacunar infarcts affect?

Basal Ganglia
Internal Capsule
Pons

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Lacunar infarcts is also known as?

Small vessel disease

What are the two type of hemorrhagic stroke?

1. Intracerebral hemorrhage 2. Subarachnoid hemorrhage

What is an intracerebral hemorrhage?

Bleeding from artery into brain parenchyma

What is a subarachnoid hemorrhage?

Bleeding from artery into sub arachnoid space

In regards to Intracerebral hemorrhage how does HTN lead to microvascular disease?

- Weaken arterial vessel walls - Forms small aneurysms (micro aneurysms) - Prone to leakage or rupture

What vessels are affected by intracerebral hemorrhage?

- Distal (small) vessels - Arteriole branches - Penetrating arteries of circle of Willis

What event precipitates intracerebral hemorrhage?

Acute increase in BP or blood flow

What type of hemorrhage can a Berry aneurysm cause?

Subarachnoid hemorrhage

What is a Berry aneurysm? And where can they occur?

- Congenital distention at bifurcation - Occur at Circle of Willis

Venous or Cavernous Malformation can cause what type of hemorrhage?

Subarachnoid hemorrhage

What is an A-V Malformation? What type of hemorrhage can this cause?

- Direct artery to vein without capillary bed - Subarachnoid hemorrhage

What are three risk factors/causes of chronic subdural hemorrhage?

- Elderly - Cerebral atrophy (increase movement between brain & skull) - Minor fall (trauma)

Tearing of (BLANK) can cause subdural hemorrhage

Bridging veins

Torn meningeal artery in periosteal layer of dura leads to what?

Epidural hematoma

What does an epidural hematoma typically occur with?

Traumatic skull fracture

In an epidural hematoma what does pooling of blood cause?

Compression of the brain

What is the onset of ischemic stroke? What vasculature is involved?

- Sudden, evolving - Blocked artery

What is the onset of intracerebral hemorrhage? What vasculature is involved?

- Gradual or sudden - Mircorvasculature

What is the onset of subarachnoid hemorrhage? What vasculature is involved?

- Gradual if leak precedes rupture - Or sudden - Arterial

What is the onset of subdural hemorrhage? What vasculature is involved?

- Gradual - Venous (bridging)

What is the onset of epidural hemorrhage? What vasculature is involved?

- Sudden/ trauma - Arterial (meningeal)

What are the symptoms and prognosis of ischemic stroke?

- Sym: Sudden, progressive focal deficits - Prog: Survival better than hemorrhage

What are the symptoms and prognosis of intracerebral hemorrhage?

- Sym: Focal deficits, headache, increased ICP - Prog: High mortality; good recovery among survivors

What are the symptoms and prognosis of subarachnoid hemorrhage?

- Sym: Generalized symptoms, headache, increased ICP - Prog: Variable with size, high mortality/ poor recovery in the elderly

What are the symptoms and prognosis of subdural hemorrhage?

- Sym: Headache, changes in mental status - Prog: Acute worse than chronic

What are the symptoms and prognosis of epidural hemorrhage?

- Sym: Compression of brain causes symptoms - Prog: Medical emergency, risk of death

T/F: The more distal the stroke = more hypoxic tissue

False - More proximal the stroke = hypoxic tissue

Usually the more proximal the stroke = more hypoxic tissue except where?

Circle of Willis

In a middle cerebral artery syndrome what are the symptoms on the contralateral side?

- UE > LE - Hemiparesis/hemiplegia - Hemianesthesia

Which hemisphere is affected with middle cerebral artery syndrome and what does this cause?

- Dominant hemisphere - Global aphasia

What are the symptoms of a superior division middle cerebral artery syndrome?

- UE/ Face weakness - Broca's aphasia - +/- sensory loss

What are symptoms of an inferior division middle cerebral artery syndrome?

- Wernicke's aphasia - +/- sensory loss

What are the symptoms of an anterior cerebral artery syndrome?

- Contralateral (LE > UE) - Hemiparesis - Hemianesthesia

Occlusion proximal to the anterior communicating artery leads to what?

Minimal dysfunction due to collateral flow

What symptoms are seen with an internal carotid artery syndrome?

MCA + ACA symptoms

Why may symptoms be minimal in an internal carotid artery syndrome?

Collateral flow

In a posterior cerebral artery syndrome, injury to the thalamic branches cause?

- Abnormal sensation - Exaggerated: light touch = pain

In a posterior cerebral artery syndrome, injury to the occipital branches cause?

- Visual changes - Homonymous hemianopia, visual agnosia

In a posterior cerebral artery syndrome, injury to the temporal branches causes?

Memory loss

In a posterior cerebral artery syndrome, injury to proximal occlusion before cerebral peduncle causes?

Contralateral hemiparesis/ hemiplegia

In a posterior cerebral artery syndrome, injury to proximal occlusion before red nucleus causes?

Contralateral ataxia

A lacunar syndrome to the internal capsule (posterior limb) cause what symptom?

Pure motor

A lacunar syndrome to the internal capsule (genu) cause what symptom?

- Weak face - Dysarthria

A lacunar syndrome to the posterolateral thalamus causes what symptom?

Pure sensory

A lacunar syndrome to the basal ganglia causes what?

Movement disorder

*Vertebral & Posterior Inferior Cerebellar Artery Syndrome* What are the symptoms of the Lateral medullary (Wallenberg's) Syndrome on the whole body?

- Vertigo - Nausea - Hoarseness - Dysphagia

*Vertebral & Posterior Inferior Cerebellar Artery Syndrome* What are the symptoms of the Lateral medullary (Wallenberg's) Syndrome on the ipsilateral side?

- Ataxia - Ptosis - Fascial sensory loss

*Vertebral & Posterior Inferior Cerebellar Artery Syndrome* What are the symptoms of the Lateral medullary (Wallenberg's) Syndrome on the contralateral side?

Torso and limb sensory loss

*Vertebral & Posterior Inferior Cerebellar Artery Syndrome* What are the symptoms of Medial medullary Syndrome on the contralateral side?

- Hemiparesis (arm, leg) - Loss of proprioception

*Vertebral & Posterior Inferior Cerebellar Artery Syndrome* What are the symptoms of Medial medullary Syndrome on the ipsilateral side?

Ipsilateral tongue weakness

What are the symptoms of the anterior inferior cerebellar?

- Ipsilateral hearing loss - Vertigo/nystagmus - Ipsilateral face / contralateral body pain & temp - Fascial weakness - Ataxia

What are the symptoms of the superior cerebellar syndrome?

- Ipsilateral ataxia - Contralateral pain / temp loss (body, limbs, face)

Complete basilar artery syndrome causes?

locked in syndrome

What are the symptoms of complete basilar artery syndrome?

- Quadriplegia - Lower bulbar palsy - Mutism

What is spared in a complete basilar artery syndrome?

- Cognition - Sensation - Vertical eye movement

What are the symptoms of a partial basilar artery syndrome?

- Ataxia - Clumsiness - Weakness

What are some ways to diagnosis strokes?

- History - CT - MRI - PET - Doppler Ultrasound

What are the pros and cons of using a CT for diagnosing stroke?

- Pro: Fast & Convenient, can detect hemorrhage - Con: Decreased detection of acute ischemic stroke

An MRI can detect (BLANK) within 2-6 hours

ischemic

An MRI can monitor what?

Ischemia / Evolution of stroke

T/F: A PET scan has higher sensitivity and earlier detection

True

What areas can be seen with a PET scan?

Areas of hypo metabolism or decreased blood flow

What is a doppler ultrasound used for in diagnosing stroke?

Carotid and vertebral arteries blood flow and identify plaque accumulation

How is a cerebral angiography performed?

- Invasive procedure - Inject radiopaque contrast agent or dye in a vein or artery - Series of x - rays are taken

What can a cerebral angiography help to diagnosis?

- Obstruction - Stenosis - Malformation

Which type of stroke can a thrombolytic agent be used?

Ischemic Stroke

When using a thrombolytic agent there is significantly more recovery if within (BLANK)

4.5 hours

There is a risk of what when using a thrombolytic agent?

Risk of hemorrhage

What thrombolytic agent is used in acute medical management of ischemic stroke?

Tissue plasminogen activator (t-PA)

T/F: a way to manage an acute ischemic is intracranial clot retrieval

True

What are some medical prophylaxis (preventive) treatment option of ischemic stroke?

- Anticoagulation therapy - Control HTN - Lipid lowering agents - Neuroprotection - Surgery (manage stenotic vessels)

When is carotid endarterectomy or stenting warranted?

If stenosis in carotid is > 70% (asymptomatic) or > 50% (symptomatic) in internal carotid then surgery is warranted

T/F: Loss of consciousness is a good prognostic indicator

False - Poor prognostic indicator

T/F: Once a patient has a stroke they are at risk for a recurrent stroke

True

90% of recovery of stroke occurs in 1st (BLANK) months

3 month

After a stroke functional recovery of movement patterns can occur for (BLANK) years

5 years

What is the medical management of other hemorrhage?

Neurosurgery - Evacuate - Repair aneurysm / malformation/ rupture

What are the medical management option of intracerebral hemorrhage?

- Control HTN - Control ICP - Manage Edema - Surgical drainage

When should you treat HTN and what can be used when managing intracerebral hemorrhage?

- Treat sBP > 160 - 180 mmHG, dBP > 105 mmHG - Rapid acting antihypertensive meds

When is surgical drainage performed when managing intracerebal hemorrhage?

- Large size - Neurological deterioration - Often performed with cerebellar hemorrhage due to risk of rapid deterioration

What are some symptoms of left (dominant) hemisphere stroke?

- Right hemiparesis - Aphasia (receptive - Wernicke's or Expressive - Broca's or Global) - Possible dysphagia

A patient with a left (dominant) hemisphere stroke tends to be (BLANK), (BLANK) & (BLANK) when approaching unfamiliar tasks

Slow, cautious & disorganized

- A patient with a left (dominant) hemisphere stroke may be easily (BLANK) & (BLANK) with communication difficulties - Also individuals aware of problems often responds with (BLANK)

- Frustrated & angered - Anxiety

A patient with a left (dominant) hemisphere stroke has problems with recognition of what?

objects, use of objects or word recall

T/F: A patient with a left hemisphere stroke is able to process information quickly in order to respond verbally or with gestures

- False - Needs time to process information and time to respond either verbally or with gestures

T/F: A patient with a left hemisphere stroke can profit from gestures and non verbal instructions

True

Why is repetition necessary for patients with a left hemisphere stroke?

They have an impaired ability to retain info

What are some symptoms of right hemisphere stroke?

- Left hemiparesis - Difficulty with spatial perceptual task - Left sided neglect - Thinking is disjoined - Safety awareness is diminished - Tends to move impulsively and not follow directions or cues - Overestimates own abilities to perform task - Judgment and integration of information is impaired - May not be aware of error

T/F: A patient with a right hemisphere stroke profits more from gestures than verbal instruction

False Profits more from verbal instructions than gestures

T/F: For a patient with a right hemisphere stroke repetition and consistency are very important and they need cues to take things one step at at time

True

Does a patient with a right hemisphere stroke have increased distractibility?

Yes

When managing an acute ischemic stroke at what BP should you intervene if the patient has not taken t-PA?

220/120

When managing an acute ischemic stroke, at what BP should you intervene if the patient has taken t-PA?

180/105

Stroke Flashcards

(117 cards)