who is more at risk for having a stroke?
- men, except in age groups 35 - 44 and > 85 years
2. African americans and hispanics > whites
intracerebral hemorrhage vs subarachnoid hemorrhaged
- intracerebral: within the cerebrum, blood can expand through the brain, do not c/o worst HA
- subarachnoid: blood within the meninges surrounding the brain, the skull/dura prevents the blood from expanding, c/o worst HA of their life
two zones of injury for ischemic stroke
- ) core ischemic zone: area of severe ischemia where blood flow falls below 10-25%. Cells die and won’t regenerate
- ) Ischemic penumbra: region surrounding the ischemic zone, mild to moderate ischemia, target area for pharmacological management and neuroplasticity. Goal is to minimize cell death here so cells can compensate for cells lost in the core ischemic zone. Positron Emission Tomography is used to identify ischemic penumbra
three types of causes for ischemic stroke
- Cerebral thrombosis: atherosclerotic plaque in the brain
- Cerebral embolus: clot travels to the brain
- Conditions resulting in low systemic perfusion pressure (IE cardiac arrest, shock, )
symptoms of subarachnoid hemorrhage
sudden and intense
c/o worst HA, neck pain, nausea and vomiting
percentage of strokes that are ischemic vs hemorrhagic
ischemic = 87% Hemorrhagic = 13%
definition of TIA
small ischemic stroke where the symptoms completely resolve within 24 hours
definition of crescendo TIA
- series of TIAs that build over time and can result in full blown ischemic stroke
- 2 TIAs within 24 hours
- 3 TIAs within 3 days
- 4 TIAs within 2 weeks
what is the ABCD prediction rule?
- The score predicts how likely someone is to have a stroke in 30 days and 90 days after a TIA.
- Higher score = increased chance of having a stroke
- score 0-7 (higher = WORSE)
- Points for: > /= 60 yo, BP > /= 140/90, has DM, duration of sx >/+ 60 minutes (2 pts) or 10 -59 mins (1 point) , weakness with (2pts) or without (1 pt) speech impairments
Common causes of intracerebral hemorrhage
HTN
ETOH
Drug abuse
Anticoagulant use
What are the etiologies of hemorrhagic strokes?
- Intracerebral hemorrhage
- Subarachnoid hemorrhage
- Succular aneurysm
- Arteriovenous malformation
What are the etiology of ischemic strokes?
- Cerebral thrombosis
- Cerebral emobolus
- Conditions resulting in low system perfusion pressure
Most common sites for aneurysm
Anterior communicating artery, internal carotid/posterior communicating artery, and MCA
Aneurysms that are at critical risk of rupturing
Diameter greater than or equal to 10 mm
