Definition of Stroke
Sudden death of brain cells in localized area due to inadequate blood flow
What are the two types of stroke?
Hemorrhagic & Ischemic
Ischemic __ % in adults?
Thrombotic - ___ %
Embolic - ___ % (associated with ________)
Unknown source ___ %
Ischemic – 87% in adults
Thrombotic-55%
Embolic-20% (often associated with atrial fibrillation)
Unknown source – 25%
Hemorrhagic-___% in adults
Intraparenchymal (Intracerebral) hypertension - __ %
Subarachnoid space (i.e. hypertension or aneurysm rupture)- __ %
Hemorrhagic-13% in adults
Intraparenchymal (Intracerebral) hypertension -10%
Subarachnoid space (i.e. hypertension or aneurysm rupture)-3%
In perinatal stroke, what type of stroke is most common?
Hemorrhagic 29/100,000 live births
In childhood, what percentage is ischemic?
50%
Causes of childhood ischmemia?
- Sickle cell disease
- Congenital heart disease (R to L shunt)
- Cerebral arteriopathy
Causes of childhood hemorrhagic stroke?
- Arterio-venous malformations
2. Other congenital abnormalities
Stroke risks outside of hospital setting?
- A-Fib
- Cardiovascular disease
- Cardio meds
- Diabetes
- Smoking
- African American
- Elderly
- Past head trauma
- Uncontrolled HTN
Stroke risks inside of hospital setting?
- Elderly
- Sedentary
- DVT
- Post op
- Cardiovascular disease
- A-Fib
What kind of headaches are at greater risk for stroke?
Migraine headaches (ischemic>hemorrhagic) because of vasoconstriction
What sleeping condition is at greater risk for stroke?
Sleep apnea
Stroke Risk Factors?
- High BP
- Physical inactivity
- Smoking/Tobacco use
- High blood cholesterol (diet / statins)
- Heart dysrhythmia (A-FIb)
- DM
- FHx Migraines
Life Style Modifications
- Regular monitoring of BP
- Healthy diet
- Relax/stress reduction
- Optimal body weight
- Exercise, sleep
- Avoid excessive alcohol/drugs
- Stop smoking
- Medication-statins, cardioembolic
- Monitor HR meds
TIA (definition / duration)
Temporary localized reduction of blood flow to brain
REVERSIBLE, usually less than 15 minutes but within 24 hours
TIA symptoms
Syncope / fall / loss of speech / weakness / numbness / temporary paralysis / visual impairment
Symptoms resolve without neurological dysfunction
TIA warning sign for?
Stroke! 40% of those that experience TIA will eventually have a stroke
BEFAST
B - balance
E- Eyes - blurry, field of vision lost
F - Face - smile, frown, even drooling
A - Arms - unequal grip, wekaness on one side
S - Speech - unable to repeat, slurs or inappropriate words
T - Time is critical
Other concerns - severe unexplained headache, seizures
Afib increase risk factor of stroke by
FIVE FOLD
Other dx other than stroke
Hyponatremia
Why is CT / X-ray chosen over MRI
Even though image is not clear, it is a 1st screening tool. Faster / more accessible.
What is done after CT?
Carotid Duplex - look for bruits
Treatment of Ischemic Stroke
if CT is negative for intracranial hemorrhage then
tPA [Window 3.5-4 hours - otherwise risk rise significantly]
Carotid bruits
33% more likely to have minimal or no deficit at 3 months than those given placebo
Assess for BLEEDING post treatment 6%
Treatment of Hemorrhagic Stroke
Reverse anticoagulation Vitamin K
Treatment of aneurysm (clipping, coiling, wrapping)
Surgical removal of hematoma
