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101 Cards in this Set

  • Front
  • Back
functional abnormality of CNS caused by disruption of normal blood supply to brain
cerebrovascular disorders
what can brain not store (2)
02 and glucose
cerebrovascular disorders are the _____ leading cause of death
3rd
what are the 2 categories of stroke
-ischemia (85%)
- hemorrhagic (15)
backflow and 02
ischemic
sudden loss of function resulting from disruption of blood supply to part of brain
ischemic stroke
ishemic AKA
brain attack
with early tx of this ischemic strokes can result in fewer stroke sx and less loss of function
thrombolytics
tx window with ischemic stroke
3 hrs after onset
plaques in large vessels of brain
larger arter thrombotic stroke
functional abnormality of CNS caused by disruption of normal blood supply to brain
cerebrovascular disorders
what can brain not store (2)
02 and glucose
cerebrovascular disorders are the _____ leading cause of death
3rd
what are the 2 categories of stroke
-ischemia (85%)
- hemorrhagic (15)
backflow and 02
ischemic
sudden loss of function resulting from disruption of blood supply to part of brain
ischemic stroke
ishemic AKA
brain attack
functional abnormality of CNS caused by disruption of normal blood supply to brain
cerebrovascular disorders
with early tx of this ischemic strokes can result in fewer stroke sx and less loss of function
thrombolytics
what can brain not store (2)
02 and glucose
tx window with ischemic stroke
3 hrs after onset
cerebrovascular disorders are the _____ leading cause of death
3rd
plaques in large vessels of brain
larger arter thrombotic stroke
what are the 2 categories of stroke
-ischemia (85%)
- hemorrhagic (15)
backflow and 02
ischemic
sudden loss of function resulting from disruption of blood supply to part of brain
ischemic stroke
ishemic AKA
brain attack
with early tx of this ischemic strokes can result in fewer stroke sx and less loss of function
thrombolytics
tx window with ischemic stroke
3 hrs after onset
plaques in large vessels of brain
larger arter thrombotic stroke
1 or more vessels---most common
small penetrating artery thrombotic stroke
dysrhythmias, valvular disease. most commonly left middle cerebral artery
cardiogenic embolic stroke
most common cardiogenic emobolic stroke
left middle cerebral artery
no known cause
cryptogenic stroke
other types of strokes caused by what (4)
- drug use
- coagulopathies
- migrane
- spont dissection carotid/ vertebral arteries
decrease cerebral blood flow resulting in anaerobic activity---acidosis--- cell death
ischemic cascade
what is the penumbra region
area of low blood flow around infarction--- at risk for cont' cell death
what does size of infarction depend on
area of flow and size of clot
goal for ischemic stroke/cascade
block extent of 2ndary brain injury caused by initial stroke
helps to increase blood flow by getting rid of clot
neuroprotectants (t-PA)
clinical manifestations dependent upon what? (4)
- location of lesion
-vessels obstructed
- size of area
-amt of collateral blood flow
S&S of ischemia stroke (5)
- motor loss
- communication loss
- perceptual disturbances
- sensory loss
- cognitive impairment
assessment for ischemic stroke should include (3)
- careful hx
- complete Px/neuro exam
- airway patency
may be a warning sign
TIA
resolves spont w/ return of normal function
TIA
how can stroke be dx
CT w/o contrast
aif stroke is ischemic what should be done after CT
further determination of source of emboli or thrombi
detects areas of ischemia earlier
MRI
#1 cause of hemorrhagic stroke
HTN
at higher risk for stroke
AA
2ndary prevention following TIA/stroke (4)
- anticoags w/ a fib
- PLT meds (ASA, plavix, ticlid
- statins
- surgery
what does t-PA do
binds fibrin and converts plasminogen to plasmin, causing fibrinolysis (dissolving)
if t-PA is given after 3 hrs what happens
revascularization of necrotic tissues and increases risk edema and hemorrhage
contraindications for t-PA (4)
- >3 hrs
- pt anticoagulated
- INR .1.7
- any recent intracranial pathology
cannot be given for 24hrs after t-PA
anticoagulants
VS protocols for t-PA
- q 15min for 2hrs
- q 30 mins x6 hrs
- q 1hr until 24hrs after tx
most common SE of t-PA
bleeding
dose for t-PA
0.9 mg/kg (max 90mg)
how is t-PA given
10% IV over 1 min and remainder over 1 hr
needed with use of t-PA (2)
- cont cardiac mtr
- freq neuro assess
HTN increases risk of what with t-PA (2)
- bleeding
-rupture
BP parameters for t-PA
systolic <180
diastolic <105
catheter delivers t-PA
intra-arterial thrombolysis
when is the acute phase
1-3days
after acute phase, assess should include (7)
- mental status
- sensation/perception
- motor control
-swallowing
- nutrition/hydration
- bowel/ bladder function
- ADLs
convalescence
rehab period
helpful to know in the convalescence stage
baseline before stroke
long term deficit in stroke pts
shoulder pain
% of hemorrhagic strokes
15-20
cerebrovascular disorders, primarily intracranial or subarachnoid bleeds
hemorrhagic stroke
where does bleeding occur with hemorr (3)
brain tissue
vents
subrachnoid space
pts who survive acute phase of hemorrhagic stroke often have what
more severe deficits and longer recovery
80% of hemorrhagic strokes r/t what
primary intracerebral hemorrhage from spont
what is the cheif cause of hemorrhagic stroke
uncontrolled HTN
results from ruptured intracranial aneurysm
subarachnoid bleed
other causes of hemorrhagic stroke (4)
- cerebral amylod angiopathy
- ateriovenous malformation
- intracranial neoplasms
- medications (anticoag/amphetamines)
what is AVM
tangle of arteries and veins w/o capillary bed
mortality rate for hem strokes at 30 days
48%
very damaging
blood in brain tissue
brain metab can be disrupted by what (3)
- exposure to blood
- increase ICP
- 2ndary ischemia from decreased perfusion pressure and vasospasm
what are Sx produced from
pressure on cranial nerves from primary hemorrhage, aneurysm, or AVM
most common with HTN and cerebral atherosclerosis
intracerebral hemorrhage
what do degenerative changes result in
vessel rupture
with intracerebral hemorrhage, where is bleeding most common (5)
- cerebral lobes
- basal ganglia
- thalamus
- brain stem
-cerebellum
dilation of walls of cerebral artery resulting from weakness in wall
intracranial aneurysm
where does intracranial aneurysm occur
bifurcation larger arteries in circle of Willis
which arteries are most commonly affected with intracranial aneurysm (3)
- internal carotid
- anterior/middle/posterior cerebral
- anterior/posterior communicating
what is a berry aneurysm
round like a berry
congenital defect that is twisting of w/o cap bed
AVM
what does absence of cap beds result in
dilation of arteries and veins
usually the outcome for AVM
rupture
most commonis AVM stroke for which group
young adults
subarchnoid hemorrhage can result from what (4)
- AVM
- intracranial aneurysm
- trauma
- HTN
what are the most common causes of sub hemorrhage
leaking from circle of Willis
and AVM
S&S of sub hemorrhage (8)
- severe HA
- vomitting
- change in LOC
- Szs d/t brain stem involvement
- neuro deficits
- tinnitus/dizziness
-bleeding
- pain in back, neck, spine
what can CT or MRI determine (3)
- size
- location
-stroke type
confirms aneurysm or AVM
angiography
prevention for stroke (3)
- screening high risk pts
- mgnt HTN
- decrease ETOH intake
used for HTN control (4)
- labetalol
- nicardipine
- nitroprusside
-hydralazine
if cause if unknown oftern r/t influx of Ca into cells... what is given to help
CCB
what is the goal of stroke (3)
-brain recovery from initial insult
-protect from rebleeding
- prevent/tx complications