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86 Cards in this Set
- Front
- Back
Stroke/Cerebrovascular Accident
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The abrupt or rapid onset of neurological deficits resulting from decreased oxygen to the brain.
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what % of 1st strokes are fatal?
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25%
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What % of 1st strokes result in moderate to severe disabilities.
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28%
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What is the key for strokes?
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prevention
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What are nonreversible risk factors for stroke?
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Gender - male higher
Age - older higher Race - blacks higher Heredity |
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What are reversible risk factors for stroke?
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Hypertension is most significant
Cardiac disease diabetes blood lipid abnormalities obesity abnormal antibodies - autoimmune problem could be cause. |
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What are some substances that are risk factors for stroke?
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Alcohol use
smoking oral contraceptives (hormones) substance abuse (cocaine) |
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What are extracranial factors affecting cerebral blood flow?
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Systemic blood pressure
Cardiac output Blood viscosity |
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How is systemic blood pressure an extracranial factor affecting blood flow?
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Map < 50 or above 150 autoregulation is effected. Leads to ischemic damage from decreased cerebral blood flow.
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How does cardiac output affect cerebral blood flow?
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When it is decreased by 1/3 it effects cerebral blood flow.
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How does blood viscosity affect cerebral blood flow?
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Polycythemia vera > COPD pts.; dehydration.
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What are intracranial factors affecting cerebral blood flow?
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Metabolic factors
Blood vessel condition Intracranial pressure |
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What metabolic factors affect cerebral blood flow?
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Decreased PO2, increased PCO2, increased HCO3 (?)
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What blood vessel condition affects cerebral blood flow?
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AV malformation, aneurysms, atherosclerosis
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How does ICP affect cerebral blood flow?
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IICP increases pressure on blood vessels - blood doesn't flow freely > ischemia.
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Stroke/Cerebrovascular Accident
|
The abrupt or rapid onset of neurological deficits resulting from decreased oxygen to the brain.
|
|
what % of 1st strokes are fatal?
|
25%
|
|
What % of 1st strokes result in moderate to severe disabilities.
|
28%
|
|
What is the key for strokes?
|
prevention
|
|
What are nonreversible risk factors for stroke?
|
Gender - male higher
Age - older higher Race - blacks higher Heredity |
|
What are reversible risk factors for stroke?
|
Hypertension is most significant
Cardiac disease diabetes blood lipid abnormalities obesity abnormal antibodies - autoimmune problem could be cause. |
|
What are some substances that are risk factors for stroke?
|
Alcohol use
smoking oral contraceptives (hormones) substance abuse (cocaine) |
|
What are extracranial factors affecting cerebral blood flow?
|
Systemic blood pressure
Cardiac output Blood viscosity |
|
How is systemic blood pressure an extracranial factor affecting blood flow?
|
Map < 50 or above 150 autoregulation is effected. Leads to ischemic damage from decreased cerebral blood flow.
|
|
How does cardiac output affect cerebral blood flow?
|
When it is decreased by 1/3 it effects cerebral blood flow.
|
|
How does blood viscosity affect cerebral blood flow?
|
Polycythemia vera > COPD pts.; dehydration.
|
|
What are intracranial factors affecting cerebral blood flow?
|
Metabolic factors
Blood vessel condition Intracranial pressure |
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What metabolic factors affect cerebral blood flow?
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Decreased PO2, increased PCO2, increased HCO3 (?)
|
|
What blood vessel condition affects cerebral blood flow?
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AV malformation, aneurysms, atherosclerosis
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How does ICP affect cerebral blood flow?
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IICP increases pressure on blood vessels - blood doesn't flow freely > ischemia.
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What are the 4 basic types of strokes?
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Thrombosis
Embolism Intracerebral hemorrhage Subarachnoid hemmorrhage |
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Thrombosis defined:
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formation of clot in brain which blocks the artery > ischemia.
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Describe what happens with thrombosis formation:
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Clot forms > decrease perfussion from clot down > ischemia, necrosis, inflammatory response, inflammation increases > more pressure on tissue.
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What is the most common type of stroke?
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thrombosis - 55-65%
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What physical conditions is thrombosis associated with?
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diabetes and hypertension
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When do thrombosis clots occur usually?
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during periods of rest when everything slows down.
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What is a warning sign of a thrombosis?
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TIA
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Which arteries are usually effected by thrombosis?
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interior middle cerebral arteries.
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What is an embolism?
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Clot that floats into area from outside brain and blocks artery. Ischemic damage occurs.
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what are some characteristics of emboli?
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Beyond lodging get same responses as above. Occur suddenly, not related to activity.
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What is a warning sign of emboli?
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TIA
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What are some causes of emboli?
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Cardiac disease (chronic A Fib; Endocarditis after acute MI; valvular disease)or atherosclerotic disease in carotid arteries.
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Will emboli reoccur?
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Yes, if you don't treat underlying cause.
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Intracerebral hemmorrhage...
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bleeding into the brain with hemorrhagic damage,
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What causes the damage in an intracerebral hemorrhage?
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pressure > ischemia, etc. and the results of the body to clean up the area.
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What are predisposing factors to intracerebral hemorrhage?
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HTN, atherosclerosis > vessels rupture, blood goes into brain > hematoma.
Bleeding into brainstem. |
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Subarachnoid hemorrhage...
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Bleeding into to subarachnoid space due to rupture of intracranial aneurysm or AVM. May also follow head trauma.
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Is subarachnoid hemorrhage related to activity?
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NO
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What is the 1st sign of subarachnoid hemorrhage?
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head ache > blood on meninges > sudden > rupture.
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What is the prognosis of subarachnoid hemorrhage?
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Poor
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Why is management of subarachnoid hemorrhage difficult?
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Because of vasospasms.
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What does temporal development mean in reference to strokes?
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Strokes typically progress through stages - develop over time.
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What does TIA stand for?
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Transient Ischemic Attack
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What is a TIA?
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brief episode of neurological deficits with no apparent residual damage. Episode last < 24 hours.
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What is considered to be the cause of TIA?
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vasospasms or microemboli which resolve.
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What is a Reversible Ischemic Neurological Deficit (RIND)?
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a neurological deficit which occurs suddenly and lasts > 24 hours but leaves no apparent residual effects.
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How long does the deficit caused by RIND last?
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may last several weeks but usually lasts < 1 week.
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Is RIND considered a warning like TIA?
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yes
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What tests will show cerebral damage even if effects not apparent?
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CT or MRI
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What is stroke in evolution?
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refers to the stroke in which deficits progress over a period of hours or days.
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What is a completed stroke?
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Deficits remain unchanged for 3 days. At this point aggressive rehabilitation begins unless stroke was due to ruptured aneurysm.
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What do the clinical manifestations of strokes depend on?
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Location, size of infarct and whether or not there is collateral circulation.
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What does the Circle of Willis contain?
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2 vertebral arteries
2 carotid arteries |
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What does the Anterior Cerebral Artery supply?
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The medial portion of brain (core)
Limbic system RAS Memory Sensory Speech Lower body - sensory, motor |
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What does the Middle Cerebral artery supply?
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Surface of brain
Hearing Judgement, rational thought Motor speech Upper body - sensory, motor |
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What does the Posterior Cerebral artery supply?
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cerebellum
brainstem |
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What are neuromuscular symptoms the result of:
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destruction of motor pathways in pyrimidal tract with loss of skilled voluntary movement.
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What is the result of right hemisphere damage?
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Left sided hemiplegia (paralysis)/paresis (weakness.
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Are upper and lower extremities affected to the same degree?
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No, can be to different degrees.
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When referring to hemi-, you are dividing the body into
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Right and left
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When referring to para-, you are dividing the body into
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upper and lower
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What is the prognosis of subarachnoid hemorrhage?
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Poor
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Why is management of subarachnoid hemorrhage difficult?
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Because of vasospasms.
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What does temporal development mean in reference to strokes?
|
Strokes typically progress through stages - develop over time.
|
|
What does TIA stand for?
|
Transient Ischemic Attack
|
|
What is a TIA?
|
brief episode of neurological deficits with no apparent residual damage. Episode last < 24 hours.
|
|
What is considered to be the cause of TIA?
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vasospasms or microemboli which resolve.
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What is a Reversible Ischemic Neurological Deficit (RIND)?
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a neurological deficit which occurs suddenly and lasts > 24 hours but leaves no apparent residual effects.
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How long does the deficit caused by RIND last?
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may last several weeks but usually lasts < 1 week.
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Is RIND considered a warning like TIA?
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yes
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What tests will show cerebral damage even if effects not apparent?
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CT or MRI
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What is stroke in revolution?
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refers to the stroke in which deficits progress over a period of hours or days.
|
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What is a completed stroke?
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Deficits remain unchanged for 3 days. At this point aggressive rehabilitation begins unless stroke was due to ruptured aneurysm.
|
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What do the clinical manifestations of strokes depend on?
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Location, size of infarct and whether or not there is collateral circulation.
|
|
What does the Circle of Willis contain?
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2 vertebral arteries
2 carotid arteries |
|
What does the Anterior Cerebral Artery supply?
|
The medial portion of brain (core)
Limbic system RAS Memory Sensory Speech Lower body - sensory, motor |