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34 Cards in this Set
- Front
- Back
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What are modifiable risks for stroke?
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Hypertension
Smoking Obesity Elevated serum fibrinogen levels Diabetes Sedentary Lifestyles Contraceptives with high levels of estrogen Systolic hypertension Cardiac disease Atrial fibrillation Alcohol Abuse |
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What are non-modifiable risks for stroke?
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Age (especially after age 75)
Gender (Slightly higher risk for males) Race - (higher risk for African-American and Hispanic) Heredity |
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List the different types of strokes.
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Ischemic (88% of all strokes & includes TIA, thrombosis, embolism, lacunar) and hemorrhagic (12% of all strokes & includes hypertensive and aneurysm).
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What are the percentages to the 3 major types of strokes?
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50% thrombotic, 38% embolic, 12% hemorrhagic
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What causes an ischemic stroke?
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Arterial blood supply to the brain is blocked either by atherosclerosis (narrowing of arteries) or clots (moving from the heart as a result of irregular heartbeat/atrial fibrillation, heart attack, or abnormalities of the heart valves).
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What is a TIA?
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A transient ischemic attack is not really a stroke, but it's a precursor. 35% of all people w/ TIAs will progress to stroke w/in 5 years unless medical intervention occurs. Full recovery expected w/in 24 hours of TIA.
IT IS A BRIEF, FOCAL LOSS OF FUNCTION. |
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How can TIAs be treated?
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Endarterectomy or angioplasty with stinting, blood thinners, monitoring BP & blood flow, diet, and exercise.
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What is a thrombosis stroke?
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occurs where arteries branch and where plaques may have narrowed the arteries for years. 60% of these strokes occur during sleep.
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What's a transitional area of the brain during a thrombosis stroke?
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It surrounds the area of anoxia. THERE ARE REVERSIBLE EFFECTS HERE!
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What's the intervention for thrombosis?
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Medication, specifically, t-PA. Must be given w/in 3 hours post onset of stroke, but most patients wait 24 hours after onset (average is 13 hours).
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What is one thing you have to make sure of before you give t-PA?
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Make sure the stroke isn't hemorrhagic! t-PA is a major blood thinner and can cause further bleeding. It can also CAUSE a bleed.
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What are some other blood thinners?
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Heparin, Warfarin, anti-platelet drugs.
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What is an embolic stroke?
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Stroke of an emboulus that can come from the heart or plaques from any artery. Generally associated with MIs and atrial fibrilation.
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With embolic strokes, how often is the middle cerebral artery involved? How often is the posterior cerebral artery involved?
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MCA= 80% of the time. PCA=10% of the time.
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When can surgery be used to remove the clot from the brain in an embolic stroke?
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After the 3 hour window given for the blood thinners.
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What is a lacunar stroke?
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A stroke of the smaller penetrating "END" arteries. Patients usually make a remarkable recovery.
These frequently occur in people w/ multiple medical diagnoses involving the circulatory system. |
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Hemorrhagic strokes are caused by what?
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AV malformations/ weakness of arterial walls, aneurysms, or head injuries
Bleeding in the brain produces an oval shaped clot that resolves slowly |
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Treatment of hemorrhagic strokes includes what?
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lowering arterial BP to prevent further bleeding & surgery to remove the clot & decrease intracranial pressure
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What are the 4 major hemorrhagic hypertensive sites?
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Putamenal (most common), thalamic, pontine (most often fatal), cerebellar (ataxia and other cerebellar symptoms)
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80% of strokes affect the ____ artery. And it affects the upper extremity more than the lower extremity.
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Middle cerebral
Causing contralateral paralysis & sensory loss, hemionopia, & limb-kinetic apraxia |
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Limb-kinetic apraxia is most commonly in the ______ hemisphere.
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left.
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In the middle cerebral artery, the dominant hemisphere strokes cause ____, while non-dominant hemisphere strokes cause _____,_____.
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Speech deficit; Hemi-neglect, unawareness of distance and midline.
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10% of strokes affect affect the ____ artery. It affects the lower extremity more than the upper extremity.
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Anterior cerebral
Causing contralateral paralysis and sensory loss, loss of grasp and sucking reflex, lack of spontaneous behavior, motor inattention, perseveration, and amnesia |
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Anterior cerebral artery stroke leads to lack of...
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spontaneous behavior, motor inattention, perseveration, and amnesia.
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7% of strokes affect the ____ artery. It affects the contralateral visual field.
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Posterior cerebral
cortical blindness (contralateral visual field), memory deficit, ataxia, may have contralateral hemiparesis, involvement of the thalamas can result in contralteral sensory loss |
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There is a possibility in arm recovery if the patient has a return of arm movement within how much time?
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withing first 2 weeks
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No grip recovery at 24 days correlates with what kind of arm function?
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no arm function at 3 months
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What 5 things are responsible for Spontaneous Stroke Recovery?
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1. Functional or adaptive recovery
2. recovery of post-stroke edema 3. reperfusion of ischemia 4. diaschisis 5. CNS reorganization |
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What is Functional or Adaptive Recovery?
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Can be defined as neurological or functional (learning to do previously learned tasks)
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What kind of stroke tends to be associated with more damage from edema?
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Hemorrhages
but recovery is often as dramatic as well |
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What is reperfusion of ischemia?
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Drug therapy and time can allow non-functioning neurons to resume function to save the surrounded area of moderate blod flow that is at risk for ischemia
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What is Diaschisis?
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The state of low reactivity that occurs after injury to the brain (including stroke) in areas of the brain previously stimulated by this portion of the brain - that is where neuronal connections lie.
Recovery of reactivity in these more distal portions of the brain occur after stroke |
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What is synaptogenesis?
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the formation of new synapses that can occur during CNS re-organization.
Enhanced through motor learning - or practice of new and learned skills |
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Re-acquiring motor skills requires changes to what?
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the undamaged portions of the involved cortex, as well as changes to the undamaged cortex
Practice! But the practice must be challenging enough to force learning |
