Tcu/abt Adult Ii Stroke Lecture

Front 1

what is the "new term" we call a stroke

Back 1

a brain attack

Front 2

what is the circle of willis?

Back 2

where the anterior and posterior areas of cerebral arterial circulation connect in the brain. Anomalies in this area are common

Front 3

what is a stroke?

Back 3

a sudden disturbance in a person's brain perfusion associated with a neurological deficit (i.e. essentially a "heart attack" in your brain)

Front 4

what are 2 physioloical causes of a stroke?

Back 4

focal ischemia, or hemorrhage

Front 5

what is a TIA

Back 5

Transient Ischemia Attack
"mini-stroke"

it is a temporary loss in neuro function caused by ischemia in one of the vascular territories of the brain, lasting inbetween 15 min and 24 hrs. Most resolve w/in 3 hrs

Front 6

what can cause a TIA

Back 6

TIAs may be d/t microemboli that temporoarily block the blood flow. TIAs are a warning sign of pregressive cerebrovascular disease.

Front 7

4 out of 5 people have one or more TIAs before one major stroke

TRUE or FALSE

Back 7

TRUE.

Front 8

Describe some of the S&S of TIAs

Back 8

they tend to be hemaparetic

partial vision loss in one eye, weakness, numbness, tingling, severe headache, speechlessness, or unexplained dizzines...depending on the artery involved.

Front 9

what is the number one cause of TIAs

Back 9

carotid stenosis (hardening of the carotid artery)

Front 10

what are some diagnostic tests that can be done for a TIA.

Back 10

CT scan w/out contrast media.

a CT scan is needed to rule out other problems like other cardio conditions. Also, subdural hematomas and increasing tumor masses can mimic the signs of TIAs and should be ruled out.

Front 11

what is a RIND

Back 11

Reversible ishcemic neurologica deficit- this is worse than a TIA, but not a full fledged stroke. it lasts more than 24hrs but the symptoms go away.

Front 12

what is a stroke in evolution?

Back 12

a stuttering stroke; it's intermittent, but the S&S get worse with each episode

Front 13

describe a stable or complete stroke

Back 13

a complete, full blown stroke. (can be hemorrhagic or ischemic)

Front 14

describe some of the warning signs for having a stroke

Back 14

sudden weakness, numbness or paralysis (usually unilateral)
sudden dimness or loss of vision (can be uni or bi lateral)
sudden difficultly speaking or understanding simple statements or confusion (expressive/receptive aphasia)
sudden severe h/a with no known cause
unexplained dizziness, unsteadiness or suddenly falls (especially with any of the other symptoms described above)

Front 15

the pneumonic "FAST" is used to tell us what? and what does it stand for?

Back 15

FAST tells us how to regognize when someone may be having a stroke

F- Face (facial palsy, can't puff out cheeks)
A- Arms (arm drift/weakness when holding out parallel)
S- Speech (slurred speech)
T- Time (two out of the three= stroke team activation)

Front 16

what are the 2 major types of stroke

Back 16

ischemic and hemorrhagic

Front 17

describe the significance of carotid stenosis

Back 17

it is a major source of thrombus formation (and hence risk factor for stroke)... this would cause an ischemic stroke

Front 18

how do you/can you treat carotid stenosis

Back 18

is there is stenosis in more than 70% of the vessel: a carotid endarterectomy is performed (where they make an incision and scrape out the plaque of the carotid artery); the pt. will also be put on long term anticoagulants

if stenosis is 50-70%- carotid endarectomy may be performed with a 6mo course of anticoagulation post procedure

if less than 50% stenosis- carotid endo is of little benefit and the pt. will be put on long term use of anticoagulant therapy to prevent problems

Front 19

what are some things to monitor after a carotid endarterectomy?

Back 19

plaque, or a clot can dislodge during surgery...monitor for S&S of stroke/TIA

Front 20

what is the difference between a thrombotic and an embolic stroke?

Back 20

thrombotic stroke happens when a clot forms on top of atherosclerotic plaque

emoboli stroke happens a clot is formed else where (usually in the heart) and dislodges and travels to the cerebral artery and occludes it

Front 21

what conditions can cause an embolic stroke?

Back 21

preexisting heart conditions, like A-Fib, MI, infective endocarditis, etc.

these conditions cause all cause a the clot to break off from the endocardium and enter circulation

Front 22

what is a hemorrhagic stroke?

Back 22

bleeding into the brain tissue itself (intracerebral or intraparenchymal) or inot the subarachnoid space or ventricles (subarachnoid hemorrhage or intraventricular hemorrhage)

Front 23

what is an intracerebral hemorrhage (subtype of hemorrhagic stroke)

Back 23

cerebral bleeding d/t rupture of a vessel

HTN is the most important cause

there is a sudden onset of symptoms with progression over hours b/c of increased bleeding..POOR PROGNOSIS... IMMEDIATE ACTION

there is a bleed--> the bleed clots--> puts pressure on the brain--> leads to ischemia/infarction (but it's considered a hemorrhagic stroke)

Front 24

describe a subarachnoid hemorrhage

Back 24

intracranial bleeding into the CSF fille dspace beween the arachnoid and pia mater

usually caused by aneurysm rupture

"worst h/a of one's life" (warning sign of ballooning aneurysm about to rupture)

LOC varies from alert to comatose

Poor prognosis- usually left with severe neuro deficits

cerebral vasospasm is a major concern

Front 25

______ has a similar presentation like that of a stroke

Back 25

HYPOGLYCEMIA

LOC, disorientation, mumbled speech can be easily confused with S&S of a stroke

Front 26

what are the 7 D's of stroke management?

Back 26

1. Detection: soft signs, facial droop, unilateral arm life, speech difficulties
2. Dispatch: call 911, rapid transportation to hospital
3. Delivery: alert the hospital of a possible stroke patient
4. Door: with in the first 25 min-- check glucose, neuro, hx, onset, and GCS
5. Data: is it ischemic? what is going on?
6. Decision: administer a thrombolytic? Treat HTN (controversial)
7. Drug: administer thrombolytic within 180 minutes upon onset of symptoms

Front 27

what are the prime clinical manifestations of a stroke

Back 27

1. motor fxn: mobility, respiratory, swallowing/speech, gag reflex, self-care abilities
2. communication: aphasia (loss of comprehension and language), dysphasia (difficulty comprehending/speaking) receptive aphasia (neither sounds, speech, nor meaning can be understood), expressive aphasia (difficulty in speaking/writing); dysarthria (difficulty articulating words)
3. affect- emotional lability, difficulty controlling emotions
4. intellectual function-memory and judgement is impaired
5. spatial-perceptual alterations- blindness in the same half of both visual fields, apraxia (inability to carry out movements)
6. elimination- urinary and bowel problems occur initially and temporarily

Front 28

what are the main goals/interventions immediately after having a stroke

(i got this answer directly from the book!)

Back 28

Goals: save life, prevent further damage, reduce disabilit

IN ORDER: (via the book)
ensure pt. airway
call a stroke code/stroke team
remove dentures
pulse ox
maintain oxygentaion
IV NS
maintain BP (only give drugs is it markedly high)
CT scan


fluid and electrolyte balance should be carefully controlled-- too much can cause cerebral edema

if elevated ICP, see ICP interventions

Front 29

Med tx for ischemic strokes

Back 29

anticoagualant therapy (Lovenox/Coumadin)

antiplatelet therapy- aspirin, 2B3A (makes platelets sticky)

carotid endarterectomy (surgical)

clot retreiver- "corkscrew" that breaks up clots

only give Antihypertensives if:
SBP >220mmHg
DBP >120mmHg

Front 30

Tx for hemorrhagic strokes

Back 30

SURGERY:
aneurysm clipping: clamp off part of the bleeding vessel

aneurysm coiling: put substance into a pouch to prevent bleeding

Front 31

if someone has an aneurysm, but it hasn't ruptured, how do you prevent it from rupturing?

Back 31

quiet dark room
limit visitation/environmental stimuli
manage pain
no coughing/sneezing/blowing nose/bearing down
stool softeners
manage stress (drug therapy)
maintain BP

Front 32

How do you treat/manage SAH (sub-arachnoid hemorrhage)

Back 32

calcium channel blockers (Nimotop)
Anti-hypertensives
CSF drainage/ shunt
antiseizure meds

Front 33

if a vasospasm is present, what do you do?

Back 33

vasospams usually occur in hemorrhagic strokes (the blood from the hemorrhage on the outside of the vessel irritates it..causing a spasm)

triple H therapy (hypervolemic, hemodilution, hypertensive)

hypervolemic- give fluid to increase BV to stop spasm

hemodilute- increase BV

hypertense- once bleed has been fixed, the pressure keeps the spasm controlled