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44 Cards in this Set
- Front
- Back
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what is the pathology behind a stroke
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interrupted blood flow causing the core area of focal infarction and the area around to become ischemic
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what does ischemic penumbra mean
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core area of focal infaction and the area around the core have interrupted blood flow
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what does the ischemia in stroke cause
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the release of a cascade of chemicals who's overall effect is increase neuronal death within hours
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cerebral edema begins with in hours and reaches its max by _____ days
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4 days!
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cerebral edema results from
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tissue necrosis and rupture of cell membranes
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swelling gradually subsides and disappears in about ____
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3 weeks
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how does stroke rank in leading causes of death
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3rd leading cause of death and MOST COMMON cause of adult disability in US
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what is the prevalence of stroke
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6.5 million
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what is the age for CVA
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increases dramatically with age
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only _____% of CVA occur under 65 yrs
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only 20% under 65 yrs
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male to female for CVA
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1.25 male to 1 female
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race for CVA
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african americanse 60% > whites
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what are the 3 etiologies for CVA
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1) ischemic (arteries narrowed/blocked)
2) hemorrhagic (blood vessel rupture) 3) TIA (transient ischemic attack) |
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what is an intracerebral hemorrhage
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rupture of one of the cerebral vessels with subsequent beleeding in the brain
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where is the most common ruptures for an intracerebral hemrrhage
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main arteries supplying the basal ganglia and internal capsule
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most intracerebral hemmorages are due to
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HTN
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what is a subarachnoid hemorrhage
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bleeding into the subarachnoid space
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a subarachnoid hemorrhage usually indicates
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rupture of cerebral aneurysm or an arteriovenous malformation
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a subarachnoid hemorrhage can cause
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increased intracranial pressure or vasospasms
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what are the causes of ischemic stroke
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thrombus and embolism
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how does a thrombus cause a stroke
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progressive stenosis with eventrula occlusion leading to reduced cerebral blood flor to the brain
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where is th emost common site for atherosclerosis
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the bifurcation of the common carotid artery
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an embolism can cause a stroke where
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traveling in the blood stream to the cerebral arteries where they produce occulsion and infarction
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where is the most common origin for an emboli to the brain
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the heart (e-fib, L ventricular hypertrophy, valve replacements, mitral valve prolapse)
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where is the most common site for blockage from an emboli
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bifurcation of the ICA and MCA
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what is a TIA
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transient ischemic attack
= temporary interruption of blood flow to the brain with aculte loss of focal brain function |
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how long do symptoms last from a TIA
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minutes to 24 hours with no permanent deficits or damage
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how are CVAs names
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by location of the lesion
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_____% of CVA will require assistance with ADLs
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25-39%
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_____% will need help with walking
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20%
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_____% will be institutionalized
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16%
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a poor prognosis post CVA if
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- prolonged flaccid period >2-4 weeks
- absence of voluntary hand movement >4-6 weeks - severe proximal spasticity |
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what is the mortality for CVA
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20-30% die during the acute phase (1st month)
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what are the characteristic symptoms of thrombus stroke
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- 60% occur during sleep
- may be preceded by TIA - uneven progression of neurodeficit over min--> days - usually no change in consiciousness - 85% survival rate at 30 days |
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what are the characteristic symptoms of an embolus stroke
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- usually while awake
- no warning sign - occurs rapidly within sec/min - 70% survival rate at 30 days |
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which has a better survival rate embolus or thrombus
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thrombus (85% at 30 days) vs. 75% at 30 days
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what are the characteristic symptoms is ICH
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- usually during activity
- severe headache with increase BP - sudden onset - may have progressive LOC - death may occur due to brainstem compression |
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what is the survival rate for ICH
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20% at 30 days
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what ar ethe characteristic symptoms for SAH
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- may occur during activity
- may have intermittent neck stiffness and HA as warning - may have seizures - usually no focal deficit intiially - sudden, severe HA after rupture - 50% survival rate at 30 days |
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what are the ways to prevent stroke
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- regulate BP
- dietary adjustments - quit smoking - anticoag/platelet inhibit - control of diseases - surgery |
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what can be given via IV in an acute ischemic stroke
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clot busters (tPA) to dissolve clot in 1-2 hours but needs to be started within 3 hours of onset!
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what is the goal of acute ischemic stroke tx
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maintain SBP
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what do you do in acute hemorrhagic stroke tx
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- evacuation of hemorrhage
- aneurysm clipping/coiling - want to maintain SBP bBELOW 100 mmHg to prevent rebleeding |
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for hemorrhagic stroke you want to maintain SBP at what level
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below 100 mmHg
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