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50 Cards in this Set
- Front
- Back
Stroke
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a sudden onset of neurological deficit that persist longer than 24 hours and may recover to a varying degree
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Nonmodifiable risk factors
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Age
Ethnicity Gender Family History Genetics |
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Modifiable Risk Factors
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hypertension
history of stroke cerebrovascular disease obesity |
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Complete interruption of cerebral blood flow causes progressive functional loss with time:
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1. Suppression/ reduction of brain electrical activity within 12-15sec
2. Inhibition of synaptic excitability of cortical neurons after 2-4min 3. inhibition of electrical after 4-6 min |
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penumbra
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cellular dysfunction..but can recover to a certain extent
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when blood flow decreases to 18 ml/100g/min
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cells do not function but have potential for recovery
-penumbra |
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At 8 ml/100g/min
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the threshold of membrane failure is reached and cell death may occur
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the two categories of strokes
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1. Occlusive (most common)
2. Hemorrhagic |
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Extraparenchymal Hemorhage
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subarachnoid , intraventricular (outside tissue)
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Intraparenchymal Hemorhage
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within tissue
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what is the most common form of occlusive stroke
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embolism
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the typical material that typically gets lodged in the artery in a cerebral embolism
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thrombus
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In the anterior circulation (ICA) what branch is most commonly occluded
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Middle Cerebral Artery
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In the posterior circulation (vertebrobasilar) the most common branch to get occluded
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a cerebellar artery or PCA
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the progession of damage within an embolus is described as
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Ishemia--> infarction
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ishchemia
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lacking oxygen but not necessarly dead
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Infarction
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vascular infficiency resulting in necrosis of the area supplied by the artery
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what is the major direct and indirect souce of emboli?
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Atherosclerosis
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other major source of emoli results from
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cardiomyopathies or arrhythmias
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Minorsources of emoli
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air emboli
fat emboli- from broken bone amniotic fluid tumor emboli |
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intracranial hemorrhage technically associated with stroke
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Subarachnoid hemorrhage
Intraventricular Hemorrhage Parenchymatous, Cerebral hemorrhage |
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Hemorrhage associated stroke can arise from vessel rupture via?
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-defect arteriovenous malformation
-aneurysms -trauma -Disease |
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Cerebral Hemorrhage is usually due to the rupture of small vessels such as the
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Lenticulostriate Arteries
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Most common hemorrhage with a hemorrhagic stroke
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sub arachnoid hemorrhage
(usually from blood leakage from a small aneurysm) |
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Major risk factors for cerebral hemorrhage
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1. Hypertension
2. Diabetes 3. Atherosclerotic disease |
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Carotid aneurysms in the canernous sinus can result in compression of
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CN III, IV, VI
and opthalmic and maxillary branches of CN V |
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compressing on CN III, IV, VI and V from a carotid aneurysm in teh cavernous sinus can produce what symptoms?
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partial or complete paralydid of eye movement, loss of the corneal reflex and paresthesias or pain wthin the distributions of CN V
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what are abnormal communications between cerebral arteries and veins which cna cause bleeding into CSF spaces or braintissue. And normally superficial
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Arteriovenous malformations
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An ateriovenous malformation of the great cerebral vein of Galen (usually seen in newborns) produces what symptoms?
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-bulging fontanelles
-progressive hydrocephalus (compression and occulsion of hte cerebral aqueduct) -dilated veins of the face and scalp |
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ICA occlusion may cause infarction of the entire hemisphere except
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-the thalamus
-inferior portion of the temporal lobe -medial portion of occipital lobe |
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Signs and Symptoms of ICA occlusion usually associated with
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MCA occlusion
(because of more direct anterior communicating artery location to anterior circulation) |
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neurological deficits occur but recover before 24 hours but usually before 10min
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TIAs
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Amaurosis Fugax
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transient blindness on the affected side from TIA in ophthalmic artery
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What distinguishes MCA syndrome from CA syndrome
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Ophthalmic involvement
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Symptoms of TIAs in carotid (Anterior) Circulation
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1. Ipsilateral amaurosis fugax
2. Contralateral sensory or motor dysfunction liminted to one side of the body 3. Language deficits may occur |
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Symptoms of TIAs in vertebrobasilar (Posterior) Circulation
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1. Bilateral or shifting motor or senosry dysfunction
2. Bilateral visual disturbances 3. Bifacial numbness 4. Vertigo 5. Diplopia 6. Ataxia |
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TIA's are often associated with
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vascular stenosis from emboli or narrowing of arteries from various causes
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Watershed regions
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the border zones between the areas supplied by the anterior, middle and posterior cerebral arteries
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watershed strokes occur along
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the borders between arterial territories
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Watershed strokes are usually from?
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Reduced cerebral blood flow from severe arterial hypotension or hypoxemia or severe carotid artery disease
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Anterior Watershed Infarcts can produce
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ACA/MCA
produce person in a barrel syndrome -proximal body motor and or sensory deficits -expressive language deficits and behavior changes |
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Posterior Watershed infarcts can produce
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MCA/PCA
-complex visual and sensory loss and a variety of lanuage problems depending upin the extent of damage to the dominant hemisphere |
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lacunar strokes occur in
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penetrating arteries to deep tissue of the brain or brainstem (not cortex)
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Lacunar syndromes include
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-1.pure motor strokes
-2.pure sensory strokes -3.ataxic hemiparesis - clumsy hand syndrome with other deficits that do not represent a large artery distribution |
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Multiple Lacunar Strokes are assoiciated with
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multi infarct dementia (MID)
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Pure Motor syndrome involves
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descending motor fibers (corticospinal tract) fibers
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PMS possible areas of involvement
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posterior limb of the internal capsule, ventral pons, corona radiata or crus cerebri
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Treatment for TIAs
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chronic antiplatelet therapy
anticoagulants carotid endarterectomy angioplasty and stents |
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Stroke in evolution is managed with
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anticoagulants
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Completed stroke is treated with
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- IV or IA thrombolytic therapy
-Antiplatelet/ anticoagulation/ antihypertensive/ antiedma -surgery |