3.28 Stroke

Question 1

2 types of strokes

Answer 1

• ischemic

- hemorrhagic

Question 2

Which type of stroke accounts for 80% of all strokes?

Answer 2

ischemic

Question 3

ischemic strokes occur because of

Answer 3

blockages

Question 4

types of blockages

Answer 4

• embolytic

- thrombotic

Question 5

embolytic blockage

Answer 5

• caused by an embolus

- travels to the spot of occlusion in the brain

Question 6

types of emboli

Answer 6

• fat
• blood clot
• plaque
• air

Question 7

fat embolus can happen when?

Answer 7

• post-surgery

- massive injury with bony damage

Question 8

Where does the blood clot embolus from a DVT go?

Answer 8

DVT from the leg (usually goes through to the lungs)

Question 9

Who gets blood clot emboli that could cause an ischemic stroke?

Answer 9

pts with ectopic heartbeat or a-fib

Question 10

Why are a-fib pts susceptible to ischemic stroke?

Answer 10

• blood hangs out in the heart

- get asynchronous pumping

Question 11

What can help determine where a stroke is?

Answer 11

ECG (echocardiogram)

Question 12

How can plaque cause a stroke?

Answer 12

• from arteries

- can be caused during an angioplasty

Question 13

Where does plaque buildup that causes a stroke start?

Answer 13

carotid arteries

Question 14

What is the procedure where plaque is removed from the carotid arteries?

Answer 14

carotid endartectomy

Question 15

How does an air embolus cause a stroke?

Answer 15

air in IV or syringe that gets pushed through the artery

Question 16

What is a thrombotic ischemic stroke?

Answer 16

• caused by a thrombus

- grows in spot of occlusion - brain

Question 17

What does TPA stand for?

Answer 17

tissue plasminogen activator

Question 18

What type of stroke is the best type to get and why?

Answer 18

• embolytic stroke from a blood clot

- can be given TPA to break it up

Question 19

What is TPA?

Answer 19

super duper blood thinner that can dissolve a clot

Question 20

downfall to taking TPA?

Answer 20

high bleed risk

Question 21

When does TPA need to be started?

Answer 21

• within 3-4 hours of the first symptom

- after 3 hours, the damage has been done

Question 22

What must be confirmed before giving TPA?

Answer 22

must be sure it’s an ischemic stroke from a clot

Question 23

signs of stroke

Answer 23

FAST = face, arms, speech, time

Question 24

Where does stroke usually occur?

Answer 24

MCA

Question 25

Why is TPA such an important drug for stroke?

Answer 25

can make a huge impact "miracle drug"

Question 26

What type of stroke accounts for 20% of all strokes?

Answer 26

hemorrhagic

Question 27

What causes a hemorrhagic stroke?

Answer 27

bleed in the brain (not inside an artery anymore) - artery is damaged - accident can create a tear that bleeds

Question 28

Hemorrhagic strokes are usually caused by

Answer 28

aneurysms

Question 29

Where do most aneurysms happen?

Answer 29

in the Circle of Willis

Question 30

Why is the Circle of Willis susceptible to aneurysms?

Answer 30

vessels come together at almost 90˚ - blood flow deflected, can get blockage - high risk for extra pressure - artery wall weakens, blood pushes in and pouches

Question 31

What kinds of "shapes" an aneurysms make?

Answer 31

- ball/bubble | - dissection

Question 32

Ball/bubble aneurysms usually occur here

Answer 32

in the brain

Question 33

Dissection aneurysms usually occur here

Answer 33

large vessels (i.e. abdominal aorta)

Question 34

Major risk factors for aneurysms

Answer 34

- long term HBP | - valsalva in HBP pt may jump BP and cause aneurysm to rupture

Question 35

Berry aneurysm

Answer 35

- runs along the Circle of Willis | - looks like a raspberry

Question 36

Why do we not know we have an aneurysm until it ruptures (typically)?

Answer 36

- bleeds until pressure builds up - nowhere else for it to go - enough pressure stops the blood flow

Question 37

What will be done if an aneurysm is bad enough?

Answer 37

craniotomy | - aneurysm is clipped

Question 38

result in brain tissue of clipping an aneurysm

Answer 38

brain tissue distal to the aneurysm dies: body reabsorbs the tissue

Question 39

AVM

Answer 39

arteriovenous malformation

Question 40

What is an AVM?

Answer 40

congenital defect that can result in stroke - poor blood flow - weakened walls - increased pressure occurs » ruptures

Question 41

Percentage of AVMs that rupture

Answer 41

50%

Question 42

preventative craniotomy

Answer 42

clip (fix) aneurysms before they rupture

Question 43

Why would a coiling procedure be done?

Answer 43

aneurysm creating strokelike symptoms because it's pushing on other tissues

Question 44

What is coiling?

Answer 44

- catheter through femoral artery to the aneurysm in the brain - make a bird's nest of wire inside the aneurysm - fills space so that blood isn't going into it anymore

Question 45

What is the result of a coiling procedure?

Answer 45

- body eventually heals up over it and encapsulates the wire | - restores blood flow