Stroke, Headache, and HTN Flashcards
1
Q
Stroke symptoms
A
Symptoms vary: location, severity, type dependent
- Weakness/numbness face/limbs, one side
- Confusion, difficulty speaking/understanding
- Agitation, seizure
- Vision changes – one/both eyes, visual field cut
- Difficulty walking, ataxia, loss of coordination
- Dizziness, vertigo, loss of balance
- Atraumatic loss of consciousness
- Sudden, severe headache
- Visual changes can be stroke!!! If someone cant see out of one eye, this may be a stroke
- Hemorrhageic are the ones associated with HA! Ischemic strokes are not
2
Q
Risk Factors for stroke
A
- TIA or previous CVA – your risk of stroke is phenomenally higher!
- HTN
- DM
- Atrial Fibrillation
- EtOH, IVDU, stimulants
- Atherosclerosis
- High cholesterol
- Sickle Cell
- Obesity/inactivity
- Tobacco
- Increasing age
- Young people too!!
- Heredity
- Family Hx of CVA
- Ethnicity
- African Americans
- Hispanic Americans
- Gender
- Men > Women
- Women > for SAH
3
Q
Critical hx for stroke
A
- When did symptoms begin?
- Treatment is time dependent
- When were you/they last normal?
- Sudden or gradual onset?
- What are the symptoms, exactly?
- Symptoms persistent or transient?
- On anticoagulation??
- PMHx, prior function, meds, risk factors
- Trauma? Syncope? N/V?
- Headache??
- Ask contraindications for tPA, thrombolytics
4
Q
Ischemic CVA
A
- ~85% of all strokes
- Thrombotic
- Atherosclerosis, gradual vessel occlusion
- Sx onset may be gradual, stuttering
- May have hx TIA
- Embolic
- Sudden occlusion; sudden, fixed deficit
- A fib, cardiac thrombus, endocarditis
- Early on – no headache
5
Q
Hemorrhagic CVA
A
- ~15% of all strokes
- Intracerebral Hemorrhage
- Subarachnoid Hemorrhage
- Causes – vessel ruptures due to:
- HTN
- Cocaine, Meth, stimulants
- Aneurysm bursts open
- Arteriovenous Malformation (AVM)
- Trauma while on anticoagulation
- Headache, ALOC are cardinal sx’s
6
Q
Brain review
A
-Left is dominant hemisphere:
All right-handed
80% left-handed
-Right is dominant in 20% lefties
7
Q
Stroke syndromes
A
Anterior circulation CVA
- Carotid artery origin
- Anterior Cerebral Artery
- Middle Cerebral Artery
Posterior circulation CVA
- Vertebral artery origin
- Posterior Cerebral Artery
- Vertebrobasilar stroke
- Cerebellar stroke
Lacunar strokes
8
Q
Anterior circulation CVA - anterior cerebral artery
A
- Motor: Contralateral weakness
- Leg, foot > arm
- Sensory: Contralateral deficit
- Leg sx’s > arm sx’s
- Loss of frontal lobe control
- Personality change
- Perseveration – repeat yourself over and over again
- Incontinence
- Gait disturbances
- Apraxia – can’t perform tasks or follow commands even though they know the task and wish to follow the command. Several specific types – you cannot execute something you understand
9
Q
anterior circulation CVA - middle cerebral artery
A
- Most common – bad if big/central
- Motor: Contralateral weakness
- Face/arms > legs
- Facial droop
- Sensory: Contralateral deficit
- Arms > legs
- Dominant hemisphere: aphasia
- Non-dominant: neglect
- Eyes turned toward side of stroke
- Homonymous hemianopsia – look at next slide for example
10
Q
Posterior circulation CVA - Posterior cerebral artery
A
- Occipital cortex affected
- Vision loss, cortical blindness
- Normal eye, eye reflexes
- May go un-noticed by patient
- Homonymous hemianopsia
- Ipsilateral CN 3 palsy
- Minimal motor findings
- Contralateral
- Cortical blindness – when the person has a normal looking eye and reflexes but they cant see!
- This visual change may go completely unnoticed by the pt
- homonymus hemanopsia - see half of vision on same side on each eye
11
Q
posterior circulation CVA - vertebrobasilar CVA
A
- Ipsilateral eye, cranial nerve defects
- Contralateral motor defects
- Vertigo/ataxia, nausea/vomiting – this is the central cause of vertigo! This is what we are looking for with vertigo!
- Tinnitus/deafness, nystagmus
- LOC or ALOC, coma
12
Q
posterior circulation CVA - basilar artery/pontine
A
-“locked-in” syndrome - can move the eyes but cant move any other muscle or body part
-Extensive motor deficit
Consciousness, eye movements spared
13
Q
posterior circulation CVA - cerebellar strokes
A
- Central vertigo, vertical nystagmus
- Cranial nerve deficits
- Abnormal finger->nose, RRAM, etc
- Ataxia
14
Q
lacunar infarcts
A
- HTN, DM
- Small vessels that perforate the deep, subcortical areas
- “pure” motor or sensory sx’s
- “clumsy hand” syndrome
- Persistent sx’s need w/u: CT, MRI
- Old, minor lacunar infarcts often seen incidentally on CT
- You will see these on CTs incidentally
- Whats the difference between TIA and lacunar stroke? Location (lacunar strokes are very deep inside the brain), the hallmark of TIAs is that it doesn’t leave a residual, so you cant see it on CT
15
Q
NIHSS (national institutes of health stroke scale (abbreviated))
A
- By EMS and on arrival to ED – ALL stroke pt’s
- Provides info on:
- Location
- Severity
- Prognosis
- Initial score <15 better
- Initial score >20 not so good
- A must in communication with consultants
- Influences Tx decisions: tPA, transfer, etc
