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Flashcards in Cerebral Vascular Disease Deck (81)
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1

Definition of cerebral ischemia

inadequate blood or oxygen to brain

2

mild or acute ischemia

syncope

3

severe or long-standing ischemia

whole brain = hypoxic-ischemia encephalopathy
focal region = stroke

4

systemic causes of short-lived cerebral ischemia

hypotension, vasovagal reaction, arrhythmia, MI

5

PE of stroke/TIA work up

BP, RR, pulse
Fundoscopy
Listen for bruits, murmurs, abnormal rhythms
Careful neuro exam

6

Labs to work up stroke/TIA

CBC, ESR, CMP, Lipid profile, Clotting studies (PT/PTT), serologic test for syphilis

7

Imaging to eval for possible embolic cause of stroke

carotid U/S, ECG, Holter monitor, ECHO, TEE, angiogram

8

Why is getting a CT/MRI important in work up of stroke?

only way to differentiate ischemic and hemorrhagic stroke

9

Difference in causes of ischemic and hemorrhagic strokes?

ischemic - thrombosis or embolic blockage of blood flow to brain

hemorrhagic - bleeding inside or around brain tissue

10

Non-modifiable RF for stroke

age, male, African American, hypercoaguable state

11

Modifiable RF for stroke

- stop smoking and drinking
- control DM, HTN
- treat hyperlipidemia, hyper coagulability, sleep apnea
- convert A-fib to sinus rhythm
- reduce obesity

12

How to decrease risk of A-fib?

anti-coags

13

How are mitral valve defects and A fib ruled out as causes of stroke?

TEE r/o mitral defect
ECHO r/o A-fib

14

What are two types of stroke and which is more likely?

Ischemic (85%)
Hemorrhage (15%)

15

What is most likely cause of hemorrhagic stoke?

HTN

16

In a stroke, if blood quickly restored then it is a ______. But if prolonged ischemia _______.

TIA
tissue necrosis -> hemorrhagic stroke

17

RF specific to ischemic stroke

atherosclerosis, AGE, fhx, HTN, DM, tobacco, high lipids, A-fib, recent MI, valvular disease, patent foramen ovale, hypercoaguable states, systemic vascular disease, HIV/AIDS

18

What are some hypercoaguable states?

cancer, thrombocytosis, factor V Leiden, oral contraceptives

19

When is tPA not appropriate for stroke treatment?

hemorrhagic strokes (or other bleeds)
acute stroke tx
after 4.5 hours of sx onset
thrombolysis (on blood thinner)
uncontrolled HTN
pregnancy

20

How/when does tPA work?

= tissue plasminogen activator

breaks up clots; used in immediate treatment of stroke (within 4.5 hrs) or MI (within 12 hrs)

21

What tx is used for acute stroke symptoms and prevention?

anti-platelet tx: Aspirin/Clopidogrel

22

Medical management to reduce complications and prevent secondary stroke?

- reduce RFs
- take Aspirin
- Save ischemic penumbra region
- Rehab: PT/OT, speech pathologist, respiratory therapist, social worker, psychologist

23

What is major risk of having TIA?

15% risk of full stroke after TIA, esp first 2 days

24

amaurosis fagux

TIA with transient monocular blindness from emboli to central retinal artery of one eye (branch of internal carotid artery); high correlation with ipsilateral carotid stenosis

25

How is TIA defined?

stroke that resolves within 24 hours; usually less than 1 hr

26

Major causes of TIA

- stenosis of major artery (carotid, vertebral)
- embolic phenomena (A-fib)
- thrombosis of smaller BV in brain

27

What is an important part of PE for TIA?

Listen to carotid arteries

28

What drug can reduce ICP?

Mannitol

29

TIA treatement

Urgent eval and tx!
Aspirin
Avoid tPA

Hospitalization for acute workup and availability of tPA if stroke occurs

30

________ are 20% of ischemic strokes.

small vessel strokes (Lacunar stroke)