Flashcards in Cerebral Vascular Disease Deck (81)
Definition of cerebral ischemia
inadequate blood or oxygen to brain
mild or acute ischemia
severe or long-standing ischemia
whole brain = hypoxic-ischemia encephalopathy
focal region = stroke
systemic causes of short-lived cerebral ischemia
hypotension, vasovagal reaction, arrhythmia, MI
PE of stroke/TIA work up
BP, RR, pulse
Listen for bruits, murmurs, abnormal rhythms
Careful neuro exam
Labs to work up stroke/TIA
CBC, ESR, CMP, Lipid profile, Clotting studies (PT/PTT), serologic test for syphilis
Imaging to eval for possible embolic cause of stroke
carotid U/S, ECG, Holter monitor, ECHO, TEE, angiogram
Why is getting a CT/MRI important in work up of stroke?
only way to differentiate ischemic and hemorrhagic stroke
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
Non-modifiable RF for stroke
age, male, African American, hypercoaguable state
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
How to decrease risk of A-fib?
How are mitral valve defects and A fib ruled out as causes of stroke?
TEE r/o mitral defect
ECHO r/o A-fib
What are two types of stroke and which is more likely?
What is most likely cause of hemorrhagic stoke?
In a stroke, if blood quickly restored then it is a ______. But if prolonged ischemia _______.
tissue necrosis -> hemorrhagic stroke
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
What are some hypercoaguable states?
cancer, thrombocytosis, factor V Leiden, oral contraceptives
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)
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)
What tx is used for acute stroke symptoms and prevention?
anti-platelet tx: Aspirin/Clopidogrel
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
What is major risk of having TIA?
15% risk of full stroke after TIA, esp first 2 days
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
How is TIA defined?
stroke that resolves within 24 hours; usually less than 1 hr
Major causes of TIA
- stenosis of major artery (carotid, vertebral)
- embolic phenomena (A-fib)
- thrombosis of smaller BV in brain
What is an important part of PE for TIA?
Listen to carotid arteries
What drug can reduce ICP?
Urgent eval and tx!
Hospitalization for acute workup and availability of tPA if stroke occurs