Chapter 64 Management of Patients w/ Cerebrovascular Disorders Flashcards
Cerebrovascular Disorder
Umbrella term that refers to a functional abnormality of the CNS that occurs when the blood supply to the brain is disrupted
What is the primary cerebrovascular disorder in the United States?
Stroke/CVA: 5th leading cause of death, primary cause for long-term disability
What are the two main categories that stroke is divided into?
Ischemic and hemorrhagic
Ischemic Stroke
87% of strokes are ischemic
Sudden loss of function resulting from disruption of blood supply to a part of the brain
What are the 5 categories of ischemic stroke?
1) Large artery thrombotic stroke
2) Small penetrating artery thrombotic strokes
3) Cardiogenic embolic strokes
4) Cryptogenic strokes
5) Other
Large Artery Thrombotic Stroke
AKA Large Vessel Occlusion (LVO)
Counts for 20% of ischemic strokes
Symptoms vary by location
- Middle Cerebral Artery (MCA): Most common
- Anterior Cerebral Artery (ACA): Least common
- Posterior Cerebral Artery (PCA)
- Vertebro/Basilar (Basilar) Artery
Caused by atherosclerotic plaque in large blood vessels of the brain
- Not necessarily clots yet
- Thrombus formation & occlusion at site of atherosclerosis result in ischemia & infarction
Infarction
Tissue necrosis in an area deprived of oxygen supply
LVO: Middle Cerebral Artery (MCA) Stroke
MOST COMMON LVO!!
MCA supplies (LT Side):
- Broca’s area: Expressive speech
- Wernicke’s area: Receptive speech
- Motor & sensory cortex (controls RT side)
MCA supplies (RT Side):
- Motor & sensory cortex (controls LT side)
- Spatial-perceptual deficits
LVO: Anterior Cerebral Artery (ACA) Stroke
Rare: Collateral circulation provided by the anterior communicating artery
- Additional blood flow
ACA supplies:
- Frontal: Thought, personality
- Pre-frontal: Motivation, planning & organizing of complex behavior
- Supplementary motor cortex: Broca’s area in the initiation of speech
- Primary motor: Contralateral movement
- Primary sensory cortex: Contralateral sensation
LVO: Posterior Cerebral Artery (PCA) Stroke
Most common symptom: Contralateral visual field deficits
PCA supplies:
- Occipital: Primary & secondary visual (sensation and interpretation; left and right visual association)
- Thalamus: Functions in the integration between cerebral cortex & the rest of the CNS
LVO: Vertebro/Basilar Artery Stroke
Most DEVASTATING stroke!! 85% mortality rate
Basilar artery Supplies:
- Posterior part of the circle of Willis
- Serves as a critical arterial supply to the cervical spinal cord brainstem, cerebellum, thalamus, & occipital lobes.
Small Penetrating Artery Stroke
AKA Lacunar infarctions
25%: Common type of ischemic stroke
Often untreated/underdiagnosed due to small size (also deep)
- Forms a cavity
Closely linked to HTN
- Likely a form of atherosclerosis
“White matter hyperintensity” or “white matter disease”
Cause of:
- Loss of function
- Disability
- Age-related cognitive decline related to dementia, strokes, motor movement issues
Affects one or more vessels
Cardiogenic Embolic Stroke
20%
Associated w/ cardiac arrhythmias usually A-fib, valvular heart disease & thrombi in the LT ventricle
Emboli originates from the heart & circulates to the cerebral vasculature
- Most commonly the LT middle cerebral artery
Preventable w/ use of anticoagulation therapy
Cryptogenic Stroke
30%
No identifiable etiology
“Other” Cause of Ischemic Stroke
5%
Includes:
- Illicit drug use
- Coagulopathies
- Migraine/Vasospasm
- Spontaneous dissection of the carotid or vertebral arteries
