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Flashcards in Etiologies 1 Deck (24):
1

What should be considered when thinking about injuries to the brain?

•Consider the mechanism of injury:
•Is the injury Focal or Diffuse?
•Is the injury Permanent or Transient?
•Is the Injury Stable or Progressive?

2

Describe a cerebrovascualr accident. What is it commonly referred to as? What is physically occuring during a CVA? What is the number 1 risk factor for stroke?

•Commonly referred to as Stroke.
•Any interruption in blood flow to the brain that causes tissue necrosis (‘death’) or impaired function. 
•The number one risk factor for stroke is stroke
•Strokes are cumulative 

3

Describe the symptoms of stroke. What may changes in functioning be related to? What are some common symptoms?

  • Any changes in functioning may be related to neurologic function. Some symptoms  are more common than others
  • F.A.S.T.
    • Face - has their face fallen to one side? Can they smile?
    • Arms - Can they raise both their arms and keep them there? 
    • Speech - is their speech slurred?
    • Time to call 911
  • Other Symptoms:
    • Any sudden muscle weakness or numbness, especially if impacts one side more than the other.
    • Vision Changes
    • Slurred speech
    • Difficulty  with Language
    • Difficulty walking

4

Describe the risk factors for stroke. What are some controllable factors? What are some uncontrollable factors?

Controllable

  • Blood Pressure (Hypertension HTN)
  • Smoking
  • High Cholesterol
  • Diet (Fat, Sugar intake)
  • Exercise
  • Atrial Fibrillation (Afib)
  • Cardiovascular Disease
  • Oral Hygiene
  • Diabetes

Uncontrollable 

  • Age
  • Gender
  • Race
  • Family History of Stroke

 

 

5

Strokes can be either ________ or _________

Ischemic or Hemorrhagic

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6

Describe ischemia. What is it? Where can it occur? What are teh four types of an ischemic stroke?

•…any restriction of blood flow to tissue that cause tissue necrosis or loss of function.
•Can happen in the brain or other parts of the body


•Thrombosis
•Embolism
•Thrombo-embolism
•Transient Ischemic Attack
 

7

What is thrombosis?  

•Clot forms along the blood vessel walls (plaque)
•Restricts blood flow to the brain
•Tissue beyond the Thrombosis does not receive sufficient blood supply to function.
•Brain Cells begin to die
•Deep Vein Thrombosis (DVT)

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8

What is an embolism?

•Clot forms outside of the brain, travels through blood stream and lodges in vessels in the brain
•One example is Atrial Fibrillation (Afib): Clot forms in the heart and travels to the brain

9

What is a thromboembolism?

•Part of a thrombosis breaks off and becomes an embolism
•It travels through the blood stream and becomes lodged in small or restricted vessels
•Deep Vein Thrombosis DVT -> Pulmonary Embolism

Clot in leg that traveleted for example.

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10

What is a transient ischemic attack?

•Can be caused by any type of ischemic event mentioned
•Symptoms are temporary and resolve within minutes or hours (up to 24hrs)
•Is a warning sign for imminent  and future CVAs

11

What is an infarct?

Site of lesion, tissue necrosis

Area of dead tissue resulting from lack of blood supply

12

What is a penumbra?

•Area of the brain that receives insufficient blood supply to function, but adequate supply to survive.
•Patients experience impaired  function associated with the penumbra
•If full blood supply is returned, patients will experience rapid improvement in function.

13

What is one type of medical treatment for an ischemic CVA? What does it break dow? How quickly must it be given? When did use increase? Can it be used for hemorrrhagic strokes?

tPA- (Tissue Plasminogen Activator)
•“Clot buster” Protein breaks down the clot and can restore blood flow 
•Must be given within 3 hrs of 1st symptoms
•Use increased significantly about 10 yrs ago
•CAN NOT be used for hemorrhagic strokes
 

14

What is a less conventional type of treatment for ischemic CVA? When is it used?

Clot Retrieval Systems

•Several options on the market
•Used if tPA isn’t an option or doesn’t work

15

What are some factors that influence the severity of a stroke?

•Size of the occluded artery
•Vascularity prior to stroke
•Time =Tissue
•tPA or Clot removal

16

Describe a hemorrhagic stroke. What else is it called?

•Ruptured blood vessel
•Allows blood to cross the BLOOD-BRAIN BARRIER
•Blood is toxic to brain tissue (to neurons)
•May also  be called Intracerebral Hemorrhage  (ICH)
 

17

Describe intracranial hemorrhages that are not a stroke

•Ruptured blood vessels outside of brain tissue (in meninges for example)
•Blood remains separate from the brain tissue
•Sometimes called Hematoma

18

Describe intracranial pressure (ICP). What is it? What is it caused by? What may be required in order to reduce ICP?

  • Too much increase in pressure is life threatening
  • Nerves don’t work under pressure
  • Caused by anything that increases volume in the cranium
    • Hemorrhage
    • Tumor
    • Hydrocephalus (too much cerebral spinal fluid)
    • Brain edema (swelling)
    • Infection (meningitis)
  • Craniotomy 
    • Evacuation

19

What is mass effect?

•Mass puts pressure on nerves -> nerves don’t work
•Causes structures to shift
•Can cause herniation which can be deadly

Pressure on bone can cause hemorrhage

20

Describe a hemorrhagic stroke. What else is it called? What happens? How quickly does it happen? What is the injury to the brain caused by? What are common symptoms? What may treatment require?

  • Ruptured Blood Vessel bleeds into brain tissue.
  • Often sudden Onset
  • Injury to the brain is caused by
    • Interruption of blood to portion of the brain
    • Disruption to Blood-Brain Barrier
    • Increased Intracranial Pressure (ICP)
    • Mass Effect
  • Symptoms
    • Headache- “The worst ever”
    • Lethargy
    • Nausea/Vomitting
    • Seizures
    • Other typical stroke symptoms

•Treatment: May require EVACUATION - surgical

21

What are some hemorrhagic stroke causes and risk factors?

•High Blood Pressure
•Blood Thinners
•Ruptured Aneurysm
•Brain Tumors

22

What is an aneurysm?

•Weakened blood vessel wall that  stretches
•Can be made worse by high blood pressure and atherosclerosis
• A ruptured  Aneurysm becomes an Intracranial Hemorrhage

23

What are some other intracranial hemorrhages? Where do they occur?

•SubArachnoid Hemorrhage (SAH) - more diffuse

  • Bleed between Pia Mater and Arachnoid.
    Blood in the Cerebrospinal fluid

•SubDural Hematoma (SDH) - keeps in place

  • Bleed between the dura mater and the arachnoid
    Older adults are more at risk

•Epidural Hematoma
 

24

What is a craniecotmy? What is removed? What does soft tissue of the scalp allow?

•Surgical procedure performed as a life-saving measure due life threatening intracranial pressure
•Bone from skull is removed and placed on ice or in patients abdomen.
•Soft tissue of the scalp allows brain to swell with less risk of death