Exam 2: Stroke - Dr. Shappy Flashcards Preview

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Flashcards in Exam 2: Stroke - Dr. Shappy Deck (76)
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1

What are two types of strokes?

which is most common and by how much?

 

  1. Thromboembolic strokes: 80% of strokes (most common)

  2. Hemorrhagic (pts call it an aneurism): 20% of strokes

2

what kinds of deficits do strokes cause?

(name two that we shouldn't forget about)

 

All kinds of stuff (she had us come up with several, but I couldn’t write fast enough)

Don’t forget autonomic functions

Proprioception

3

how severe are strokes?

 

Severity can range from minute losses to zero function

4

What is a TIA

 

(Transient Ischemic Attack)

Symptoms Last less than 24 hours

  • pt may not even know it happened
  • pt may never seek medical attention for these symptoms

5

What is the difference between hemiplegia vs hemiparesis?

 

Hemiplegia vs Hemiparesis

Hemiparesis is weakness of the entire left or right side of the body.

Hemiplegia is its most severe form, complete paralysis of half of the body.

(http://en.wikipedia.org/wiki/Hemiparesis)

Dr. Shappy's lecture:

  •  Plegia = complete loss
  •  paresis = half loss

6

what is significant about the 3-week mark after a stroke?

 

Return of Function in the First three weeks gives us a pretty good prediction of recovery

(anything)

  • sensory
  • motor
  • autonomic

7

Where do strokes fall in leading causes of death in the USA? (are they common or not?)

what is a demographic who is at greater risk?

 

Strokes are Third leading cause of death in the United States (not a test number)

  • strokes are in abundance
  • millions of people who have had a stroke at some level
  • minorities are at greater risks (2x higher)
    • probably because of preventative care

8

what are some risk factors for stroke?

(three main ideas)

 

Risks (similar to Heart Disease)

  • minorities
  • age 65 or older

9

Mortalitiy numbers:

What percentage of people with a stroke will die within a year?

what percene will die in 8 years?

(these should not be on the exam)

Mortality

  • About 25% of those with a stroke will die within a year
  • About 50% will die in 8 years

10

what are IADLs?

 

(It stands for Instrumental Activities of Daily Living)

More advanced ADLs

Example: writing checks or grocery shopping (more than just basic self-care in the home. They require more complex reasoning)

11

how many pts with strokes oare found in Inpatient Rehab Units (IRUs)?

 

Stroke pts are the largest percent of people admitted into IRUs

12

What is the actronym taught for stroke detection to the general public?

What does it mean?

 

 

FAST acronym

  1. face
    1. look for drooping on one side
  2. arms
    • look for one lagging when held out
  3. speech
    • slurred
  4. time
    • can use clot-buster if caught in time (I think 1 hour window)

13

what is done for aneurisms (hemmorhagic strokes)?

 

What do they do with aneurysms?

  • surgery - clip it
    • metal clips that stay in there

14

what percentage of stroke pts will end up in a nursing home in the first year?

 

25% stroke pts will end up in nursing home

  • if you have a stroke and you are older, not as many people want to take you home, or they may not be able to take you home
  • number is probably a lot higher after a year

15

what is the etiology of stroke? (6-ish)

 

Similar to Cardiac

  1. Atherosclerotic narrowing of arteries
  2. Ischemic issues, clot growing or staying stationary
  3. Thromboembolic formation
  4. breaking free and flowing downstream
  5. blocking anything distal to where clot is
  6. Ischemia etc.

16

What are some different areas of stroke? (4)

 

Different areas of stroke

  1. Anterior Cerebral Artery
  2. Posterior Cerebral Artery
  3. Middle Cerebral Artery
  4. Homunculus

17

What is a lacunar stroke?

 

Dr. Shappy said: "A stroke caused by clots in the more distal vessels"

So I think she meant the penetrating arteries, but also closer to the surface

Wikipedia says:

Lacunar stroke or lacunar infarct (LACI) is a type of stroke that results from occlusion of one of the penetrating arteries that provides blood to the brain's deep structures. Patients who present with symptoms of a lacunar stroke, but who have not yet had diagnostic imaging performed, may be described as suffering from lacunar stroke syndrome (LACS).

http://en.wikipedia.org/wiki/Lacunar_stroke

18

If a stroke is called an "ischemic stroke" what does that mean?

A trhomboembolic stroke is referred to as an ischemic stroke

A hemorrhatic stroke ist not called an ischemic stroke (even though it is technically ischemic too)

19

Hemorrhagic stroke: large or small?

 

could be either

blood can clot and brain can heal, resulting in a small attack

  • cell injury (not death)
  • cell death - no regeneration

20

Hemorrhagic stroke: typical attributes of pt (risk factors) (3)

 

  1. pts tend to be younger
  2. HTN
  3. anatomical malformations
    • arteriovenous malformations
      • can cause lack of blood flow??

 

21

what is a uniqe problem of hemorrhatic strokes?

 

Blood getting into the brain can also cause its own problems

22

Risk factors for stroke (10)

 

Risk Factors (about the same as cardiac disease)

  1. 75%? of those who have stroke have HTN
  2. CHF
  3. PAD
  4. CAD
  5. Diabetes
  6. Hyperlipidemia
  7. Valve disorders in the heart
  8. Coronary artery bypass surgery
    • during surgery and after
    • after because if vessels in the heart have atherosclerosis, then vessels in other places have it too.
  9. A-fib (5x more likely to have stroke)
    • because blood coagulates in the atria
    • Aorta is the first one out
      • first sets of arteries go to heart and brain 
  10. Endocarditis
  •  

23

Is a stroke preventable?

yes the same old lifestyle stuff

24

What is a TIA a warning sign for?

 

TIA is warning sign for impending stroke (not as good as angina in the heart)

  • 10% of people with TIAs will have a full stroke within 90 days?
  • 5% will have strokes within 2 days

In heart we get angina that warns us about impending MI

25

What are early warning signs of stroke? (10)

 

Early warning signs

  1. FAST, etc.
    • doesn’t have to have all FAST symptoms
    • FAST is more for middle cerebral artery stroke
  2. numbness
  3. weakness
  4. facial droop
  5. trouble speaking
  6. gait/balance disturbances
  7. sudden severe headache (hemorrhagic)
  8. nausea/vomiting
  9. anxiety
  10. Faint/syncope/coma

26

Ischemic Cascade happens in what time frame?

3-4 hours

27

Eschemic Cascade process (5)

 

 

  1. •Excess neurotransmitter substances
  2. •Limits energy production
  3. •Influx of calcium ions with neuronal membrane pump failure
  4. •Free radical formation
  5. •Inflammatory factors
     

28

what happens after ischemic cascade?

 

Cerebral Edema

29

Describe what happens during Cerebral Edema/ Due to Cerebral edema: (5)

  1. •Fluid accumulation
  2. •Inflammatory mediators and blood factors
  3. •Increased ICP
  4. •Brainstem herniation
  5. •Cell death
     

30

how long does it take to reach maximum cerebral edema?

Max accumulation in 3-4 days