Flashcards in Ischemic Stroke Deck (45)
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1
Stroke is
Injury to the brain caused by interruption of bloodflow or by bleeding into or around. Produces teh abrupt onset of focal neurologic defects that frequently result in permanent disability or death.
2
Transient Ischemic attack
abrupt onset of focal neurological deficits that resolve in less than an hour.
3
What percentage of strokes are hemorrhagic and describe a hemorrhagic stroke
about 20%... Hemorrhagic strokes may be caused by bleeding into the parenchyma of the brain or around the surface of the brain.
4
Bleeding into parenchyma of brain called
Intracerebral hemorrhage
5
Bleeding around the surface of the brain called
subarachnoid hemorrhage
6
Ischemic stroke may have what 4 potential underlying causes?
1) Atherosclerotic occlusion of an intra/extracerebral blood vessel
2) Embolus
3) Lacunar infarcts ( disease of the lumen of small arterioles
4) 30% are cryptogenic (unknown cause)
7
Stroke risk factors
- Age: doubles each decade
- Gender: male at one and a half times higher risk
- Race: african americans
- Family Hx
8
Modifiable stroke risk factors
- HTN
- Diabetes
- Hyperlipidemia
- Smoking
- Carotid Artery Stenosis
- Atrial Fib
- Obesity
- Physical inactivity
9
In the absence of blood supplying glucose to the brain, each 100gm of brain has sufficient energy stores to last how long?
two and a half minutes. The brain has very little energy storage. Thus, important to keep blood flowing to it.
10
Hyperthermia and hyperglycemia accelerate and worse stroke brain injury
ok
11
Under normal conditions, neurons metabolize glucose delivered by the blood almost exclusively through what type of metabolism
aerobic
12
Within minutes of the loss of blood supply, brain energy stores are depleted through the metabolism of glucose via glycolytic pathways with the accumulation of lactic acid.
Lactic acid is bad. High temps will accelerate glycolytic lactic acid production as will high blood glucose levels. Body temperature and blood glucose should be brought down asap.
13
Ischemic core
The central area downstream of an embolus most affected by loss of bloodflow, fewer collaterals providing circulation.
14
Ischemic Prenumbra
Peripheral areas with less severe ischemia.
15
Ischemic core suffers irreversible injury how fast?
Within 1 hour or less
16
Ischemic prenumbra may survive for how long?
Hours
17
Therapeutic window for stroke intervention is generally recognized as being
4-6 hours
18
slide 15
KNOW IT
19
CBF (Cerebral blood flow) in norma individuals?
around 55ml/100gm brain/ minute
20
Neurologic signs and symptoms produced by stroke include
- weakness or paralysis
- loss of sensation
- loss of vision in one eye
- difficulty talking or understanding what is being said
- difficulty with organization or perception
- clumsiness
21
Anterior circulation stroke involves occlusion of:
Internal Carotid Artery
ANterior Cerebral
Middle Cerebral
22
Posterior Circulation stroke involves occlusion of:
Posterior Cerebral
Vertebral artery
Superior Cerebellar Artery
Anterior Inferior Cerebellar Artery
23
Besides vessel location, what is the other way to classify ischemic stroke?
Vessel sze
24
Middle Cerebral Artery
KNOW
25
Small penetrating branches of the MCA called
Lenticulostriate arteries
26
Know slide 21...anterior and middle cerebral and what parts of the brain they provide vasculature to
ok
27
What are the three clinical brainstem stroke syndromes?
- Lateral Medullary Syndrome
- Pontine syndrome
- Midbrain syndrome
28
Medullary Stroke Syndrome features
- Loss of pain and temperature from the ipsilateral side of the face due to lesion of the trigeminal nucleus and tract
- Dysarthria and Dysphagia due to lesion of nucleus ambigus
- Loss of pain and temperature on the contralateral side of the body due to lesion of spinothalamic tract
- Gait ataxia on the ipsilateral side of the body due to lesion of the spinocerebellar tract
29
Medullary stroke syndrome due to
occlusion of the PICA or vertebral artery?
30
