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Clinical Conditions II > Lecture 4: Stroke > Flashcards

Lecture 4: Stroke Flashcards

(56 cards)

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1
Q

Stroke

A

Nontraumatic brain injury caused by occlusion or rupture of cerebral blood vessels that result in sudden neurologic deficit.

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2
Q

Transient Ischemic Attack

A
  • Reversible neurologic deficit within a few, up to 24, hours
  • Brain injury likely if beyond 1 hour
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3
Q

Most strokes are

A
  • Ischemic
    • thrombotic (60%)
    • Embolic (20%)
    • Vasculitic, hypercoaguable
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4
Q

Hemorrhagic strokes

A
  • Intracerebral (10%)
  • Subarachnoid (5%)
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5
Q

Pathophysiology Ischemia

Thrombosis (at the site)

A
  • Plaque
  • Fatty streaks at an early age
  • Lipid core
  • Vessel narrowing
  • Small/large vessel
  • could become embolic
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6
Q

Pathophysiology Embolic

(clot travels)

A
  • A-fib, cardiomyopathy, valve disease, patent foramen ovale
  • Calcified plaque
  • Infectious endocarditis
  • Rheumatic Heart disease
  • Breaak off part of thrombus
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7
Q

Pathophysiology Hypercoaguable

A
  • Sickle cell anemia
  • Polycythemia vera
  • Protein C & S defecient
  • Factor V
  • Antithrombin III defecieny
  • Antiphospholipid syndrome
  • Hyperhomo.
  • Essential throbocytosis
  • Prothombin gene mutuation
  • Lupus
  • Anticardiolipid antibodies
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8
Q

Thrombotic stroke clinical presentation

Ischemic

A
  • Slower
  • Stuttering
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9
Q

Embolic stroke clinical presenation

Ischemic

A
  • Sudden onset
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10
Q

Hemmorhagic stroke presenation

A
  • Severe headache
    • Worst headache of my life
  • Sudden
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11
Q

Risk factors for stroke

Nonmodifiable

A
  • Age
    • risk doubles every decade after 55
  • Sex: female/older age
  • Race
  • Previous stroke
  • Family history
  • Coronary artery disease: modifiable?
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12
Q

Risk factors for stroke

modifiable

A
  • HTN
  • Hyperlipids
  • A fib
  • Diabetes
  • Smoking
  • Oral contraceptives
  • physical inactivity
  • Diet
  • Sleep apnea
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13
Q

Allow permissive ___ first few days after stroke

A

HTN

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14
Q

Exercise, diet and logevity

A
  • Protecting your tolemeres (caps on your DNA)
  • Plant based diet
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15
Q

Primary treatment of CVA

A
  • Reverse or limit impact
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16
Q

Secondary treatment of CVA

A
  • Prevent the recurrence
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17
Q

BEFAST

A
  • Balance
  • Eyes
  • Face
  • Arm
  • Speech
  • Time
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18
Q

First thing you do to diagnose a stroke

A

CT Scan

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19
Q

Primary treatment of stroke

A
  • Alteplase (TPA)
    • Symptoms less than 4.5 hours
    • No hemmorrhage
    • SBP less than 185; DBP less than 110
    • No recent surgery, MI, bleeding
    • No minor or improving defecits
    • Given IV
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20
Q

Things that may be given with alteplase

A
  • Throbectomy
  • Large vessel occlusion
  • At times up to 24 hours
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21
Q

Asprin and primary stroke treatment

A

IF NOT GIVEN ASPRIN → HIGH RISK OF EXTENSION OF ISCHEMIC STROKES IN THE FIRST WEEK

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22
Q

Secondary prevention of stroke

A
  • asprin
    • not reccommended if no previous CVA/TIA
  • Clopidrogel (plavix)
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23
Q

Carotid Endartarectomy

Study These Flashcards
A
  • Indicated for 70-99% stenosis in men
  • Not indicated for less than 50% stenosis
  • Risk is perioperative stroke
24
Q

Stroke outcomes

Study These Flashcards
A
  • Mortality
    • 20% overall
    • Higher in hemorrhagic
  • Strength: 3 months
  • Language/Cognition: 6 months
  • Function: early or late
  • Cortical involvement: worse outcome
25
4 pillars of care
1. quality 2. safety 3. efficiency (cost) 4. satisfaction (relationships)
26
How to improve care DMAIC
1. Define 2. Measure 3. Assess 4. Improve 5. Control
27
Post stroke care
* Prevent deconditioning * Splinting/positioning * Spastic reduction * Swallow assessemnt * Monitor clinical stauts * Functional training * Braching
28
Antidepressants & SSRI in post stroke care
* Improves motor recovery * Given in first 3 months
29
Left MCA
30
Right MCA
31
Posterior cerebral arteries 4 D's
1. Diplopia 2. Dizziness 3. Dysphagia 4. Dysarthria
32
#1 goal of patients after a stroke
* Gait * Need balance * Need hip flexion * Braces can help; they are not a “crutch”
33
acute impatient
* Intensive: 3hrs/day, 5-6x/weel * short stay
34
subacute impatient
* longer term, less intense caare
35
TBI
Definition: physical injury to brain tissue that temporarily or permanently impairs brain function
36
TBI population
* more common in men * peak incidence teens and elderly * most common causes * falls: under 17 or over 55 * MVA: 18-55 * Sports * Violence
37
most common cause of TBI
falls of ppl \> 75
38
fall prevention
* address polypharmacy, balance impairments, orthostatic hypotension, minimze sedating meds
39
Glascow Coma scale
Mild: \> 12 Moderate: 9-12 Severe: 8 or less
40
Diffuse axonal injury
* Leading cause of morbidity → primary injury stroke (cognitive, behavioral, and arousal defecits in TBI) * Occurs during acceleration and deceleration events
41
Imaging and TBI CT vs MRI
CT: acute blood and bone injury MRI: diffuse axonal injury
42
Epidural hematona
* Buildup of blood occurring between the dura mater (the brain's tough outer membrane) and the skull * Results from a blow to the side of the head leading to a fracture of the temporal bone tearing the middle meningeal artery (high pressure → bleed quickly)
43
Subdural hematoma
Build-up of blood between the dura and the arachnoid (the middle layer of the meninges) * Caused by head injury where velocity changes within the skull may stretch and tear small bridging veins (low pressure → slow bleeds) * Common in the elderly and alcoholic due to cerebral atrophy * “Crescent shaped” * Shaken Baby Syndrome
44
Subarachnoid Hemorrhage
* Bleeding into the subarachnoid space-the area between the arachnoid membrane and the pia mater. * Cause by traumatic and nontraumatic brain injury (ruptured aneurysm) * Thunderclap headache-“Worst headache in my life.”
45
Epidural hematoma pic
46
Subdural hematona pic
47
Subarcahnoid hemmorhahe pic
48
hemorrhagic contusions
49
AVM
Congenital disorder of the connections between veins and arteries in the vascular system * “Tangle of Spaghetti” on arteriogram * Can bleed with devastating-stroke-like effects
50
Sugical management of AVM
* Craniotomy * Epidural Hematoma * Subdural Hematoma * Burr hole drainage * ICP monitoring * Ventricular drain
51
Medical management of AVM
* Close observation * Prevent hyperthermia which has poorer outcome * Elevated ICP * Hyperventilation * Osmotic diuretics: mannitol * Elevate head * Cerebral perfusion pressure goal: 70-100 mm Hg * ICP goal: 5-15 mm Hg * SBP goal 100-180 mm Hg * Ventricular drain * Sedation to prevent ICP spikes
52
Complications of TBI
* DVT/PE * Pneumonia * Skin breakdown * Pain * Bowel/Bladder dysfunction * Spasticity * Contractures * Deconditioning
53
TBI sequlae
* Neurologic findings * Cognition * Executive function
54
Spasticity Management
* Cold * Prevent noxious stimuli * Manual techniques * Splinting/ serial casting * Botulinum Toxin and Phenol Injections * Baclofen Pump * Medications * Baclofen, Zanaflex, dantrium, clonidine, valium
55
Botulinum Toxin
* Different types * Best for focal spasticity * Indications * Medication failure * Improve function * Improve hygiene * Prevent Pain
56
Baclofen Pump
* Indications * Lower extremity spasticity * Improve function, hygiene * Lessen pain * Procedure * Test dose * Surgical implantation * Refill every 3 months

Clinical Conditions II (5 decks)

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