Flashcards in Stroke I Deck (58)
What is the definition of stroke?
Sudden change in neurological function d/t a disruption of blood flow to a region of brain tissue resulting in cell death
What is the definition of a TIA?
Stroke process without cell death
True or false: Time is not an element of the definition of a TIA or stroke
What percent of strokes are hemorrhagic? Ischemic?
15% = hemorrhagic
85% = ischemic
True or false: a lot of medicine is consensus based
What percent of strokes are SAH? ICH?
ICH = 10%
What is the most common cause of ischemic strokes?
Idiopathic / cryptogenic
What percent of strokes are 2/2 a.fib?
What are the three components of Virchow's triad?
3. Endothelial damage
Are lacunar strokes 2/2 small or large vessels?
What is moyamoya disease?
Gradual occlusion of the internal carotid artery, causing formation of collateral vessels, that looks like a puff of smoke. Usually results in multiple CVAs or TIAs
What is the association between migraines and strokes?
May be related to migraines with auras
What are lacunar strokes?
Subcortical strokes from deep penetrating blood vessels in the brain
What are the lenticulostriate arteries?
Branches from the middle cerebral artery that feed the caudate, internal capsule, thalamus, and lentiform nucleus
What comprises the lentiform nucleus?
Putamen and the globus pallidus
The vertebral arteries come together to form what vessel?
What are the three vessels that feed the thalamus?
What are the types of lacunar strokes? (5)
-Clumsy hand dysarthria
True or false: ataxia is independent of weakness
True--weakness = dyssynergia
Most of the time, strokes are not stereotypical. What does this mean?
Strokes do recur with the same s/sx
When do stuttering strokes occur?
When the same vessel is occluded
What is lipohyalinosis?
Small vessel disease of the brain d/t endothelial dysfunction and necrosis of the vessels, and eventual occlusion
What are the three risk factors for lipohyalinosis?
What is the biggest risk factor for developing a stroke?
Where in the brain do most hemorrhagic strokes occur?
What is Dejerine-Roussy syndrome?
(aka thalamic pain syndrome)--Where a stroke to the thalamus causes a allodynia or dysesthesias
What is the general s/sx of a stroke?
*Sudden* change in neurological function
Why is LOC not common with strokes?
Have to either hit both cortices, or posterior pons
Is memory loss a typical stroke symptom?
What are the components of the anterior circulation? What are the functions that lesions to this interrupt?
Carotid and its branches
Motor, cognition, speech, language, vision
What are the components of the posterior circulation? What are the functions that lesions to this interrupt?
Vertebrobasilar and its branches
Motor, sensory, speech, vision, *cranial nerves*
What is intraparenchymal hemorrhage?
Deep hemorrhages in the BG, internal capsule, pons, thalamus, and deep cerebellum
How do you diagnose intraparenchymal hemorrhage? Why?
CT--very sensitive for blood
What is the sensitivity of CT in detecting subarachnoid hemorrhages?
What are the features of subarachnoid hemorrhage?
-Sudden, severe HA
-LOC, focal neuro s/sx
-Meningeal sign variable
What is a sentinel hemorrhage?
Little bleeds before the big bleed, that causes s/sx that precede SAH
How do you dx SAH? (2)
-Head CT within the first 12 hours
What is the sensitivity of CSF xanthochromia with SAH in the first 12 hours?
What is the sensitivity of head CTs with SAH in the first 12 hours?
What is the sensitivity of angiograms for aneurysms in diagnosing SAH?
What type of blood is found with xanthochromia (old or new)?
What percent of SAH pts have more than one aneurysm?
What percent of patients with a negative angiogram will have one on repeat testing?
What is the treatment for a SAH?
Why is Nimodipine given post SAH?
Prevent vasospasm, which can cause ischemic strokes
What are the complications that can result from SAH? (6)
What is the leading cause of death or neurological morbidity within the first two weeks post SAH? Treatment?
-Bed rest + antifibrinolytics
What is a paradoxical embolus?
Embolus that goes through a PFO and into the brain vasculature
Are most strokes venous or arterial in origin?
What is the artery that is given off of the Vertebral arteries, just before they converge to form the basilar?
What are the arteries that come off of the basilar (5, from posterior to anterior)?
What are Charcot-Bouchard aneurysms?
Aneurysms of the brain vasculature which occur in small blood vessels. They are most often located in the lenticulostriate vessels of the basal ganglia and are associated with chronic hypertension
How do you monitor for vasospasms?
Transcranial doppler will look for vasospasms
What days post stroke carry the greatest risk for vasospasms?
What is the medication that can help prevent vasospasms?
What are the components of the triple H therapy for SAHs?
What is the cause of hyponatremia post SAH?
Cerebral salt wasting--idiopathic