stroke pt 1 Flashcards by Catherine McDowell

how long does it take for brain cells to die?

3-5 minutes

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what are the 2 kinds of strokes? which is more common?

1 - ischemic* more common
2 - hemorrhagic

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ischemic stroke

sudden interruption of blood flow to the brain

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hemorrhagic stroke

bursting of blood vessels

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which type of stroke is more severe?

hemorrhagic

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stroke is the ___th leading cause of dead

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what region of the US are strokes the most prevalent in?

southeastern

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there is 1 stroke every _____ seconds in the US

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atherosclerosis def

condition in which fatty desposits called plaque build up on the inner walls of the arteries and cause narrowing of blood vessels

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what are 3 common sites for atherosclerosis?

common carotid, MCA, vestibular/basilar arteries

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thrombus

a blood clot attached to the interior wall of an artery or vein

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embolis

a blood clot formed somewhere else in the body and travels to cerebral circulation

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What type of hemorrhage?
rupture of cerebral vessel with subsequent bleeding into the brain

intracerebral

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what type of hemorrhage?
nontraumatic spontaneous hemorrhage small blood vessels weakened by antherosclerosis leading to an aneurysm

cerebral h

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what type of hemorrhage?
bleeding into subarachnoid space typically from saccular or berry aneurysm affecting large blood vessels. can be due to mechanical damage or congenital defects

subarachnoid

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what type of hemorrhage?
congenital defect characterized by tange of arteries and veins with agenesis of an interposing capillar system

arteriovenous malformation (AVM)

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name some major risk factors for stroke

hypertension, heart disease, disorders of heart rhythm, diabetes m,

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what are some modifiable stroke risk factors

smoking, physical activity, obesity, diet

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what are some non-modifiable stroke risk factors

family history, age, gender, race

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T or F: stroke is the leading cause of long term disability

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FAST (stroke)

face drooping
arm weakness
speech difficulty
time to call 911

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what three areas are involved in a stroke

infarct core
penumbra
benign oligemia

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salvageable area after a stroke

penumbra (lots of edema though)

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non-salvageable area after stroke

infarct core

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is cerebral circulation mostly aerobic or anaerobic?

aerobic

what happens to cerebral circulation when ischemia develops

it switches to anaerobic metabolism which causes a lot of glutamate to be released. glutamate attracts calcium which leads to free radicals. free radicals cause edema, increased pressure and more neuronal death

what are some clinical signs of elevated intracranial pressure

- decreased consciousness - widened pulse pressure - increased HR - cheyne-stokes respiration - vomiting - unreactive pupils - papilledema

transient ischemic attack (TIA)

temporary interruption of blood supply to the brain *this is a warning sign that something is going on

what are TIAs not considered stroke?

symptoms last less than 24 hours and there is no residual brain injury

severity of stroke depends on what 4 things related to vascular supply

1 - location 2 - size 3 - nature and function of structures involved 4 - collateral blood flow

what 2 major arteries make up the circle of willis

carotid and vertebral/basilar

this artery supplies the frontal lobe, parietal lobe, and subcortical structures

anterior cerebral artery

clinical signs of ACA stroke

- contralateral hemiparesis and sensory loss - apraxia - akinetic mutism - urinary incontinece

is the LE or UE more affected with ACA stroke?

this artery supplies the frontal, temporal, and parietal lobes, and subcortical structures

MCA

clinical signs of MCA stroke

- contralateral spastic hemiparesis and sensory loss - aphasia - spatial and perceptual deficits - contralateral homonymous hemianopsia

is the UE or LE more affected with MCA stroke?

contralateral hemianopsia

temporal field is absent on one side and nasal is absent on the other *perception is in tact but vision is gone

the MCA and ACA are supplied by?

internal carotid artery *so if you have this kind of stroke symptoms are a mix of ACA and MCA

uncal herniation

rising ICP causes portions of the brain to move from one intracranial compartment to another

this artery supplies the occipital obe, medial and inferior temporal lobe, upper brainstem, midbrain, and thalamus

PCA

prosopagnosia

inability to recognize faces

agnosia

the inability to recognize familiar objects

thalamic pain syndrome is caused by what kind of stroke

PCA

this artery supplies the cerebellum and medulla

vertebral

this artery supplies the pons, internal ear, and cerebellum

basilar

locked in syndrome

individual is aware and capable of thinking but is paralyzed and cannot communicate *can only move eyes vertically

locked in syndrome is a result of what kind of stroke

basilar artery

what are 3 key features of a brainstem stroke

sudden vertigo, ataxia, and diplopia

phases of stroke (5)

0-24hrs = hyperacute 1-7day = acute 7day-3mth = early subacute 3-6mth = late subacute >6mth = chronic

when is the max potential for recovery after stroke

0-3mth

what are 3 things the glasgow coma scale assess?

1 - eye opening 2 - verbal response 3 - motor response

scoring for glasgow coma scale

out of 15: <8 = severe 9-12 = moderate 13-15 = minor

eye opening response scale (GCS)

4 - spontaneously 3 - to speech 2 - to pain 1 - no response

verbal response scale (GCS)

5 - oriented x3 4 - confused 3 - inappropriate words 2 - incomprehensible sounds 1 - none

motor response scale (GCS)

6 - obeys commands 5 - moves to localized pattern 4 - withdraws from pain 3 - abnormal flexion 2 - abnormal extension 1 - none

wernicke's area

inability to comprehend speech

broca's aphasia

inability to produce speech

dysarthria is due to lesions where?

primary motor cortex, primary sensory cortex, or cerebellum

dysphagia is most common in what kind of stroke

brainstem

what does the mini-mental status exam assess?

cognitive function

scoring of MMSE

21-24 = mild cog impairement 16-20 = mod cog impair <15 = severe cog impair

altered emotional status comes from a lesion in what 3 areas

frontal lobe, hypothalamus, limbic system

pseudobulbar affect

emotional outbursts of uncontrolled or exaggerated laughing or crying that are inconsistent with mood

patients with agnosias often have a lesion where

right parietal cortex

T or F: persistent incontinence is a poor prognosis for functional recovery

you patient has been immobilized for multiple days due to a stroke and now complains of pain and tightness in his calf. what could this be

a DVT

your patient has been immobilized for multiple days due to a stroke and is now complaining of chest pain, is tachycardic and has a persistent cough. What could it be?

pulmonary embolism