Week 7 Stroke

Question 1

what are two ways we can get a stroke (CVA)

Answer 1

hemorrhage, or a broken vessel or a blockage and then a burst.

Question 2

how often do people have strokes, and how often does someone die of a stroke

Answer 2

40 seconds, dies every 4 minutes

Question 3

how many people have new and recurrent strokes every year

Answer 3

first: 610,000
recurrent: 185,000

Question 4

how has more strokes at younger ages

Answer 4

men

Question 5

in total, do men or women have more strokes per year

Answer 5

women

Question 6

T/F: almost 2x risk of first stroke every in africans vs whites.

Answer 6

true

Question 7

stroke is the ___ or ____ leading cause of death, according to different sources

Answer 7

5th or 3rd

Question 8

every ___ minutes, some one dies from a stroke

Answer 8

3-4 minutes

Question 9

what is the estimated indirect or direct cost of stroke

Answer 9

36.5 billion

Question 10

what is he stroke belt

Answer 10

down like in the Bible Belt

Question 11

25% of people age ___ and younger have a stroke

Answer 11

55y/o

Question 12

only ___% of people under 40 have a stroke

Answer 12

5%

Question 13

are the rate of hospitalization, rate of strokes in younger people and rates of stroke in white and blacks increasing

Answer 13

yes to all, all of these rates are increasing

Question 14

why do we care that the age of stroke is getting younger

Answer 14

people are living longer with disability.

Question 15

what is the leading risk factor for stroke

Answer 15

HTN is the leading

Question 16

what are other risk factors for stroke

Answer 16

DM, heart rhythm things (A-fib increases risk stroke 5 fold, and is undetected), high cholesterol, smoking, tobacco use, physical inactivity, nutrition, family history and genetics, and chronic kidney disease.

Question 17

are the risk factors modifiable or non modifiable. Why does this help us

Answer 17

they are modifiable, so we can do something to try and prevent stroke, or decrease the risk of a recurring stroke.

Question 18

what are the signs and symptoms of stroke

Answer 18

• sudden numbness and weakness (faces, arm and leg)
• sudden confusion or difficulty speaking or understanding others
• sudden difficulty with vision
• sudden dizzy, difficulty walking, loss balance and coordination
• sudden severe HA (worst ever)

Question 19

what does FAST mean, and what do we use it for

Answer 19

to spot a stroke 
face dropping 
arm weakness 
speech difficulty
time to call

Question 20

can we educate patients using the FAST method

Answer 20

yes, educate them, and inform them that if they get these S and S to call 911 immediately

Question 21

what is a stroke

Answer 21

damage to the brain from ischemic or hemorrhagic loss

Question 22

what is the primary pathology of a stroke

Answer 22

reduced arterial blood flow, cell death due to ischemia

Question 23

what is the secondary pathology of a stroke

Answer 23

cell death, edema, increased ICP, more cell death

edema can lead to herniation

Question 24

if symptoms last more than 24 hours what is it considered. less then 24 hours

Answer 24

more: CVA (Cerebrovascular accident)
less: TIA (transient ischemic attack)

Question 25

how much of the normal CO goes to the brain

Answer 25

17-20%

Question 26

what happens to blood flow in the brain with changes in the BP

Answer 26

increase BP, stretch the arterial wall, then it contracts, decreases flow and decreases BP in the brain

Question 27

what is normal cerebral blood flow

Answer 27

autoregulation, do chemical regulation, O2 vs CO2, pH, viscosity and ICP, and changes in BP

Question 28

if you increase ICP, what happens to blood flow

Answer 28

you decrease blood flow

Question 29

if autoregulation is disrupted, what are some S and S

Answer 29

dizziness and other signs

Question 30

what do we respond to more, changes in O2 or CO2

Answer 30

CO2

Question 31

what two things fall under the ischemic stroke category. what percent of strokes are these ischemic ones

Answer 31

87% | cerebral thrombus and cerebral embolus

Question 32

hemorrhage accounts for 13% of strokes. There are two types of these, what are they

Answer 32

``` inter cranial (10%) subarachnoid (3%) ```

Question 33

a clot (Cerebral thrombus) leads to occlusion which leads to...

Answer 33

hypoxia, ischemia, infarction and tissue death

Question 34

what is a transient ischemic attack (TIA)

Answer 34

deficit lasting less than 24 hours

Question 35

what % of strokes are preceded by TIA

Answer 35

15%

Question 36

what is the medial management of the cerebral thrombus

Answer 36

increased circulation, HOB down, normalize BP and thrombolytics

Question 37

what do thrombolytics do

Answer 37

destroy the clot, while having a TIA

Question 38

what must you manage with a cerebral thrombus

Answer 38

cerebral edema

Question 39

what are common sites for plaque build up and a thrombus

Answer 39

at bifurcations, like the carotid, brachiocephalic trunk, internal cerebral arteries and vertebral arteries

Question 40

what is a cerebral embolus

Answer 40

a traveling blockage, like thrombus, fat, air or bacteria that will cork the vessel

Question 41

what is the medical management of the cerebral embolus

Answer 41

anticoagulants and DVT prophylaxis

Question 42

why does A-fib put you at a higher risk for embolus

Answer 42

the atria doesn't empty as well, and the blood with pool and thicken in the atria, then it clots, and travels

Question 43

what are the 2 types of hemorrhage

Answer 43

intracerebral and subarachnoid

Question 44

what are the potential causes of a hemorrhage

Answer 44

aneurism, arteriovenous malformation (AVM) and HTN

Question 45

what is arteriovenous malformation (AVM)

Answer 45

capillary beds are leaky

Question 46

what is hemorrhagic conversion

Answer 46

a complication of acute stroke. you have the tPA administered. the clotted vessels die, which weaken the surrounding vessels and then they break and leak, so you get a second hemorrhage

Question 47

what are the two types of hemorrhagic conversion

Answer 47

hemorrhagic infarction and parenchyma hematoma

Question 48

what are the predictors of hemorrhagic conversion

Answer 48

large infarct A-fib and cerebral embolism hyperglycemia thrombolysis

Question 49

what are the causes of cerebral edema dan increased ICP

Answer 49

bleeding in to the brain or fluid around the brain | swelling in the brain (by ischemia)

Question 50

what are the signs and symptoms of cerebral edema and increased ICP

Answer 50

behavior changes, decrease consciousness, HA, lethargy, decline in neuro status, vomiting, seizures.

Question 51

what are the treatments for cerebral edema and increased ICP

Answer 51

osmotherapy, corticosteroids, and surgical decompression

Question 52

what are the determinants for CVA severity

Answer 52

location of lesion, size or extent, early acute management, amount of collateral blood flow, and amount of brain swelling.