Stroke

What is a MRI use for in a stroke?

Determine the extent of brain injury

What is CT scan used for in a stroke?

- Rapidly distinguish between ischemic and hemorrhagic stroke - Helps determine size, and location of stroke

What drug therapy prevention should be used for strokes?

1 Antiplatelet drugs- prevent further stroke in patients who have had TIA 2. Aspirin - most frequently used anti platelet agent 3. Ticlopidine (ticlid) 4. Copidrogel (plavix) 5. Statins

What are non-modifiable risk factors of a stroke?

1. Age >65years 2. Gender- more common in men (more women die from stroke) 3. Race- African American 4. Heredity/family history

What are the communication manifestations of a stroke?

1. Aphasia-total loss of comprehension & use of language- when stroke damages the dominant hemisphere of the brain 2. Left hemisphere is dominant for language skills in the right-handed persons and in most left-handed persons 3. Dysphasia- difficulty related to the comprehension or use of language and is due to partial disruption or loss 4. Dysarthria- disturbance in the muscular control of speech (does not affect the meaning of communication or the comprehension of language- it DOES affect the mechanisms of speech) 5. Impairments of pronunciation, articulation, & phonation

What heart conditions are associated with emboli stroke?

1. Atrial fibrillation 2. Myocardial infarction 3. infective endocarditis 4. rheumatic heart disease 5. valvular prostheses 6. atrial septal defects

What is an intracerebral hemorrhage stroke? Cause?

1. Bleeding within the brain caused by rupture of a vessel 2. Hypertension is most important cause 3. Hemorrhage commonly occurs during periods of activity

What are the intellectual function manifestations of a stroke?

1. Both memory and judgement may be impaired 2. Left-brain stroke is more likely to result in memory problems related to language

Diagnostic studies for strokes

1. CT scan 2. CTA- angiography 3. MRI 4. MRA- Angiography 5. Digital subtraction angiography (DSA) 6. Transcranial Doppler (TCD) 7. Lumbar puncture 8. LICOX brain tissue oxygenation catheter

Characteristics of an ischemic embolic stroke?

1. Commonly has rapid occurrence of severe clinical symptoms- warning signs less common than thrombotic 2. Onset usually sudden and may or may not be related to activity 3. Patient usually remains conscious, although he may have a headache

What prevention care should be included for strokes?

1. Control of hypertension 2. Control of diabetes mellitus 3. Treatment of underlying cardiac problem 4. No smoking 5. Limiting alcohol intake

What is the pyramidal pathway in strokes?

1. Destruction of motor neurons here- causes symptoms of impaired motor function 2. Contralateral- damage to one side of the brain effects motor function on the opposite side of the body

When happens during a stroke?

1. Functions are lost or impaired- such as movement, sensation or emotions that were controlled by the affected area of the brain 2. Severity of the loss of function varies according to the location and extent of the brain involved

What are thrombotic strokes associated with?

1. Hypertension 2. Diabetes mellitus

What are modifiable risk factors of stroke?

1. Hypertension**- single most important modifiable risk factor 2. Metabolic syndrome 3. Heart disease- (A.fib, MI, cardiomyopathy, cardiac valve abnormalities, cardiac congenital defects) 4. Heavy alcohol consumption 5. Poor diet 6. Drug abuse 7. Sleep apnea 8. Obesity 9. Physical inactivity 10. Smoking

When does thrombotic ischemic stroke occur?

1. Injury to a blood vessels wall and formation of a blood clot 2. Most common cause of stroke

What are the hemorrhagic strokes?

1. Intracerebral hemorrhage 2. Subarachnoid hemorrhage

What happens during a subarachnoid hemorrhage? cause?

1. Intracranial bleeding into cerebrospinal fluid-filled space between arachnoid and pia mater 2. Commonly caused by rupture or cerebral aneurysm

What are the different types of stroke?

1. Ischemic 2. Hemorrhagic

What are the surgical interventions of a stroke?

1. Ischemic stroke = MERCI 2. Hemorrhagic stroke = immediate evacuation of aneurysm- induced hematomas, & cerebellar hematomas >3cm - coil or clipping/wrapping of aneurysms

What are the motor function manifestations of a stroke?

1. Most obvious effect of stroke 2. Impaired mobility 3. Impaired respiratory function 4. impaired swallowing and speech 5. impaired gag reflex 6. impaired self-care abilities 7. an initial period of flaccidity- last from days to weeks, related to nerve damage 8. spasticity of the muscles follows the flaccid stage- related to interruptions in upper motor neuron influence

What are the clinical manifestations of a stroke?

1. Motor activity 2. Communication 3. Affect 4. Intellectual function 5. Spatial-perceptual alterations 6. Elmination

Manifestations of intracerebal hemorrhage stroke

1. Neurological deficits 2. Headache 3. Nausea and/or vomiting 4. Decreased levels of consciousness 5. Hypertension

How are patients screened prior to receiving tPA?

1. Noncontrast CT or MRI to rule out hemorrhagic stroke 2. Blood tests for coagulation disorders 3. Recent history of GI bleeding, stroke or head trauma within past 3 months or major surgery within 14 days

When does an embolic ischemic stroke occur? Results?

1. Occurs when an embolus lodges in and occludes a cerebral artery 2. Second most common cause of stroke 3. Results in infarction and edema of the area supplied by the involved vessel

What are the causes of strokes?

1. Sudden vascular compromise causing disruption of blood flow to the brain 2. Thrombosis 3. Trauma 4. Aneurysm 5. Embolism 6. Hemorrhage

What are the ischemic strokes?

1. Transient ischemic attack- precursor 2. Thrombotic stroke 3. Embolic stroke

When is aspirin used for strokes? What kind of strokes is it used for?

1. within 24-48 hours of a stroke 2. Platelet inhibitors and anticoagulants may be used in thrombus and embolus stroke patients after stabilization 3. Contraindicated for hemorrhagic stroke

What is hemorrhagic stroke?

A burst blood vessel may allow blood to seep into and damage brain tissues until clotting shuts off the leak

What is a stroke and when does it occur?

AKA brain attack - Occurs when ischemia or hemorrhage into the brain results in death of brain cells

What is a embolic stroke?

An embolus is a blood clot or other debris circulating in the blood. When it reaches an artery in the brain that is too narrow to pass through, it lodges there and blocks the flow blood

Where are majority of aneurysms?

Circle of Willis

What is a CT angiography used for in a stroke?

Provides visualization of cerebral blood vessels

Which is described as the "worst headache of one's life?"

Subarachnoid Hemorrhage Stroke

What is thrombotic stroke?

The process of clot formation (thrombosis) results in a narrowing of the lumen, which blocks the passage of the blood through the artery

What is the most common stroke?

Thrombotics - 80% of all strokes are ischemic

Why is recombinant tissue plasminogen activator used? When is it administered?

To reestablish blood flow through a blocked artery to prevent cell death in patients with acute onset of ischemic stroke symptoms **Must be administered within 3-4.5 hours of onset of clinical signs of ischemic stroke