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All main topics / Stroke Management / Stroke

Stroke (21 Cards)

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1
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stroke  =
abrupt onset of focal or global neurological impairment...

of 24+ hours...

caused by ischemia or hemorrhage
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stroke is the #      leading cause of death in US
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stroke is the #      cause of long term disability
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incidence of stroke
1:1000
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    %  of strokes are                    type.
    %  of strokes are                    type.
80% ischemic

20% hemorrhagic
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4 possible outcomes of brain ischemia
no effect                                  (anastomoses compensate)


transient physiological disturbance    (TIA)


selective neuronal necrosis             (incomplete infarct)
       just affects neurons; glia are intact

pan-necrosis of neurons & glia            (complete infarct)
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histopathologic identification of stroke
red neuron is a dead neuron

24h:    neutrophils
48h:    macrophages
wks:    debris removed  =>  space
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mass effect of stroke over time

peak within 2 days, remains for 1 week
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2 types of ischemic stroke
global
   due to cardiac arrest, systemic hypotension, increased ICP
   widespread, multifocal ischemic necrosis
   especially pronounced in border zones / watershed areas
   symmetric


focal
   emboli
   occlusion of blood vessel
   infarction
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lacunar infarction
occlusion of lenticulostriate / penetrating artery...

...due to small vessel arteriosclerosis
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usual causes of brain hemorrhage
hypertensive small vessel disease

cerebral amyloid angiopathy

ruptured vascular malformation

drugs     (cocaine, amphthemine)

neoplasm

ruptured Berry aneurysm

bleeding diathesis

trauma
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consequence of hypertensive small vessel disease
rupture of arteriosclerotic small penetrating artery

parenchymal brain hemorrhage
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berry aneurysm
arise at forks of arteries in CoW

85% in anterior circulation
15% in posterior circulation

5% prevalence

most do not rupture
    annual risk of <1%
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complications of aneurysmal subarachnoid hemorrhage
elevated ICP

rebleeding

vasospasm

hydrocephalus
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AV malformation
congenital

tangle of abnormal arteries & veins with no intervening capillary bed

wedge-shaped

involve brain & meninges

can rupture into subarachnoid space or brain

annual risk:   3%

feeder vessels can develop berry aneurysms
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cavernoma
=  cavernous angioma

small, tightly-packed group of thin-walled blood vessels

annual risk of rupture:  <1%


can cause seizures

can be familial

can be multiple
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stroke flow chart
stroke

ischemic
   atherosclerotic
      large artery atherothrombosis     (extracranial, intracranial)
      small artery atherothrombosis     (lacunar infarction)
   embolus
      intra-artery
      cardiogenic
      paradoxical               (R=>L heart via patent foramen ovale)
   systemic hypotension / cardiac arrest

hemorrhagic
   brain hemorrhage
         due to hypertension, cerebral amyloid angiopathy
   subarachnoid hemorrhage
         due to ruptured berry aneursym
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TIA
transient episode of focal neurological dysfunction resulting from ischemia...


...not associated with permanent cerebral infarction

...always <24hrs
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risk factors for stroke
non-modifiable modifiable
HTN age
diabetes gender
cardiac disease race
atrial fib heredity
TIA / prior stroke
dyslipidemia
smoking
EtOH abuse
obesity
physical inactivity
carotid stenosis
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clinical management of stroke
history

neurological exam

localization

CT to evaluate for blood

thrombolysis

supportive management

diagnosis of pathophysiology

secondary prevention

rehabilitation
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secondary prevention of stroke
ischemic stroke
   identify & remove cause
   antiplatelet drugs:
         aspirin, clopidogrel
   risk factor modification
         BP, cholesterol, smoking, diabetes
         anticoagulation in atrial fibrillation
         carotid endarterectomy in carotid stenosis


hemorrhagic stroke
    identify and remove cause of bleeding
    BP management
Flashcard set info:
Author: bstokes25
Main topic: Stroke Management
Topic: Stroke
Published: 27.03.2010
 
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