Term
| Stroke is the 1st/2nd/3rd leading cause of death in the US |
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Definition
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Term
| Approx what percentage of strokes occur outside a hospital? |
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Definition
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Term
| name some risk factors for stroke |
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Definition
1) age - risk doubles after 55
2) family history - higher in families with stroke victims
3) gender - risk higher in men but death rate higher in women
4) race - higher risk in african-americans
5) hypertension - 5x higher incidence
6) carotid or periphery artery disease
7) diabetes - 3x higher incidence
8) smoking - 4x higher incidence
9) alcohol abuse - 3x higher incidence
10) drug abuse - higher in cocaine users |
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Term
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Definition
| an acute and focal neurologic deficit resulted from a sudden interruption of blood flow in the brain due to blockade or rupture of blood vessel |
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Term
| what % of oxygen carried by blood goes to the brain? |
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Definition
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Term
| what is the primary energy source of neurons? |
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Definition
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Term
true or false?
the brain only stores a small amt of oxygen, glucose and other nutrients to use in case of interruption of blood supply |
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Definition
false
relies on constant supply of blood |
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Term
| What are the two main blood supply systems for the brain? |
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Definition
1) carotid arteries
2) basilar artery |
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Term
| The circle of Willis is a redundant sys that makes _____________ __________ possible |
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Definition
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Term
| Why is the circle of willis the main site of stroke? |
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Definition
| because > 80% of cerebral blood supply involves the circle of willis, it is the main site of stroke |
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Term
| what are the three types of strokes? |
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Definition
| ischemic, hemorrhagic, transient ischemic attack |
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Term
| what is an ischemic stroke? |
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Definition
| the most common stroke (80%) that is caused by blockade of blookd flow in cerebral vessel |
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Term
| what is hemorraghic stroke? |
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Definition
| less common stroke that is caused by bleeding into brain tissue from a blood vessel rupture |
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Term
| TIA-mini-strokes last less than __ hours |
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Definition
| 1 hour - sometimes you do not know it happened |
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Term
| in an ischemic stroke, a ______ grows big enough to block blood flow or a ____ from a broken part of a _____ |
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Definition
| thrombus, embolus, thrombus |
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Term
| normally, in atherosclerosis, when macrophages digest LDL, they become ____ cells and die |
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Definition
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Term
| 30% of ischemic stroke originate as ____ or undetermined cause |
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Definition
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Term
| the 5% of ischemic strokes of unusual causes are usually what? |
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Definition
| migraine, coagulopathy (blood clotting disorder) |
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Term
| in the evolution of events in ischemic stroke..the steps are... |
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Definition
1) thrombus/embolus
2) ischemia
3) infarction |
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Term
| the affected areas of ischemic stroke can be either core or _____ |
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Definition
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Term
| in one of the cellular consequences of ischemic stroke, the massive release oof osmoylytes and amino acids -> what? |
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Definition
| build up of glutamate inducing excitatory toxicity on neighboring cells |
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Term
| in one of the cellular consequences of ischemic stroke, the massive release oof osmoylytes and amino acids -> what? |
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Definition
| build up of glutamate inducing excitatory toxicity on neighboring cells |
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Term
| How does the restoration of blood flow in inschemic stroke cause secondary damage? |
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Definition
1) injured tissues interact with oxygen and nutrients to form more free raidcals that are toxic to healthy cells
2) local inflammatory response |
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Term
| according to the time line of schemic stroke, it takes about ___ mins for tissue anoxia to initate a chain of irreversible events |
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Definition
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Term
| what are some warning signs of ischemic stroke? |
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Definition
sudden weakness in arm or leg..often one side
- sudden numbness in face, arm or leg especially one sided
sudden confusion, difficulty speaking or understanding
sudden loss of vision
sudden severe headache without known cause
sudden dizzines, trouble walking or coordination. |
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Term
| what are some frequent causes of delay in treatment of stroke? |
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Definition
patient or family not recognizing signs of stroke
not having immediate medical access |
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Term
| Some of the diagnostic tools for stroke include: (describe how they are used also) |
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Definition
1) physical exam
2) lab tests
3) computer tomography (CT) scan
4) computed tomography angiography (CTA)
5) MRI
6) MRA(angiography)
7) carotid ultrasonography and trans-cranial doppler
8) positron emission tomography (PET) scan |
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Term
| pharmacological treatment for ischemic stroke include: |
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Definition
1)) thrombolytic meds
2) anti-coagulants
3) anti-platelet agents |
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Term
| what is tissue plasminogen activator? (tPA) |
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Definition
| physiologic factor to trigger the dissolution of blood clot (formed due to damage to blood vessel) to allow blood flow to resume and repair to take place |
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Term
| One of the major guidelines for tPA use is timing...where it should be used < ___ mins since stroke occurred |
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Definition
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Term
| What cannot be used with tPA because it will promote bleeding? |
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Definition
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Term
| What is the major risk of using tPA beyond the 3 hour IV window? |
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Definition
| excessive bleeding in the brain and bleeding systemically (GI tract) |
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Term
| when balancing benefits and risks of anti-coagulants - when should heparin be given? |
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Definition
| not immediately after first stroke, usually given a day after onset |
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Term
| what are the benefits and risks of warfarin? |
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Definition
| may reduce occurrence of second stroke, but increases rate of hemorrhage. |
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Term
| Why is aspirin given 12-24 hrs after onset? |
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Definition
| may reduce incidence of death and severe disability...can also serve to be a primary method of prevention |
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Term
| what are some possible future treatments of stroke? |
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Definition
1) antagonists for EAA
2) inhibition of free radical production
3) calcium channel blockers
4) better thrombolytic agents - streptokinnase
5) reduce plaque formation
6) cyto-neuro-protective agents |
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Term
| what are some surgical treatments for ischemic strokes? |
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Definition
1) carotid endarterectomy
2) revascularization
3) angioplasty and stenting |
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Term
| what are some risks for carotid endarterectomy? |
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Definition
| infection, stroke, reblockage of same artery, cranial nerve injury |
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Term
| when is revascularization often used? |
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Definition
| when patients have inaccessiblle plaques to CEA |
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Term
| what are some methods of stroke management? |
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Definition
| previous stroke, mini stroke or warning sign should prompt - management of related illness.condition, quitting smoking, alcohol abuse or drug use, diet management, and physical activity |
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Term
| a TIA should not be overlooked because it is can be as dangerous as a full blown stroke...true or false? |
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Definition
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Term
| hemorrhagic stroke starts with a sudden artery rupture, intracerebral hemorrhage, then .... |
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Definition
| edema, compression, spasm of adjacent blood vessel |
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Term
| What causes a subarachnoid hemorrhage? |
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Definition
| sudden rupture of a blood vessel outside of the brain and inside the skull |
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Term
| what is the death rate for SAH in the first 6 months? |
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Definition
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Term
| What are the major causes of SAH? |
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Definition
| aneurysm, arterlovenous malformation, and tumor or head trauma |
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Term
| what are some warning signs of SAH? |
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Definition
| sudden severe headache, warning headache from minor blood leakage, nausea and vomiting, meningeal irritation, visional change, loss of consciousness. |
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Term
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Definition
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