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Stroke - FP
Terms in this set (29)
STROKE - overview
- _______ neurological injury
- Worldwide, stroke is the __________ most common cause of mortality (death)
- ________ most common cause of disability
- Incidence of stroke is __________ in high-income countries, including the United States
- Incidence is __________ in low-income countries
This might due to education, diet, etc
- Men have a higher incidence of stroke than women at younger but not older ages, with the incidence reversed and higher for women by age _____ years and older
- Acute neurological injury
- Worldwide, stroke is the second most common cause of mortality (death)
- Third most common cause of disability
- Incidence of stroke is decreasing in high-income countries, including the United States
- Incidence is increasing in low-income countries
This might due to education, diet, etc
- Men have a higher incidence of stroke than women at younger but not older ages, with the incidence reversed and higher for women by age 75 years and older
Modifiable risk factors for stroke
- Atrial fibrillation, causing irregular pumping increasing chance for blood clot
- Carotid artery stenosis. Happens with atherosclerosis
Non-modifiable risk factors for stroke
Age, gender, race, family history, genetic disorders (sicle cell, CADASIL)
Usually due to a burst blood vessel into the brain
lack of blood.
due to thrombosis, embolism or systemic hypoperfusion
or (RARE) blood disorder increasing blood coagulability --> thrombuss
Local in situ obstruction of an artery
a plaque or thrombus breaks free, travels to another area --> blocking arterial access to a part of the brain
Low perfusion pressure in the systemic circulation, decreasing blood flow to the brain
More general circulatory problem
The clot that are formed in.... can end up causing stroke
- Wall of ventricle and/or atrium
- On the atrial appendices
- Near the valves
- On the aorta
- On the carotid arteries
Systemic hyperfusion stroke may be caused by
Reduced cardiac pump, due to
- cardiac arrest
- pulmonary embolism
- pericardial effusion
Hypoxemia (low O2 in blood)
What is a transient ischemic attack?
Associated neurologic symptoms that typically lasts < 24 hour
May cause permanent brain injury
a tear on the artery wall and blood goes through the dissected section (abnormal pathway) resulting in a reduced blood flow to the brain
Inflammation of the vessel narrowing pathway for blood
Narrowing of certain cerebral arteries resulting in stroke
Pathologies affecting large intracranial vessels
Delivery of adequate blood through a blocked artery depends upon
Small vessel disease
When branches of the coronary artery are damaged and cant DILATE properly
It affects intracerebral arterial system, specifically penetrating arteries that arise from
The distal vertebral artery,
The basilar artery
The middle cerebral artery stem
The arteries of the circle of willis
What can cause small vessel disease?
Lipohyalinosis and fibrinoid degeneration
Atheroma formation at the parent artery
lipid hyaline build-up distally secondary to hypertension
Two types of brain hemorrhage
Intracerebral haemorrhage - bleeding directly into the brain parenchyma
Subarachinoid haemorrhage (SAH) - into the CSP within the subarachinoid space
Two major causes of SAH
1. Rupture of arterial aneurysms (ballooning of the bv)
2. Bleeding from vascular malformations
May be caused by: Bleeding diatheses, trauma, amyloid angiopathy, and illicit drug use are less common
ICH bleeding usually derived from
arterioles or small arteries
ICH bleeding may cause formation of hematoma. Explain!
Hematoma can continuously grow until the surrounding pressure equalises it or untill the haemorrhage decompresses itself by emptying into the ventricular system or into the CSF.
If prolonged, the brain can herniating out of the foramen magnus = death
Causes of ICH
- Bleeding diatheses
- Amyloid angiopathy - Common in elderly
- Illicit drug use (mostly amphetamines and cocaine)
- vascular malformations
Less frequent causes include bleeding into tumours, aneurysmal rapture, and vasculitis
Management of ischaemic stroke
Restore blood flow! time is critical
Assessment of stroke
- weakness one side ONLY
- no associated rash, fever (thatd be infection)
- sudden weakness
ischaemic or haemorrhagic? CT!
Holter monitor - arterial fibrilations?
imaging of internal arteries - is there a narrowing in the arteries
Echocardiogram - is there clotting?
Blood study (cholesterol, glucose level)
Reperfusion therapy is very __ dependent. why?
its useful for ischaemic
TIME - if the person have had a stroke where half of the brain has died, clot dissolving medication will only predispose them to bleed in the area thats already affected by stroke.
When can you use reperfusion therapy?
what is alteplase
when the patient havent had a severe stroke/bleeding.
so to salvage the tissue you can give them
a tissue plasminogen activator to dissolve clot.
It has to be administerd within 3-4.5 hours after stroke onset.
Not 100% effective
2. Clot retrieval (intra-arterial mechanical thrombectomy)
Mechanically retrieve the clott (pull it out)
For large artery occlusion
NOT EVERYONE ELIGIBLE
risk rupturing the artery
Management of Haemorrhagic stroke
- reduce blood loss
- control blood pressure
- reverse bleeding tendency if possible
THIS SET IS OFTEN IN FOLDERS WITH...
Neurophysiology 1 - FP B.bmed
Enteric nervous system - FP B.bmed
Gut-Brain axis - FP - B.bmed
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