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Flashcards in Stroke & TIA Deck (72)
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1

Define Stroke

Alteration of cerebral blood flow

2

Types of Stroke

Ischemic
Hemorrhagic

3

Reasons for Ischemic Stroke

Thrombosis
Embolism
Systemic hypoperfusion

4

Types of Hemorrhagic Stroke

Intracerebral hemorrhage
Subarachnoid hemorrhage

5

Internal carotid give way to which vessels?

Anterior cerebral artery
Middle cerebral artery

6

Posterior cerebral artery originates from which vessels?

Vertebral
Basilar

7

Etiologies of Ischemic Stroke

A-fib
Atrial septal defect
Ventricular septal defect
Endocarditis
Cardiac tumor
Valvular disorder
Atherosclerotic plaques
Vasculitis
Prothrombotic State
Cerebral Hemorrhage

8

Etiology: A-fib

Embolization of intracardiac thrombi
Anticoagulation decreases risk by 70%
Aspirin decreases risk by 20-25%

9

Etiology: Atrial Septal Defect

Only if associated with a R to L shunt

10

Etiology: Ventricular Septal Defect

Only if associated with a R to L shunt

11

Etiology: MI

Most common after an anterior wall infarction

12

Etiology: Endocarditis

Emboli from vegetations

13

Etiology: Cardiac Tumor

Obstruction of blood flow
Can lead to arrhythmias
Embolization of tumor fragments

14

Etiologies: Valvular Disorders

Rheumatic MS: most commonly associated with stroke
Mitral valve prolapse: fibrinous deposits on valve
Prosthetic valve: require lifelong anticoagulation
Repaired valves: require anticoagulation short term

15

Percent of all strokes are hemorrhagic

20%

16

Causes of Spontaneous Intracerebral Hemorrhage

Poorly controlled HTN
Bleeding disorders
Amyloid angiopathy

17

Causes of subarachnoid hemorrhage

Trauma
Spontaneous subarachnoid
Abnormal vascular composition
Illicit drug use
Intracranial arterial dissections
No identifiable cause

18

Intracranial Aneurysm

Located in Circle of Willis (most common)
Size and location determine risk of rupture

19

Arteriovenous Malformations

Abnormal connection
Venous side develop high pressures
Associated with risk of seizure

20

Types of Ischemic Stroke

Anterior circulation
Posterior circulation
Lacunar

21

Intracerebral Hemorrhage

Arterial bleeding directly into the brain
Accumulation over minutes to hours
Symptoms increase over time

22

Major causes of intracerebral hemorrhage

HTN
Trauma
Bleeding disorder
Amyloid angiopathy
Illicit drug use
Arteriovenous malformations

23

Goal of treatment of intracerebral hemorrhage

Contain and limit the bleeding to prevent herniation

24

Major causes of Subarachnoid Hemorrhage

Ruptured aneurysm
Atriovenous malformation

25

What is a Subarachnoid Hemorrhage?

Bleeding into the CSF and the space surrounding the brain
Increases ICP

26

Treatment for Subarachnoid Hemorrhage

Identification of source of bleeding
Prevent brain damage

27

Ischemic Stroke: Anterior Circulation

Most are middle cerebral artery occlusions due to direct flow from internal carotid

28

Ischemic Stroke: Posterior Circulation

Have terrible outcomes
Affects occipital lobes, cerebellum, and brainstem

29

Ischemic Stroke: Lacunar Infarcts

Lesions that occur in the penetrating arterioles off of the MCA
"Punched out hypodense areas"
Less morbidity/mortality

30

Stroke Risk Factors

HTN
DM
Hyperlipidemia
Cigarette Smoking
Cardiac Disease
Elevated blood homocysteine levels
AIDS
Recreational drug abuse
Alcoholism
Family hx of stroke
Overweight
Ischemic heart disease
PVD
Sedentary lifestyle
Men >45 & Women >55
Oral contraceptives +smoking
Hypercoagulopathy
Polycythemia
Prior Stroke
Sleep Apnea
Bleeding disorders