-
THROMBOTIC Stroke (p.2-3)
- More common than embolic
- Occur in small and large arteries
- Result from obstruction of blood flow in an artery due to pathological process within that artery
- Can occur over time as plaque forms
-
EMBOLIC Stroke (p.2-3)
- Caused when blood clots or atheromatous debris form outside the brain and becomes lodge in cerebral circulation
- Can lodge in small vessels
- At risk – patient with plaque formation, a-fib, valvular heart disease, coronary heart disease, or cardiomyopathy
-
HEMORRHAGIC Strokes (p.2-3)
- 20% of strokes
- Occurs when blood vessel supplying brain ruptures
- As clot expands, pressure placed on brain tissue and surrounding rim of clot becomes ischemic
-
SUBFLOW Strokes (p.2-3)
- Too little blood flow to brain causes:
- o Blood clot (thrombus) originating in brain
- o “Traveling” blood clot (embolus) from outside the brain
- Either way, thrombus or embolus in brain impedes/stops blood flow from involved vessel
- Result = cerebral infarction
-
When would tPA be contraindicated in patient with ischemic stroke? (p.61)
- Symptoms are minor or are rapidly improving
- Seizure at onset of stroke
- Another stroke or previous head trauma within past 3 months
- Major surgery within 14 days
- Known history of ICH
- Sustained SBP > 185 mmHg
- Sustained DBP > 100 mmHg
- Aggressive treatment required to lower BP
- Symptoms suggestive of SAH
- GI or urinary hemorrhage within 21 days
- Arterial puncture at noncompressible site within 7 days
- Received Heparin within 48 hours and has elevated PTT
- PT > 15 seconds or INR > 1.7
- Platelet count < 100,000 uL
- Serum glucose <50 or >400 mg/dL
-
What is usual cause of subarachnoid hemorrhage? (p.6)
- Rupture of cerebral aneurysm
- When aneurysm ruptures, blood enters subarachnoid space ( ICP) encircling the brain (--> blood can act as irritant to brain generating vasospasm)
-
How would patient typically describe HA associated with SAH?
- “Worst headache of my life”
- Sudden, intense, of un-distinct location or quality, different than previous HA
- HA can be followed by transient LOC
|
|
