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Thrombotic stroke
(p.2-3)
- More common than embolic
- Occur in small and large arteries
- Obstruction of blood flow in 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 become lodged in cerebral circulation
- Can lodge in small vessels
- At risk = pt with plaque formation, a-fib, valvular heart disease, coronary heart disease, cardiomyopathy
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Hemorrhagic stroke
(p.2-3)
- 20% of strokes
- Occurs when blood vessel supplying brain ruptures
- Clot expands, causes pressure on brain tissue, surrounding rim of clot becomes ischemic
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Subflow states
(p.2-3)
- Too little blood flow to brain
- Blood clot (thrombus) - originating within brain
- "Traveling" blood clot (embolus) - from outside the brain
- Thrombus or embolus impedes/stops blood flow of involved vessel
- Result = cerebral infarction
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When is tPA contraindicated for a patient with ischemic stroke? (15)
(p.61)
- 1) symptoms minor or rapidly improving
- 2) seizure at stroke onset
- 3) stroke or head trauma in past 3 months
- 4) major surgery within past 14 days (2 weeks)
- 5) Hx of ICH
- 6) Sustained SBP > 185 mmHg
- 7) Sustained DBP > 100 mmHg
- 8) aggressive treatment to lower BP
- 9) symptoms suggesting SAH
- 10) GI or GU hemorrhage in past 21 days (3 weeks)
- 11) arterial puncture at noncompressible site in past 7 days (1 week)
- 12) received heparin in past 48 hours AND elevated PTT
- 13) PT > 15 seconds or INR > 1.7
- 14) Platelets < 100,000 uL
- 15) serum glucose < 50 or > 400 mg/dL
-
What is the usual cause of subarachnoid hemorrhage?
(p.6)
- Ruptured cerebral aneurysm
- When aneurysm ruptures, blood enters subarachnoid space encircling brain
- --> increased ICP
- --> blood acting as irritant to brain generating vasospasm
-
How would patient typically describe the headache associated with SAH?
- "Worst headache of my life"
- Sudden, intense, un-distinct location or quality, different than previous headaches
- Can be followed by transient LOC
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