Define cerebrovascular accident
- An artery that supplies blood to the brain bursts or is blocked by a blood clot. Within minutes, nerve cells damaged. Within hours die.
Prevalence of cerebrovascular accident
- Stroke: leading cause morbidity 3rd mortaility
- 150,000 stroke deaths per yearMost common neurologic reason for hospitalization
What are the non-modifiable risk factors of cerebrovascular accident?
- Age: most important. Old high risk.
- Sex: males
- Family hx
- Race/ethnicity: blacks- high BP, obese & cigs
What are the modifiable risk factors of cerebrovascular accident?
- Hypotension: second most important
- Diabetes: obesity
- High cholesterol: obesityCoronary artery disease & other heart conditions
- Smoking & secondhand smoke
- Medications: birth control, anticoagulants & hormone replacement therapy
- Heavy use of alcohol
- Illegal drug usage: cocaine
What are the types of stroke?
Ischemic & hemorrhagic
Ischemic stroke: what's the % and what happens?
- 80% of all strokes
- Blood clot blocks flow to brain
- Symptoms minor: goes unnoticed
What causes blood clots in an ischemic stroke?
- 1. Atherosclerosis
- 2. Atrial fibrillation
- 3. Heart valve problems
- 4. Endocarditis
- 5. Blood clotting disorders
- 6. Vasculitis
- 7. Myocardial Infarction
- Other causes: Hypontension
- Surgery on caotid arteries
Hemorrhagic stroke: what's the % and what is it?
- Bleeding inside the brain: intracerebral hemorrhage
- Bleeding around the brain: subarachnoid hemorrhage
What are the causes of hemorrhagic stroke?
- 1. Uncontrolled hypertension
- 2. Ruptured aneurysm
- 3. Inflammation of blood vessels
- 4. Blood clotting disorders: hemophilia
- 5. Head or neck injuries
- 6. Radiation treatment
- 7. Cerebral amyloid angiopathy
What are the symptoms of stroke?
- 1. Numb, weak, or paralysis
- 2. Vision problems
- 3. Confusion, speech impared
- 4. Difficulty walking
- 5. Severe headache
Symptoms of hemorrhagice stroke only!
- 1. Nausea & vomiting
- 2. Neck stiffness
- 3. Seizures
- 4. Possible unconsciousness
In an ischemic stroke, where do symptoms usually occur?
opposite side of the body from the side of the brain where the blood clot occurred
What is a transient ischemic attack?
- Temporary interruption of blood flow
- Before stroke
- Symptoms sim. to stroke, disappear after 10-20 min.
- Warning sign of an impending stroke
How long does it take until brain cells become damaged? So because of this what is critical?
What do you use to diagnose a stroke?
- 1. CT: determine type
- 2. MRI: small strokes
- 3. EEG
- 4. Lab work: CBC, liver & kidney funcion, clotting test & glucose
Treatment overview for stroke?
- Prompt. treatment
- Quit smoking
Initail treatment of Ischemic stroke?
- Tissue plasminogen activator (t-PA): dissolves clot
- Antiplatelet & anticoagulant: within 24-48 hrs
Initial treatment of Hemorrhagic stroke?
- Surgery: drain or remove blood in or around brain
- Surgery: repair brain aneurysm
- Surgery: repair abnormally formed blood vessels
Tell me about stroke rehab?
- Critical for success
- Stroke pts: 1/2 lose some independence & 20% dependent
Prevention for a stroke:
- Prompt treatments for TIAs
- Control hypertension
- Atherosclerosis: control cholesterol-take aspirin
- Surgery: open blocked arteries