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Strokes are the ____ leading cause of death in the US
3rd
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What are some random facts about strokes?
- every 40 seconds someone has a stroke
- strokes kill more women than breast cancer yearly
- leading cause of long term disability
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What are the two different types of CVAs and their difference?
- hemorrhagic: 13% of CVAs- arterial blood bleeds out
- occlusive: 87% of CVAs- blockage of arterial blood
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What are causes of hemorrhagic stroke?
- hypertension
- aneurysm
- arteriovenous malformation
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How does hypertension cause a stroke?
microaneurysms form and burst, leaving pockets of brain damaage
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What are the defecits caused by a HTN stoke like?
defecits are minor per stroke, but they are cummulative
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How do aneurysms cause a stroke?
weak arterial wall --> ballooning of wall --> rupture into arachnoid space
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What are some of the statistics of aneurysms?
- 50% die within 6 months
- 1/3 of survivors have neurological defecits
- incidence higher in women
- mean age is 50 years
- 27,000/year
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How does arteriorvenous malformation cause a stroke?
arterial vessels feed directly into veins and high pressure causes bleeding
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What are some characteristics of ateriovenous malformation?
- 2% of hemorrhagic strokes
- occurs between 20-40yo
- congenital
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What are signs/symptoms of a hemorrhagic stroke?
- sudden, severe headaches
- nausea and vomitting
- aversion to light
- weakness/numbness in arm/leg
- loss of consciousness
- stiff neck
- seizure
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What are the two types of blockage that can occur in occlusive strokes?
- thrombus: vessels at site slowly build a plug
- embolus: plus moves around and eventually gets stuck
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What are causes of occlusive strokes?
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Where does artherosclerosis offten occur?
- carotid arteries
- vertebral arteries
- middle cerebral arteries
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What are risk factors for atherosclerosis?
- HTN
- diabetes
- obesity
- smoking
- AA
- increased serum lipids
- hypothyroid
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What is arteritis and when does it occur?
- inflammation of arteries
- occurs in lupus, syphillis, and polymyositis rheumatic
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What are signs and symptoms of an embolus?
- abrupt onset
- symptoms may improve rapidly (transient ischemic attack)
- usually <50 yo
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What are signs and symptoms of a thrombus?
- history of HTN or atheroclerotic heart disease
- remain conscious
- symptoms progress (tingling, weakness, dizzy, aphasia)
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What is a transient ischemic attack?
- from an embolus (plaque in carotid artery)
- puts you at risk for a major stroke
- often in young people 30-40
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What are symptoms of transient ischemic attack adn how long do they last
- usually resolve in 24 hours
- amaurosis fugax: blind in one eye, occlusion of opthalamic artery
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What are characteristics of a middle cerebral artery?
- contralateral hemianopsia
- contralateral hemiparesis
- possible aphasia/dysphagia
- contralateral hemisensory loss (look by modality not dermatome)
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What are characteristics of anterior artery stroke?
- only 1% of strokes
- marked weakness in contralateral leg
- no sensory loss b/c sesnory strip is deep
- possible personality changes
- expressive aphasia if in dominant hemi
- apraxia if in non-dominant hemi
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What are characteristics of posterior cerebral artery stroke?
- 3% of strokes
- contralateral hemipareisis
- homonymous hemianopsa (loss of visual field on same side)
- receptive aphasia
- possible thalamic pain
- possible cerebellar ataxia
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What are characteristics of posterior inferior cerebellar artery stroke?
- dysarthria- motor dysfunction of speech
- dysphagia- motor dysfunction w/ swallowing
- vertigo/nystagmus
- ipsilateral ataxia
- ipsilateral horners
- contralateral loss of pain/temp in body, ipsilateral in face
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What are characteristics of vertebral and basilar artery strokes?
- ipsilateral ataxia
- vertigo
- dysarthria
- ipsilateral facial weakness
- coma
- locked in state- can only move eyes
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How can you diagnose a stroke?
- history of signs/symptoms
- blood test
- MRI/CT scan
- EKG
- blood pressure
- arteriogram
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How do you treat a stroke?
- clot buster if within 6 hours
- maintain airway if unconscious
- control HTN
- maintain hydration and electrolyte balance
- prevent cerebral edema
- bowl and bladder care
- prevent contractures, skin ulcers, and thrombophlebitis
- surgery
- rehab
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What is the prognosis of a stroke?
- 10% return to work
- 40% have residual disability (may be independent at home)
- 50% have severe disability (help with ADL)
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What are consequences of stroke?
- changes in muscle tone/strength
- synergist movement (move in patterns)
- neglect/inattention/extinction
- aphaisa (dominatn hemi)
- sensory loss (check by modality)
- incontinence
- personality change
- apraxia
- ataxia
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