15960048
Descripción
Fichas por Amelia Tuffley, actualizado hace más de 1 año
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Creado por Amelia Tuffley
hace alrededor de 6 años
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| Pregunta | Respuesta |
| Blood flow to the brain | 750mL/min 20% of blood volume circulates through the brain |
| Brain regulating mechanisms we can influence | Carbon dioxide concentration - too low causes vasoconstriction Oxygen concentration - hyperoxygenation causes oxidative stress, free radicals, |
| Define embolic/ischaemic stroke | An episode of neurological dysfunction caused by cerebral, spinal or retinal infarction |
| Most commonly affected vessels | 1. Middle cerebral artery 2. Posterior cerebral artery 3. Basilar artery 4. Vertebral artery The larger the artery affected, the greater the affected area and associated deficit |
| Pathophysiology of ischaemic stroke | 1. Plaque ruptures, or tumour, fat globules, air or amniotic fluid 2. Thrombus formation, typically at origin or bifurcation of arteries 3. Plaque formation with fibrous fab -> degradation of cap by macrophages, initiation of thrombus formation |
| Causes of embolism | - Vascular stasis - Stenotic vessels - AF - AMI - Aneurysms - Thromboembolism - Gas embolism - Amniotic fluid embolism during child birth - Fat embolism in major fractures |
| Virchow's triad | - Hypercoagulability - Haemodynamic changes - stasis, turbulence - Endothelial injury/dysfunction |
| Large vessel occlusion, vessels affected | - <20% of AIS - Most severe stroke with worst prognosis - Middle cerebral artery - Internal carotid artery - Basilar arteries |
| Arterial dissection facts | - 20% of AIS <25 years - Females 3x more likely than males - Chiropractors and hairdressers dangerous - Neurological symptoms and a sore neck -> arterial dissection until proven otherwise |
| Risk factors for embolic stroke (7) | - AF - Endocarditis - Dilated cardiomyopathy - Recent MI - Heart valve replacement - Rheumatic heart disease - Patent foramen ovale |
| Risk factors for thrombotic stroke (7) | - Hypertension - Hyperlipidaemia - Diabetes - Smoking - Obesity - Systemic atherosclerosis - Hypercoagulable state |
| Intracerebral haemorrhagic stroke pathophysiology | Rapidly developing clinical signs of neurological dysfunction attributable to a focal collection of blood within the brain parenchyma or ventricular system that is not caused by trauma |
| Subarachnoid haemorrhagic stroke pathophysiology | Rapidly developing clinical signs of neurological dysfunction and/or headache because of bleeding into the subarachnoid space, which is not caused by trauma |
| Haemorrhagic stroke presentation | - Severe sudden headache in 95% of victims, often occipital lobe - 50% have a warning leak, mild headache - Upper neck pain -> inflammation of CSF - Photophobia - Nausea and vomiting - Hypertension - Bradycardia - Herniation - late stage |
| Other "stroke" | An episode of acute neurological dysfunction presumed to be caused by ischaemia or haemorrhage persisting >24 hours or until death, but without sufficient evidence to be classified as one of the above |
| Transient ischaemic attack (TIA), pathophysiology and relation to stroke prediction | Neurological deficit that resolves within 24 hours 1 in 2 TIAs will progress to stroke. 1/2 within 12 months |
| Stroke epidemiology | - 80% of strokes can be prevented - one occurs every 10 mins in Aus - One of Australia's biggest killers and cause of disability |
| Non-modifiable risk factors for stroke | - Age - Gender - Family history of stroke |
| Modifiable risk factors for stroke | TIA Hypertension Smoking High cholesterol Poor diet and lack of exercise Obesity Diabetes Alcohol AF |
| Lateral pointine syndrome | - Presents scarily similar to narcotic overdose - Basilar artery - Pinpoint pupils - Respiratory depression - No response to naloxone |
| Locked in syndrome | - Basilar artery |
| Five aspects of neurological assessment | LOC Motor function and tone Sensory function Speech Pupillary response |
| Differential diagnoses of stroke | Intracranial space-occupying lesion Subdural haematoma Multiple sclerosis Head injury Hypoglycaemia Seizure disorders – Todds paresis (one sided paralysis -> resolves) Complex migraine |
| Endovascular clot retrieval | Most benefit for large vessel occlusion Up to six hours post onset of symptoms Posterior circulation stroke up to 24 hours due to poor prognosis |
| Pre-hospital stroke cares | Oxygen - causes oxidative stress Head position - semi-recumbent is haemorrhagic, supine is ischaemic Aspirin - can't tell if clot Magnesium - no benefit found |
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