Patho 3

Thrombotic stroke(p.2-3)

More common than embolicOccur in small and large arteriesObstruction of blood flow in artery due to pathological process within that arteryCan 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 circulationCan lodge in small vesselsAt risk = pt with plaque formation, a-fib, valvular heart disease, coronary heart disease, cardiomyopathy

Hemorrhagic stroke(p.2-3)

20% of strokesOccurs when blood vessel supplying brain rupturesClot expands, causes pressure on brain tissue, surrounding rim of clot becomes ischemic

Subflow states(p.2-3)

Too little blood flow to brainBlood clot (thrombus) - originating within brain"Traveling" blood clot (embolus) - from outside the brainThrombus or embolus impedes/stops blood flow of involved vesselResult = cerebral infarction

When is tPA contraindicated for a patient with ischemic stroke? (15)(p.61)

1) symptoms minor or rapidly improving2) seizure at stroke onset3) stroke or head trauma in past 3 months4) major surgery within past 14 days (2 weeks)5) Hx of ICH6) Sustained SBP > 185 mmHg7) Sustained DBP > 100 mmHg8) aggressive treatment to lower BP9) symptoms suggesting SAH10) 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 PTT13) PT > 15 seconds or INR > 1.714) Platelets < 100,000 uL15) serum glucose < 50 or > 400 mg/dL

What is the usual cause of subarachnoid hemorrhage?(p.6)

Ruptured cerebral aneurysmWhen 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 headachesCan be followed by transient LOC