NEURO STROKE

• Stroke: A neurological deficit of sudden onset accompanied by focal dysfunction and symptoms lasting more than 24h that are presumed to be of non-traumatic vascular origin.
• Transient ischemic attack: symptoms that last less than 24 hours
• If there is trauma, it will be categorized under head trauma
• All disorders that ruptured blood flow from the brain, whether due to occluding blood vessels or hemorrhaging results from the ruptured blood vessels = CVA or cerebrovascular accidents
• CVA: sudden onset, no chronicity
• CVA: focal neurologic deficits greater than 24 hours
• focal deficits mean problems with motor functions, speech, cognition
• CVA (vascular origin): the problem lies under the blood vessels. either occluded or the blood vessels is ruptured.
• stroke: leading cause of adult disability
• transient ischemic attack: Neurological events that have a duration shorter than 24h, followed by complete return to baseline (complete recovery). must resolve within 15-30 mins
• TIA: signal of an impending sign of stroke. 35% precedes with stroke
• TIA: acquire 2d echo to know whether it is thrombi or emboli formation, and where did it come from
• thrombus: stasis, where the clot happens, it only stays there.
• embolus: moving blood clot, possibly coming from the heart.
• too much viscousness, you place the patient under blood thinners.
• heart problem, it is structural = valvular defect, higher tendency that the clot in the heart will be dislodged and sasama sa circulation.
• 2d echo: to see if it is cardioembolic in nature. problem in valve, higher chances of developing clot, arrythmias
• non-modifiable risk factors: age, male sex, family history (cardiac problem, blood problem, history of stroke/TIA), race, blacks (caucasian)
• Modifiable risk factors: HPN, TIA, valvular heart disease, arterial fibrillation, CAD, DM, smoking, dyslipidemia, stress, alcoholism, hyper coagulable state
• Coronary artery disease: control fat intake
• 2d echo: to know if it is cardioembolic in nature. Arrhythmias that cause clotting of the blood in the heart, this needs to be addressed immediately and not the stroke itself because it will develop a series of stroke because the origin which is the heart was not able to be resolved.
• ischemic stroke: 85%, thrombotic or embolic in nature
• ischemic stroke: blood clotting only, no rupture of vessel, vasation, hemorrhage
• ischemic stroke: caused by interruption of oxygen and blood supply to a particular/specific part of the brain
• cause of ischemic stroke: hyperlipidemia
• hyperlipidemia: too much fats in the vessels.
• flow of blood -> attracts platelets and clotting factors -> total occlusions
• the larger the clot = ischemic stroke
• ischemic: thrombotic, local origin of the clot. atheroslerosis
• ischemic stroke: usually develops at night during sleep, symptoms perceived in the morning, suspect history of atherosclerosis, hypercoagulable state, 50% of all stroke cases
• ischemic stroke: affects larger cerebral arteries
• common site na tinutubuan ng ischemic (thrombotic): bifurcation of carotid artery (internal and external)
• ischemic (emboli): proximal origin of the clot, galing sa malayo
• ischemic emboli: occurs anytime, during strenuous or vigorous activities
• ischemic emboli: history of arterial fibrillation, thromboembolism from MI
• ischemic emboli: 32% of all strokes
• majority of cases of thrombus are related to atherosclerosis
• ischemic emboli: common site is in the bifurcation of middle cerebral artery
• Cerebral blood flow provides brain oxygen for energy at a rate of 55ml/100 gms of brain/ min.
• When rate is <8-10 ml/ 100 gms/ min -> cell membrane failure -> cell death. this is called electrical silence.