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Brain Attack
Cathy's lecture on TIAs & Strokes
61
Nursing
Graduate
09/17/2011

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Cards

Term
The ____ lobe is the primary motor area. It is responsible for an individual's overall _____, their _____,____,and ____values, ____ thought, ____-term memory, and _______ ____ movement. Also, this is where the _____ ______ _____ is.
Definition
Frontal lobe is the primary motor area. It is responsible for an individual's personality, their moral, ethical and social values, abstract thought, long-term memory, and voluntary eye movement. This is also where Broca's speech center is.
Term
The _____ lobe is responsible for understanding sensation, texture, size, shape and ____ reasoning and perception. It is important for ____, _____ ____ and processing ______ ____ experiences, as well as perception of ____ ___ and ___ _____ awareness, and ____ impulses for interpretation
Definition
Parietal lobe: understanding sensation, texture, size shape and spatial reasoning. Important for playing instruments, singing, and processing nonverbal visual experiences, perception of body part and body position awareness, and taste impulses for interpretation.
Term
Someone who bangs into objects after a stroke, likely has damage to the ____ lobe.
Definition
Parietal.
Term
The ____ lobe is the auditory center, where the brain interprets sound. It is complicated by _______ patterns. It is also where ________ area for _____ is located, so a person with a stroke in this area may have exceptional _______.
Definition
Temporal lobe is the auditory center for sound interpretation. It is responsible for complicated memory patterns and is where Wernicke's area for speech is, so a person with a stroke in the Temporal lobe may have exceptional aphasia.
Term
In addition to vision and visual recognition of objects, the occipital lobe is also responsible for ______ comprehension.
Definition
Reading comprehension.
Term
The _____ _____ is responsible for our _____ skills, ____ behavior, moods, _____ ______ associated with _______, _______ and memory.
Definition
Limbic system: survival skills, primitive behavior, moods, visceral processes associated with emotions, learning and memory
Term
80% of the brain is fed through the ________. A person with this kind of stroke will have ____ ____.
Definition
MCA: Middle Cerebral Artery---> Profound deficits
Term
Arteries associated with cerebral circulation
Definition
Internal carotid arteries (anterior circulation) and vertebral arteries (posterior circulation)
Term
Damage to the ____ arteries will inhibit supply to the _____, ______ and _____ lobes, the basal ganglia, and part of the ________ (______&________)
Definition
Carotid arteries: frontal, parietal, and temporal lobes, the basal ganglia, and part of the diencephalon (thalamus & hypothalamus)
Term
The _____ arteries join to for the basilar artery, supply the middle and lower part of the _____ lobes, _____ lobes, cerebellum, ______ and part of the _________.
Definition
Vertebral arteries join to for the basilar artery, supply the middle and lower part of the temporal lobes, occipital lobes, cerebellum, brainstem and part of the diencephalon.
Term
__ _______ __ __________ is what connects the arteries of the front and back of the brain
Definition
Circle of Willis
Term
Blood flow to the brain = ____-____ml/min, or ____% of the cardiac output
Definition
700-1000ml/min or 20% of cardiac output
Term
Cerebral auto regulation maintains a range of systolic bp of ______. This auto regulation is impaired with ____ _____.
Definition
50-150 mm/hg

Cerebral ischemia
Term
Effect of carbon dioxide on the brain
Definition
Carbon dioxide is a potent vasodilator. Increased levels of Carbon dioxide increases cerebral blood flow (the vessels "open up like a pipe")
Term
The right side of the brain receives messages from the ____ ____ of the body.
Definition
Left side of the body.
Term
Temporal lobe is vital of perception of _____
Definition
Time
Term
___% of stroke survivors recover completely, while __% have minor impairments and can return to work
Definition
10% no impairment, 20% minor
Term
Risk factors for stroke
Definition
HTN
Smoking
High cholesterol
Alcohol
Obesity
Sedentary lifestyle
Diabetes
Term
Non modifiable risk factors for stroke
Definition
Age, gender, race, family history (heredity)
Term
Modifiable risk factors for stroke
Definition
*HTN, heart disease, *a-fib, mi, valve disease, cardiomyopathy, DM, hyperlipidemia, smoking, obesity, physical inactivity, oral contraceptive
Term
Biggest cause of an embolic stroke*
Definition
A-fib
Term
Additional risk factors for stroke
Definition
Carotid artery stenosis, *TIA (marker for possible stroke!!!) Transient monocular blindness (*amarosis fugax: "it felt like a shade came over my eye and alsted for 20 minutes"), migraine, prior stroke, hypercoagulability/sickle cell, alcohol and drug use
Term
Cerebral blood flow must fall below _/_ of normal before brain does not receive adequate blood flow (MAP<___). After _-_ minutes, cell death and permanent changes occur.
Definition
fall below 2/3 (MAP <50) then cell death and permanent changes after 3-10 minutes
Term
There is a ___ hour window between having a stroke and safe, effective response to TPA
Definition
*4 and 1/2 hour window
Term
Brief, reversible episodes of neurological dysfunction, usually caused by temporary, focal cerebral ischemia
Definition
Transient Ischemic Attack, TIA
Term
Those who have a TIA have a __% chance of having a stroke withina year
Definition
30% chance of having a stroke
Term
Most important diagnostic marker for a TIA
Definition
CT scan WITHOUT contrast dye
Term
85% of all strokes
Definition
Ischemic: thrombotic and embolic

Partial or complete blockage of blood flow to the brain
Term
*****Salvagable tissue, ______, is saved by keeping
O2: ____
BP: _____
Glucose: ____
Definition
Penumbra

O2: > or = 92%
BP: < or = 185/105
Glucose: 140mg/dl
Term
Thrombotic stroke is the formation of a ____ or ____ that results in the _____ or occlusion of a ____ ___ with eventual ____.
Definition
Blood clot or coagulation that results in the narrowing of hte lumen of a blood vessel with eventual occlusion
Term
The most common cause of cerebral infarction*
Definition
Thrombotic stroke
Term
*2 major disorders associated with a thrombotic stroke
Definition
HTN and diabetes
Term
______ strokes tend to develop in sleep, or within one hour of waking (they go to bed fine, and wake up looking terrible)
Definition
Thrombotic stroke
Term
2nd most common cause of a stroke
Definition
embolism
Term
the patient with A-fib should be on ____ or ____ to prevent embolic stroke
Definition
coumadin or aspirin
Term
_____ stroke onset is withing a matter of seconds to minutes. The person usually remains ____ and has a _____. It is not associated with _____and usually has no _____ _____.
Definition
Embolic stroke

Remains conscious
Headache
Not associated with activity

Often NO warning

May have rapid improvement

Usually normotensive
Term
Hemorrhagic stroke is usually caused by ______
Definition
HTN
Term
Save the penumbra by keeping O2
Definition
> or = 92%
Term
Save the penumbra by keeping BP ____
Definition
< or = 185/105
Term
Save the penumbra by keeping glucose ____
Definition
around 140mg/dl
Term
85% of all strokes are ____. These may be either _____ or ____.
Definition
Ischemic: thrombotic, embolic
Term
*****Thrombotic strokes tend to develop ________
Definition
During sleep or within one hour of waking**
Term
When a person has an embolic stroke, the clot is usually formed in the _____
Definition
Heart. Most common cause is a-fib!
Term
Onset of an embolic stroke
Definition
Rapid, matter of seconds-minutes
Term
Hemorrhagic stroke is usually caused by _____
Definition
HTN
Term
ICH, ________ ______, usually occurs during ____, during ____ ___ ____. Symptoms are ____ ____ with _____, HTN and decreased ____. The onset is ____ to complete ______.
Definition
Typically during waking hours, during periods of activity. Severe, pounding* headache with n/v. Rapid onset to complete hemiplegia. Prognosis is poor.
Term
Putamen(_______), internal capsule, central white matter hemorrhage symptoms
Definition
(In the forebrain and involved in movement) Weakness on one side, including face, arm and leg, slurred speech deviation of the eyes.

Rapid progression of symptoms r/t severe hemorrhage include hemiplegia, fixed and dilated pupils, abnormal body posturing and coma
Term
Thalamic hemorrhage symptoms is characterized by more ____ than _____ loss
Definition
Hemiplegia with more sensory than motor loss
Term
Cerebellar hemorrhages
Definition
Severe H/A, vomiting, inability to walk, dysphagia, dysarthria, eye movement disturbances
Term
Pons hemorrhage*
Definition
Most serious! Life functions (respiration) affected.

Hemiplegia leads to complete paralysis, coma, abnormal body positioning, fixed pupils, hyperthermia and death
Term
Subarachnoid hemorrhage occurs when there is _____ ______ into the _______ ____-_____ space between the arachnoid and pia mater membranes
Definition
Occurs when there is bleeding into the cerebrospinal fluid-filled spaces between the arachnoid and pia mater membranes on the surface of the brain
Term
Cocaine-users are high risk for ____ ____ ___
Definition
subarachnoid hemorrhage
Term
SAH symptoms
Definition
H/A, alert to comatose LOC, N/V, stiff neck*, focal neurologic deficits
Term
If someone has an aneurism, it is likely they will ___ ____
Definition
Have another
Term
SAH Treatment:

Surgical ____ of _____
Endovascular techniques: ______
Med for vasospasm _______ ____ ___ (_______)
Definition
Surgical clipping of the aneurysm
Endovascular techniques: coiling
Vasospasm: administer calcium channel blocker. Nimodipine (Nimotop)
Term
Warning signs for SAH
Definition
Sudden: weakness on one side of the body, changes in speech, vision, or hearing

Abnormal sensations one side of the body

H/A
Term
Manifestations of left brain stroke

Paralysis on _____ side
Impaired ____/ ______ ______
Impaired ____/_____ discrimination
Slow performance
_______
Aware of _______: depression and anxiety
Impaired comprehension
Definition
Paralysis on the right side
impaired speech/ language aphasias
impaired right/left discrimination
slow performance, cautious
Aware of deficits: depression, anxiety

impaired comprehension r/t language and math
Term
4 key symptoms of a left brain stroke
Definition
L: gaze preference
R: visual field cut
R: hemiparesis
RL hemisensory loss
Term
Manifestations of a R brain stroke
Definition
Paralysis on the left side, left-sided neglect, spatial-perceptual deficits, tends to deny or minimize problems, rapid performance, short attention span, impaired judgement, impaired concept of time
Term
Interventions for client with a R hemisphere stroke
Definition
Don't overestimate abilities
Use verbal cues if having difficulty with demonstration
Break tasks into small steps
Minimize clutter
Avoid rapid movement around the client
Term
LOC if MCA stroke
Definition
Drowsy to comatose
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