STROKE

SULLIVAN CHAPTER 15
Pathology
● CVA is caused by an interruption of the blood flow to the brain
○ Thrombosis
○ Embolus
○ Hemorrhage
○ Atherosclerosis
○ Arteriovenous malformation (AVM)
■ Abnormal vessels undergoing progressive dilation with age
● Sudden and severe bleeding can result in death within hours
○ ICP rises rapidly and adjacent cortical tissues are compressed or displaced as in
brainstem herniation
● Ischemic cascade - a number of damaging cellular events

Epidemiology
● Younger ages
○ male>female
● Older (85 yrs old)
○ male<female

● Risk factors
○ Hypertension (1)
○ Heart disease (2)
○ Disorders of the heart rhythm (3)
○ Diabetes mellitus (4)
○ Specific to women
■ Early menopause (before 42)
■ The use of estrogen or estrogen plus
■ pregnancy
■ Birth
■ 6 weeks postpartum
■ Preeclampsia
● Highblood pressure that occur during pregnancy
○ Modifiable
■ Cigarette smoking
■ Physical inactivity
■ Obesity
■ Diet
○ Nonmodifiable
■ Family history
■ Age
■ Gender
■ Race
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● Multiple pathologies increase significantly with age:

○ BP : >140/90 mmHG
○ Elevated blood cholesterol / hypercholesterolemia : > 240mg/dL
○ Elevated low-density lipoprotein:
■ Bad
● Borderline highlevels : 130-159 mg/dL
● High level : 160-189 mg/dL
● Very high level : >190 mg/dL
○ Low levels of low-density lipoprotein:
■ good
● Adult males: 40 mg/dL
● Adult female: <50 mg/dL
○ Fasting triglyceride level: >150 mg/dL
○ Elevated hematocrit - from generalized reduction of CBF
● Cardiac disorders
○ Rheumatic heart valvular disease
○ Endocarditis
○ Cartier surgery

● Medication
○ Tissue plasminogen activator (tPA)
■ If stroke is atherothrombotic
■ Given 3 hrs of the onset
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Types of Stroke:
● Transient Ischemic Attack (TIA)
○ Temporary interruption of blood supply in the brain
○ Symptoms may last for only few mins-hours but not longer than 24 hrs
○ May result from different etiological factors:
■ Occlusive episodes
■ Emboli
■ Reduced cerebral perfusion
■ Cerebrovascular spasm
○ susceptible to both cerebral infarction and myocardial infarction

● Ischemic stroke
○ Mc
○ Affecting 80% of individuals with stroke
○ From clot blocks or impaired blood flow - depriving the brain of essential oxygen
and nutrients
○ Produces cerebral edema- can elevate ICP
○ Cheyne-strokes respiration - irregular respirations
○ Cerebral edema - most frequent cause of death
■ Characteristic of large infacts involving
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● Middle cerebral artery (MCA)

● Internal carotid artery (ICA)
○ Disabilities:
■ Hemiparesis
■ Unable to walk without assistance
■ Dependent ADL
■ Aphasia
■ Depression
○ Types
■ Cerebral thrombosis
■ Cerebral infarction/ atherothrombotic brain infarction (ABI)
■ Cerebral embous
○ Characteristic
■ Cerebral edema - accumulation of fluids within the minutes of insult

● Hemorrhagic stroke
○ Blood vessel rupture - causing leakage of blood in or around the brain-increasing
ICP
○ Closely linked to chronic hypertension
○ Types
■ Intracerebral hemorrhage (IH)
● By rupture of cerebral vessel with subsequent bleeding into the
brain
■ Cerebral hemorrhage
● Aka nontraumatic spontaneous hemorrhage
● Occurs in small blood vessels weakened bt atherosclerosis
producing aneurysm
■ Subarachnoid hemorrhage (SH)
● It affects large blood vessels