Acute Ischemic Stroke: Etiology, Pathophysiology, Clinical Features, Diagnostics,
Treatment
We are going to have comprehensive notes illustrations on acute ischemic stroke
that will aid in your academic understanding of this topic. We will go through each
one of these causes in great detail the first one that we have here on the docket
is global hypoperfusion. If you do not have a good oxygen carrying capacity from a
severe hypoxemic hypoxia, this will lead to ischemia infarction. Another potential
cause of global hypoperfusion besides cardiac arrest and acute respiratory failure
would be something where they have a big fatty plaque within their internal carotid
artery. These thrombi that we are going to discuss are very common in what is
called large vessels and we will denote which ones I mean by these large vessels.
These large vessels that can form thrombus are usually going to be your internal
carotid artery. The next one is your posterior circulation so your vertebrals and
your basilar arteries. These can form these nice fatty plaques there from a couple
different risk factors we will discuss.
These thrombi form when we didn't talk about that yet so there's particular things
called risk factors so I want to talk about primarily the risk factors that you can
modify okay because that's the things that we can treat later on. Hypertension is
the most common cause that can lead to thrombi. Diabetes mellitus, hyperglycemia
and hyperlipidemia are the other modifiable risk factors. Embolic causes are by far
going to be the most common causes for acute ischemic strokes and they can be
broken down into three different categories. The first one is arterial to arterial
emboli. The second one is the thrombotic causes that's a big one right all right.
There's not an effective atrial contraction because there's an arrhythmia there, so
atrial fibrillation we'll denote that as a fib or atrial flutter to some degree as
well. The other thing is what if there's a problem with the valve so you've got a
valvular issue there.
Paradoxical embolus: a very interesting embolus is one called a paradoxical
embolus. This usually happens with small cortical vessels, which are branches of
larger vessels. The other rare cause to be aware of is vasculitis dissection, which
is usually due to trauma. Dissection can occur in your vertebrals.
-Factors that can cause acute stroke include Factor 5 Leiden, Factor 5 Leiden,
prothrombin gene mutation, and polycythemia. -The clinical features of acute
scheming stroke depend on the vascular territory affected. -The most important
thing to do when someone you suspect has an acute ischemic stroke is to get
imaging. -CT scans are the most common type of imaging, and can show an ischemic
infarct. -After imaging is done, an MRI may be helpful for a more sensitive
diagnosis.
The echo looks at the heart and determines if there is any atrial thrombin,
ventricular thrombic or vegetations on the valve. The echo will also give the
individual's ejection fraction and look for motion wall motion abnormalities. The
most important thing is to make sure that if someone has low glucose, before giving
them tpa, they are corrected. If someone has an inr greater than 1.7 and is taking
warfarin, we need to take that into consideration when giving tpa. Polycythemia may
be a diagnosis for the individual's cause of stroke. Make sure they are
hypoglycemic because it can cause a stroke mimic. When giving tpa, you cannot be
hypoglycemic also coagulopathy must be checked to see if they are bleeding.
Checking their cbc may show signs of anemia or low platelets thrombocytopenia.
If you have a suspicion that a clot is due to vasculitis, then you should give the
tPA. The guidelines say you need an nih stroke scale score greater than four to be
able to get tPA. Vasculitis is a low on your differential and so you should check
for autoimmune causes and for infectious causes. If you have a suspicion that a
clot is due to vasculitis, then you should give the tPA.
A mechanical thrombectomy is an interventional radiology procedure that uses a
catheter to suck out or place a stent in a clot to remove it. The recommended
dosage of tPA is 0.9 milligrams per kilogram, but the procedure is preferable if it
is done within six hours of onset of ischemia. If the patient has stroke, tPA can
be effective in saving tissue around the area of the stroke.
Treatment
We are going to have comprehensive notes illustrations on acute ischemic stroke
that will aid in your academic understanding of this topic. We will go through each
one of these causes in great detail the first one that we have here on the docket
is global hypoperfusion. If you do not have a good oxygen carrying capacity from a
severe hypoxemic hypoxia, this will lead to ischemia infarction. Another potential
cause of global hypoperfusion besides cardiac arrest and acute respiratory failure
would be something where they have a big fatty plaque within their internal carotid
artery. These thrombi that we are going to discuss are very common in what is
called large vessels and we will denote which ones I mean by these large vessels.
These large vessels that can form thrombus are usually going to be your internal
carotid artery. The next one is your posterior circulation so your vertebrals and
your basilar arteries. These can form these nice fatty plaques there from a couple
different risk factors we will discuss.
These thrombi form when we didn't talk about that yet so there's particular things
called risk factors so I want to talk about primarily the risk factors that you can
modify okay because that's the things that we can treat later on. Hypertension is
the most common cause that can lead to thrombi. Diabetes mellitus, hyperglycemia
and hyperlipidemia are the other modifiable risk factors. Embolic causes are by far
going to be the most common causes for acute ischemic strokes and they can be
broken down into three different categories. The first one is arterial to arterial
emboli. The second one is the thrombotic causes that's a big one right all right.
There's not an effective atrial contraction because there's an arrhythmia there, so
atrial fibrillation we'll denote that as a fib or atrial flutter to some degree as
well. The other thing is what if there's a problem with the valve so you've got a
valvular issue there.
Paradoxical embolus: a very interesting embolus is one called a paradoxical
embolus. This usually happens with small cortical vessels, which are branches of
larger vessels. The other rare cause to be aware of is vasculitis dissection, which
is usually due to trauma. Dissection can occur in your vertebrals.
-Factors that can cause acute stroke include Factor 5 Leiden, Factor 5 Leiden,
prothrombin gene mutation, and polycythemia. -The clinical features of acute
scheming stroke depend on the vascular territory affected. -The most important
thing to do when someone you suspect has an acute ischemic stroke is to get
imaging. -CT scans are the most common type of imaging, and can show an ischemic
infarct. -After imaging is done, an MRI may be helpful for a more sensitive
diagnosis.
The echo looks at the heart and determines if there is any atrial thrombin,
ventricular thrombic or vegetations on the valve. The echo will also give the
individual's ejection fraction and look for motion wall motion abnormalities. The
most important thing is to make sure that if someone has low glucose, before giving
them tpa, they are corrected. If someone has an inr greater than 1.7 and is taking
warfarin, we need to take that into consideration when giving tpa. Polycythemia may
be a diagnosis for the individual's cause of stroke. Make sure they are
hypoglycemic because it can cause a stroke mimic. When giving tpa, you cannot be
hypoglycemic also coagulopathy must be checked to see if they are bleeding.
Checking their cbc may show signs of anemia or low platelets thrombocytopenia.
If you have a suspicion that a clot is due to vasculitis, then you should give the
tPA. The guidelines say you need an nih stroke scale score greater than four to be
able to get tPA. Vasculitis is a low on your differential and so you should check
for autoimmune causes and for infectious causes. If you have a suspicion that a
clot is due to vasculitis, then you should give the tPA.
A mechanical thrombectomy is an interventional radiology procedure that uses a
catheter to suck out or place a stent in a clot to remove it. The recommended
dosage of tPA is 0.9 milligrams per kilogram, but the procedure is preferable if it
is done within six hours of onset of ischemia. If the patient has stroke, tPA can
be effective in saving tissue around the area of the stroke.
