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NESC 3227 Lecture Notes - Lateral Ventricles, Hypertension, Meninges

Course Code
NESC 3227
Kim Good

of 2
March 28th, 2013
1:08 PM
Laterality of vascular disorders on admission to hospital
56% of stroke patients in hospital are in left hemisphere
Laterality could be explained by the fact that left hemisphere ones are more noticeable, so
perhaps some right hemisphere patients just don't get reported and admitted to hospital
Non-hemorrhagic strokes
Are disease of the blood vessels (arteries)
o Clotting of blood in the vessel, slowly preventing blood flow into the brain
o Blood or fatty clog moved from larger to narrower vessel that blocks the blood supply
An arrhythmia can lead to a blood clot that would cause an embolism
Stroke care
Try to get them to a hospital within 3 hours
o Need CT and MRI
o In nova scotia patients within CDHA are 50% less likely to die from stroke
Treatment of acute infarct
First thing that needs to happen is a CT or MRI scan
o In order to try to rule out a hemorrhagic stroke, because if it's not IV tPAs can be given, and
functions as a clot buster (within 1-3 hours of stroke ideal time to administer this)
o Need to be sure to rule out hemorrhagic because if it is a hemorrhagic stroke and you give
tPA, it will thin your blood and make it bleed even more
Treatment of Transient Ischemic Attack (TIA)
Risk factors
o Older
o High blood pressure
o Signs of aphasia or hemiplegia
Are often confused with migraines and epilepsy
Many of these people will have a stroke at some point
o Risk highest in the first 10 minutes
Hemorrhagic CV event
Intracerebral event
o Bleeding into the lateral ventricle
Subarachnoid hemorrhage
o Bleeding between pia and arachnoid layers of the meningeal coverings of the brain
o Blood vessels become weakened, and blood will pool in these weak areas
o Often found within the circle of willis, but most often never found when they exist
o Most of these never rupture though
o When they're treated if they do rupture, there are often good outcomes
But 49% experience cognitive deficits 1 year after
Only 60% return to previous employment
When unruptured aneurysms are discovered by chance
You can clip the neck of the aneurysm
o But that's a very invasive procedure
Changes in lifestyle to manage the risk of rupture the most common treatment as all the surgical
procedures are quite invasive
Depression after stroke
7-79% of cases show depression after a stroke
o Prevalence can increase at 6 months and resolve at 2 years
This is known to impede recovery and rehabilitation efforts
It increases the risk for morbidity and mortality
Controversial results as to what side of stroke is more likely to induce depression