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Mechanisms that Produce a Stroke
Blockage of an artery (80% of strokes) --causes ischemia (inadequate blood flow) This deprives the brain of oxygen and glucose, and slows waste removal --affected brain tissue functions abnormally or stops functioning, and will die if ischemia persists Rupture of an artery (20% of strokes) --causes hemorrhage within or around the brain. This distorts, compresses, and tears surrounding tissue ventricle Lumen
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Stroke Risk Factors Relationship to pathology Directly or indirectly promote conditions that ‘encourage’ blockage or rupture of arteries supplying the brain: ventricle Development of atherosclerotic plaque Thrombus formation in heart or cerebral arteries Physical stress and direct damage to walls of large and small arteries Lumen
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Stroke Risk Factors Hypertension Heart Disease Diabetes Mellitus
Behaviors / Lifestyles ‘Who We Are’ Medical Conditions (treatable/controllable) Hypertension Heart Disease Myocardial Infarction Atrial Fibrillation Diabetes Mellitus Hyperlipidemia Carotid Stenosis Cigarette Smoking Physical Inactivity Excess Alcohol Use Obesity Age Gender Race/Ethnicity Family History Prior Stroke/TIA ventricle Lumen
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Stroke Risk Factors Behaviors or Lifestyles Cigarette Smoking
Increases risk about 1.5X The heavier the smoking, the greater the risk 5 years after quitting, risk matches that for nonsmokers Physical Inactivity Sedentary lifestyle is independent risk factor (30 min. moderate-to-vigorous daily exercise recommended) Excessive Alcohol Consumption ≥ 5 drinks/day and binge drinking Obesity Body mass index ≥ 30 doubles risk ventricle Lumen
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Stroke Risk Factors Medical conditions: treatable or controllable
Hypertension Blood pressure ≥ 140/90 mm Hg for extended periods Heart Disease Myocardial Infarction Atrial Fibrillation Diabetes Mellitus Fasting plasma glucose ≥ 126 mg/dL Hyperlipidemia Total cholesterol ≥ 240 mg/dL accelerates atherosclerosis Carotid Artery Stenosis ≥ 70% narrowing of the carotid artery in the neck Hypertension is the most significant treatable risk factor! increase risk of thrombus formation in heart, and thus embolic strokes ventricle
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Stroke Risk Factors Unmodifiable conditions: ‘Who we are’ Age
Risk of stroke doubles every 10 years after age 55 Gender Women’s first strokes occur when they are older Race/Ethnicity African-Americans 60% more likely to have a stroke, and twice as likely to die compared to other groups Family History First-degree relative with stroke Inherited defects influencing blood clotting Previous Stroke or TIA 1:6 ischemic stroke survivors has another stroke in 2 yrs Having a TIA increases the chances of stroke 10 times ventricle Lumen
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atherosclerotic plaque narrows lumen ( )
Basilar Artery atherosclerotic plaque narrows lumen ( ) plaque
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Aorta - Atherosclerosis Numerous ulcerated plaques
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atherosclerotic plaque and thrombus
Carotid Bifurcation atherosclerotic plaque and thrombus Thrombus on plaque surface plaque Thrombus on plaque surface
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Embolus Plugging Artery
Piece of thrombus that traveled from heart Arterial wall ventricle Lumen Plugged lumen
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Intracerebral Hemorrhage
ventricle Lumen Clotted blood
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Intracerebral Hemorrhage
CT Scan - 3 Hours after onset of symptoms ventricles
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