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Coumadin

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-Thrombolytic agents to dissolve clots:

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-1-2 hours after onset

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-Surgery:

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-Such as carotidectomy

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NIH stroke scale

Measuring took that determines what level a patient is functioning 24h after stoke

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cerbral vascular accident (CVA) or stroke

•Disrupts blood flow to the brain.

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•Several types- ischemic, thrombosis, embolism

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Ischemic stroke

-Occlusion of an artery, usually the MCA or the carotid, causing a reduction or cessation of blood flow.

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-Caused by atherosclerosis, proliferation of cells, high cholesterol

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Thrombosis

Type of CVA

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-Occurs from an accumulation of platelets and fatty plaques on the vessel wall at the site of the occlusion.

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-Sudden, increases in severity over time

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-Higher incidence among people with diabetes mellitus and hypertension

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-A frequent signal of impending

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thrombosis is the transient ischemic

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attack (TIA

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transient ischemic

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attack (TIA)

-temporary disruption of the

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blood flow that produces transient

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neurological signs indicating that platelet formation is underway.

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-A TIA is experienced as a blurred vision, numbness, weakness, speech difficulty, imbalance of gait, etc.

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-A TIA lasts less than one hour. It is completed within 24 hours.

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-Mini stroke that may signal impending thrombosis

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Thrombectomy / angiogram

-Surgery to remove a blood clot from inside an artery or vein to avoid a permanent blockage in the vein or artery.

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-surgeon makes an incision into a blood vessel. The clot is removed and the blood vessel is repaired. This restores blood flow. In some cases, a balloon or other device may be put in the blood vessel to keep it open

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-Risks include bruising at the puncture site, blood clot could travel deeper into the artery or vein, and stroke

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Embolism

type of CVA

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-Platelets and fatty plaque break off a vessel and travel until they become stuck in a smaller artery.

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-The heart is the most common source of embolic material

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-May also be secondary to

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trauma

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-No warning signs

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infarction

-When metabolism is prohibited for 2 minutes the result is death (necrosis) of neural tissue. This necrotic tissue is called an infarct.

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-Damaged tissue softens and liquefies;

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this waste is removed,

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probably by the astroglial

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cells that are supportive of

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neuron.

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-Gliosis- waste removal. Leaves a cavity in the cortex.

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Hemorrhage

-Associated with hypertension, aneurysm, or AVM. It also accompanies TBI.

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-Rupture of a cerebral blood vessel. There is no blood flow above the site of the rupture

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-2 types- Intracerebral hemorrhage and subarachnoid hemorrhage

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Intracerebral hemorrhage

invades the regions of the thalamus, internal capsule, and lenticular nuclei. There is usually a loss of consciousness, precipitated by an increase in blood pressure during physical activity or emotional stress. Most susceptible are the branches of the circle of Willis and basilar artery.

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subarachnoid hemorrhage

Occurs in the pia-arachnoid space surrounding the brain. Can be caused by a ruptured aneurysm.

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Aneurysm

dilated blood vessel that stretches and weakens the vessel wall caused by sudden exertion.

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Arteriovenous Malformation (AVM)

-a tangle of blood vessels in the brain or on its surface that diverts blood from the arteries to the veins. It is:

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-A congenital condition

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-Not signaled until bleeding or seizures occur

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-A bleed into subarachnoid space

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-A weakening of the arterial walls where capillary network between arteries and veins is absent

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-Usually less damaging than an aneurysm.

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Hematoma

accumulation of blood caused by a hemorrhage

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What are tumors?

-Abnormal mass of tissue

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-Headache is one of the earliest signs precipitated by stopping, straining, or exercising.

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-Other signs include:

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◦Nausea and vomiting N/V - sign

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◦Sensory impairments

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◦Dulled mental functioning

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-A common source is the supportive cells through the CNS.

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-Classified according to their tissue origin

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What are the types of tumors?

-May be malignant (cancerous) or benign (non cancerous).

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-Degree of malignancy is indexed on a scale of I (benign) - IV (high grade and malignant)

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-Primary tumors result from uncontrolled growth of glial or meningeal cells.

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Glial cell tumors (gliomas)

the most frequent form of brain tumor. One common form of gliomas is an astrocytoma (a benign, slow growing tumor). Another common type is a glioblastoma multiforme, a malignant and fast growing tumor.

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Meningioma

benign tumor that arises from the meninges. If it is removed early enough, so that it does not impinge on other structures, it may have no impact on cortical functioning.

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Secondary or metastatic tumors

spreading tumors that typically arise from elsewhere in the body, and travel to the brain via the blood supply, or lymphatic system. They are usually secondary to breast, lung, and skin cancers.

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Episodic Memory

person's unique memory of a specific event. (graduation)

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Semantic Memory

refers to portion of long-term memory that processes ideas and concepts that are not drawn from personal experience. Includes things that are common knowledge and other basic facts acquired over a lifetime. (ex. zebras fur is born brown)

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Procedural Memory

a part of long-term memory that is responsible for knowing how to do things such as tying your shoes or cooking an omelet.

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Lexical Memory

refers to our ability to remember words/vocabulary of a language.

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What is a cerebral angiogram used for?

Evaluates cerebral vascular structures and is used for arterial, venous, and lymphatic circulation studies.

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Used to diagnose vascular (blood vessel) disorders

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¨Thrombosis

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¨Hemorrhages

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¨Aneurysms

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¨embolism

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Cerebral angiogram procedure

-A radiopaque (glow in the dark) contrast substance is injected into the femoral artery (through catheter).

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-The contrast substance follows the path of the flowing blood.

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-Radiographs at various angles are used to visualize the major cerebral arteries and blood flow through these arteries. Any traffic jams?

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Cerebral angiogram risk factors

-Significant risk factor for the procedure=stroke due to the invasive nature of the procedure.

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-Iodine in the contrast medium may cause a marked allergic reaction in some patients=>testing for hypersensitivity is indicated before the radiopaque substance is used.

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-After the procedure, the patient is monitored for signs of bleeding at the puncture sight, and bed rest for a number of hours is required.

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Computed Tomography (CT) scan - complex explanation

-Narrow beam of X-rays of the brain are taken at different angles, then are compiled by 2 computers producing cross-sectional images of the brain.

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-The radiation that emerges from the other side of the head is recorded by detectors which measure the quality and quantity of the transmitted radiation.

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-Each image is displayed with varying shades of white, grey, and black to correlate with various areas of x-ray attenuation

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CT scan - simplified explanation

A series of X rays are used to examine the head, and an image is created based off the quality and quantity of absorbed X rays

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What can a CT scan detect?

Tumor masses, infarctions, bone displacement, accumulations of fluid

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Magnetic Resonance Imaging (MRI) scan - complex explanation

In our bodies, H atom movement are random. When they are placed in a large external magnetic field, they align in a single plane. When the electical field ends, they return to their previous positions and release electromagnetic signals. A computer collects these signals and converts them into an image based off differences in relaxation.

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Magnetic Resonance Imaging (MRI) scan - simplified explanation

Uses electromagnetic fields and radio waves to produce a 3 dimensional image of the brain

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MRI advantages

-Superior soft tissue contrast resolution

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-Ability to image in multiple planes

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-Lack of ionizing radiation hazards

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-Considered superior to CT for most CNS abnormalities (particularly those of the posterior fossa, brainstem, and spinal cord)

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-The procedure usually does not require a contrast medium but may employ an intravenous injection of gadolinium

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MRI disadvantages

-Many patients experience claustrophobia, so about 15% will require an anxiolytic (anti-anxiety medication), and children may need a sedative as well

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-Motion artifacts are a disadvantage and patients must remain motionless for high quality imaging.

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-Images may also be degraded by motions related to heart contractions, respirations, and bowel peristalsis.

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-Contraindications to MRI are pacemakers, metallic aneurysm clips, and some metallic prosthesis and foreign objects

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Positron Emission Tomography (PET) scan - complex explanation

-A radionuclide and glucose solution is injected into the body

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