Summary of Stroke in Women



Summary of Stroke in Women

1) Teach patients’ acute CVA symptoms, so that they will present to the emergency room as soon as possible.

2) Speaker recommends TPA within 3 hours, and intra-arterial TPA within 6 hours; note that a recent “actual-use” study in large community hospitals showed harms>benefits.

3) Women have fewer CVA’s, but higher mortality (60% versus 34%); 102,000 deaths in 1999 .

4) It is helpful to recognize patterns of stroke. The posterior cerebral artery forms the border between anterior and posterior circulation – this artery can be involved in either a carotid or a vertebral artery stroke.

5) Characteristic patterns of stroke:

a) anterior cerebral artery: LE weakness, amaurosis fugax

b) middle cerebral artery: neglect of the left side (for right MCA), or speech problems for left MCA

c) posterior cerebral artery: ipsilateral facial and contralateral LLE and LE signs

6) The “watershed areas” on the edge of the arterial circulation occur in the frontal and occipital lobes, and are most prone to hypoxia. Acceptable to allow blood pressure to be as high as 210/120 in acute thrombotic CVA.

7) Lacunar CVA’s occur secondary to lipohyalinosis (the end-arteries “fill with goo”); small CVA’s affect large areas. Therefore, anticoagulants don’t work, and aspirin has limited benefit.

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