PATHOPHYSIOLOGY

Precipitating factors: Hypertension

Atrial fibrillation Atherosclerosis Stenosis of the artery Blood swirls around the irregular surface of the plaques, causing platelets to adhere to the plaque. [thrombus formation] Obstruction of vessel lumen [emboli formation] High cholesterol Diabetes Atherosclerosis Smoking Alcohol Obesity Carotid Artery Predisposing factors: Disease Age Gender Race Heredity Pregnancy Sudden onset of manifestations Hemorrhagic stroke Bleeding into brain tissue Rupture of cerebral vessel

Emboli detachment Travels through the cerebral circulation until it lodges & occludes a cerebral artery Ischemic stroke

Slow onset of manifestations

Sx: occipital or nuchal headache, vertigo or syncope, paresthesias, transient paralysis, epistaxis, and retinal hemorrhages

Cells in the center of the stroke area, or the core, die almost immediately after the stroke onset [primary neuronal injury] A cascade of biochemical processes occurs within minutes of cerebral ischemia. Local acidosis occurs.

Sx: apahsia, dysarthia, dysphagia, apraxia, visual changes, homonymous hemianopia, Horners Syndrome, agnosia, unilateral neglect, sensory deficits, behavioral changes, incontinence

Membrane depolarization occurs.

Results in influx of calcium and sodium.

May lead to temporary neurologic deficits

Cytotoxic edema & cell death [secondary neuronal injury]