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DU PA Stroke

Duke PA Stroke

Stroke is the __ leading cause of death in the United States third
Definition of stroke acute neurological deficit of vascular etiology with symptoms lasting longer than 24 hours
Differential diagnosis for stroke infection, autoimmune, metabolic, neoplastic, trauma, epilepsy, dymyelinating disease, psychiatric disease
15-20% of all strokes are __ hemorrhagic
80-85% of all strokes are __ ischemic
most common cause of primary parenchymal intercerebral hemorrhage hypertension
typical locations for primary parenchymal intercerebral hemorrhage due to hypertension thalamus, basal ganglia, pons, cerebellum
hemorrhage in the thalamus or basal ganglia can present as contralateral motor/sensory deficit, aphasia, neglect, depressed LOC with mass effect, IVC extension
hemorrhage in the cerebellum may present as ipsilateral ataxia, depressed LOC
hemorrhage in the pons can present as vertigo, diplopia, crossed signs, depressed LOC
Amyloid angiopathy presentation elderly, hx of dementia, episodic worsening, no hx of hypertension, acute limb weakness
deposits in small blood vessels causeing them to become more friable. multiple microhemorrhages are common. Patient may present with dementia amyloid angiopathy
general presentation of a patient with venous infarction young woman, oral contraceptives, smokes, has headaches, aphasia, limb weakness
Aneurysmal Subarachnoid Hemorrhage presentation middle aged, abrupt/severe headache, meningismus, depressed consciousness, non-focal neurological examination
Atheroembolic Strok characteristics single vascular territory, warning signs, stepwise progression
atheroembolic presentation older adult, hx of hypertension/CAD, trasnient focal neurologic symptoms (aphasia, unilateral limb weakness), normal head CT, doppler ultrasound-high grade stenosis of internal carotid artery
most common cause of large vessel atheroembolic stroke local atherosclerosis
problem with articulation of speech (slurred speech) dysarthria
problem with language (formation or perception) aphasia
cranial nerves affected on one side with peripheral weakness on the contralateral side indicates a __ brainstem problem
the deeper you go into the brain a small lesion will affect a __ peripheral area larger
the more superficial you go in the brain a small lesion will affect a __ peripheral area smaller
what turns white on CT rocks, blood, contrast
classic lacunar syndromes pure motor stroke, pure sensory stroke, ataxic hemiparesis, clumsy hand-dysarthria
cardioembolic stroke presentation older adult, hx of a-fib, aphasia, hemiparesis/hemisensory deficit affecting face and arm, carotid ultrasound normal
cardioembolic stroke characteristics maximal deficit at onset, multiple vascular territories, cardioembolic source, hemorrhagic infarction
cardioembolic sources atrial fibrillation, cardiomyopathy, acut myocardial infarction, valvular heart diseae
TIA definition acute focal neurological deficit, symptoms/signs resolve within 24hrs, ischemic etiology
if a patient presents with a TIA 63% of strokes will occur within __ the first week
if a patient presents with a TIA 85% of strokes will occur within __ the first month
if a patient presents with a TIA there is an 11% risk of stroke within __ three months
60% of stroke deaths occur in __ women
__ are more likely to have a stroke men
non-modifiable risk factors for stroke older, african american, male, with a family history of stroke
the most common of the documented treatable risk factors for stroke hypertension
normal BP by JNC-7 guidelines <120/80
pre-hypertension according to JNC-7 120-139/80-89
stage 1 hypertension according to JNC-7 140-159/90-99
stage 2 hypertension according to JNC-7 >160 systolic or >100 diastolic
lifestyle modifications for hypertension weight reduction, DASH diet, sodium reduction, physical activity, moderate alcohol consumption
Atrial fibrillation risk stratification system CHADS
CHADS stands for CHF, Hypertension, Age>75, Diabetes, Stroke or TIA
when do you use aspirin alone for prophylaxis in someone with atrial fibrillation low risk on CHADS score
when do you use aspirin or warfarin in someone with atrial fibrillation moderate risk on CHADS score
when do you use warfarin in someone with atrial fibrillation high risk on CHADS score
what is the formula for measuring % stenosis 1-(A/B) with A being the stenosed diameter and B being the normal diameter
__ complications are not affected by glucose control in diabetics macrovascular
how do you decrease the risk of stroke in diabetics tight BP control, treatment with satins
in general there is no benifit for using __ for stroke prophylaxis in the low risk patient. The risks outweigh the benifits aspirin
treatment with TPA must take place withing __ of symptom onset of stroke or TIA 3 hours
to receive TPA a head CT without evidence of __ or other complicating lesion must be done hemorrhage
to receive TPA the patient must be over the age of __ 18
TPA can take an ischemic stroke and turn it into a __ stroke, if patients are not selected for this therapy carefully hemorrhagic
Cerebral blood flow (CBF)= Mean Arterial Pressure (MAP)/Cerbral Vascular Resistance (CVR)
if you __ in an acute ischemic stroke you may cause harm b/c the cerebral blood flow will be reduced lower blood pressure
if you lower the Mean Arterial Pressure (MAP) in a patient with an acute ischemic stroke the __ will also be lowered and harm may occur Cerebral Blood Flow (CBF)
each 10mmhg decrease in systolic BP is associated with __% decrease stroke risk 28
Created by: bwyche