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DU PA Stroke
Duke PA Stroke
| Question | Answer |
|---|---|
| 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
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