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Stroke
Clinical Medicine II
| Question | Answer |
|---|---|
| Insufficient blood flow into part or all of the brain | stroke |
| Names of stroke | CVA, AIS, and today CVI |
| Stroke sxs | sudden numbness/weakness, sudden confusion, or difficulty speaking, sudden deterioration of vision in one or both eyes, sudden difficutly walking, dizziness, loss of coordination, balance, severe HA w/ no known cause |
| What does F.A.S.T. stand for | face, arms, speech, time |
| How many strokes are caused by ischemia, hemorrhagic? | 80% to 20% |
| Where are strokes more frequently seen | African Americans, Asians, and 2/3 >65 yo |
| Four types of strokes | thrombotic, embolic, lacunar, watershed infarction |
| What are the three was ways a thrombotic strokes happens | mural thrombosis at site of atherslerosis and obstructs, rupture of a plaque or disruption causes an embolism, dissection: hemorrhage into a plaque |
| What are the two mc originations of an embolic stroke | cardiac or arterial origin |
| What are common cardiac causes of a embolic stroke | aFib, patent foramen ovale, prosthetic valves, endocarditis, cardiomyopathy |
| What will we commonly see on a MRI with an embolic stroke | signs of a previous CVI commonly ~20% all ischemic CVIs |
| Where do lacunar strokes occur | lenticulostriate arteries |
| Small, deep, penetrating branches of middle cerebral artery (MCA) | lentriculostriate arteries |
| What small vessel disease are often associated w/ dementia | lacunar strokes or lenticulostriate arteries |
| How do lacunar strokes get their names | as the necrotic brain cells are reabsorbed, leaves a very sm. Cavity/lake or lacune (French) in the brain |
| What are known as border zone infarcts | watershed infarcts |
| How do watershed infarcts occur | relative hypoperfusion in most distal arterial territories that can produce bilateral sxs |
| MC causes of watershed infarcts | hypotension, or preop situations, overzealous tx of chronic HTN |
| What are RF’s for strokes | HTN, CAD, DM, smoking, alcohol, etc, HTN is most common, aFib, |
| What is the j-shaped relationship | b/w alcohol and stroke, 1-2 units/day ↓ risk but binge/heavy drinking significantly ↑ risk of having a stroke |
| What is the name of moderately ischemic tissue that is partially perfused by collateral BV’s and can be rescued | ischemic penumbra |
| What are some less common causes of stroke in younger pt’s | cocaine use, recent trauma, Hypercoagulable states, sickle cell, fibromuscular dysplasia |
| What is a TIA | transient ischemic attack |
| Classifications of TIA | transient, so only temporary or reversible, usually <1hr median duration is 14mins in carotid and 8 mins in vertebrobasilar ischemia |
| What is the “cut off” of a TIA dx vs. stroke | usually less than 2hrs of sxs |
| What are the classifications of the ABCD2 score | >60 1pt, BP >140/90 1pt, unilateral weakness 2pts, speech impairment 1 pt, DM 1 pt |
| How do we make dx of TIA | it is a clinical dx, by pt’s hx, usually sxs have stopped prior to seeing pt, if not: stroke? |
| What is the assessment tool to admit pt or not | ABCD2 score <4 send home on aspirin |
| TIAs involving the posterior/vertebrobasilar vascular territory | VBI or vertebrobasilar insufficiency |
| What can VBI sxs present as | labyrinthitis, vestibular neuronitis, benign paroxysmal positional vertigo |
| What does true vertigo look like | positional, paroxysmal, no diplopia, dysarthria, dysphagia, paresthesis or HA |
| When should we think VBI | dizziness or vertigo w/ no other cause |
| What is RIND | reversible ischemic neurological defect: >24hrs, but <3 wks, a stroke but reversible |
| What is the MC artery stroke occurs in | MCA or middle cerebral artery: affects face, arms>leg, conjugate eye deviation toward infarct, trouble speech production and understanding |
| Which area is for speech production, understanding | Brocas, Wernickes |
| Signs for PICA infarcs | vertigo, ataxia, nystagmus, dyscongiage gaze |
| Signs of PCA occlusion | occipital lobe: vision, and hemianopsia signs, usually more subtle visual disturbances (can’t read, or finish a word) |
| What is wallenberg’s syndrome | Lateral medullary syndrome d/t occlusion of the vertebral artery: ipsilateral facial numbness, weakness of the palate, pharynx, vocal cords, loss of pain and temp |
| When will we see “locked-in-syndrome” | w/ involvement of the Pons: quadriplegia, aphonia, impairment of horizontal eye movement |
| Contralateral weakness and sensory loss involving primarily the lower extremity to a lesser extent the arm | Anterior communicating artery |
| Causes of blockage of the ACA | vasospasm post SAH d/t ACA or ACoA aneurysm |
| Workup for a stroke | ABC’s, finger Blood gluc, quick stroke scale, EKG, CBC, INR, Electrolytes, non-contrast Head CT, O2, saline, bp>200 or DBP>120, neuro consult, ASA if HCT – for bleed |
| Tx of an ischemic blood clot, window? | TPA Tissue plasminogen activator, window <3hrs |
| What is the administrations of TPA | stroke scale<8: intravenous systemic >8 <3hrs, intra-arterial right in front of the clot |
| If suspect a stroke, what is 1st test we want | non-contrasted head CT to r/o a hemorrhagic stroke (head bleed) MC is nl. |
| Remember to look over CT scans | :D |
| 2nd step post nl non-contrast HCT | CT angiogram w/ contrast to determine site of thrombus, helps determine tx |
| Problem w/ contrast | it can be nephrotoxic (check creatinine) and allergenic |
| Tx of stroke | TPA IV <3hr TPA IA <6hr faster is better |
| MERCI procedure | Mechinaical Embolus Removal in Cerebral Ischemia, use w/ CT angiogram <6hrs |
| From door to tx, what is the timeframe we want to achieve | 60mins |
| TPA CI’s | any reason for bleeding, Intracranial tumor, etc |
| Cause of a hemorrhagic CVI | untreated chronic HTN, AVM, or hemorrhagic tumor |
| Sxs of hemorrhagic CVI | Will have a HA (ischmic won’t have a HA), |
| Names for a hemorrhagic stroke | hemorrhagic CVI, or intracerebral hemorrhage (ICH) |
| What is moyamoya | arteriovenous malformation, “ puff of smoke” w/ CT angiogram |
| What is the MC location for a SAH | Anterior communicating artery |
| What does hydrocephalus in a SAH mean | ↑ICP |
| Pahto of SAH | bleeding into subarachnoid space from a ruptured aneurysm or vascular malformation |
| What is the glasgow coma scale indicated for intubation | 8 |
| What is developed for trauma but is a convenient way to communicate a pt’s neuro exam | Glasgow coma scale |
Created by:
streetsmarts
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