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Clinical Medicine II

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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