cerebrovascular accidents: TIA and ischemic stroke
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
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show | hemorrhagic and ischemic
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show | transient ischemic attack and stroke
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ischemic stroke | show 🗑
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show | bleeding occurs inside or around the brain tissue
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show | artheromas in major cerebral arteries in areas of turbulent flow
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emboli lodged in cerebral artery because of: | show 🗑
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show | bleeding in space between brain and skull
caused by aneurism
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symptoms of SAH | show 🗑
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show | nuchal regidity, paralysis
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Tx goal of SAH | show 🗑
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Tx choice for SAH | show 🗑
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show | phenytoin
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Tx of rebleeding | show 🗑
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Tx of hydrocephalus | show 🗑
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show | age (risk doubled every decade after 55)
gender M>F
low birth weight
race black>hispanic>white
genetics - paternal history
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show | HTN, smoking, alcohol, diabetes, A fib, dyslipidemia, CHD, sickle cell, post menopausal therapy, obesity, diet, body fat distribution, physical inactivity
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show | treat modifiable risk factors
aspirin use recomended in women >65y/o with high stroke risk
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assessment of TIA and ischemic stroke | show 🗑
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show | identifies location of ischemia
guides theraputic decisions
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NIHSS score <20 | show 🗑
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NIHSS score >22 | show 🗑
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transient ischemic attack (TIA) | show 🗑
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show | rapid symptom onset
Sx resolves w/i 24h usually in 15mins
no residual neurologic deficit
warning sign of impending stroke
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show | permanent focal neurologic lesion (cell death has occured)
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course of stroke | show 🗑
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symptoms of TIA and stroke | show 🗑
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F.A.S.T. | show 🗑
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acute Tx of TIA | show 🗑
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TIA goals for therapy | show 🗑
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show | ASA 325mg po qd (immediately)
(clopidigrel 75mg po qd if allergic to ASA)
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benefits of ASA | show 🗑
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show | Alteplase (tPA) MUST ADMINISTER WITHIN 3 HOURS OF SYMPTOM ONSET (based on efficacy and safety)
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show | infuse 0.9mg/kg IV over 60 minutes within 10% of the dose given as a bolus over 1 minute (max bolus dose 90mg)
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show | prevent complications
reduce long standing neurological deficits
physical therapy/occupational therapy
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additional Tx for ischemic stroke | show 🗑
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acute ischemic stroke BP drugs | show 🗑
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antithrombotic therapy in acute ischemic stroke | show 🗑
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secondary stroke prevention general principles | show 🗑
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show | ASA 50-325mg monotherapy OR
dipyridamole 200mg ER + ASA 25mg (aggrenox) BID OR
clopidigrel 75mg po qd monotherapy
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show | aggrenox or plavix monotherapies are more recommended than ASA alone
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show | clopidigrel more prefered by neurologists due to less adverse reactions
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show | HA, GI, dizziness, fainting, more bleeding
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ASA + clopidigrel | show 🗑
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ASA + aggrenox | show 🗑
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show | use them they are good for you decrease risk of stroke by 18% with or without CHD
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