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