1 Stroke Risk/Management

Question 1

What are some general uncontrollable risk factors for stroke?

Answer 1

• Age - for each decade after 55 risk factor doubles
• Gender - women more likely to have stroke compared to men (60%)
• Genetics/ ethnicity
  
  • past family history
  • African Americans twice as likely
  • native americans, asians, islander, more risk factor

Question 2

What are the modifialble/Controllable risk factors for stroke?

Answer 2

• BP : 140/90 increased risk
• Cardiac Disease: Atrial Fib (inc risk 5x)
• Lipids
• Diabetes: Inc Risk of stroke by 4x
• TIA: warning sign

Question 3

What are lifestyle modifications for stroke?

Answer 3

• Smoking
• Weight: 30% above average - significant
  
  • men 35-64, women 65-94
• Inacitvity

Question 4

What does FAST stand for?

Answer 4

• Facial weakness
• Arm Weakness
• Speach difficulty
• Time is brain

Other symptoms: Sudden numbness/weakness in face arm leg one side

Confusion, speaking/understanding trouble

Seeing in both or one eyes

Sudden sever headache

Sudden loss of balance

Question 5

What imaging is better for stroke

Answer 5

MRI for diagnosing than CT

-MRI takes longer and has delay not in ER

Question 6

What are the 2 zones created by Ischemia?

Answer 6

• Infarcted cored: severe local ischemia, hypoxia depetes oxygen and glucose = tissue necorsis
• Penumbra: Surrounding tissue ischemic areas. Cells in this area still recieve enough O2 and glucose to remain alive for limited time. Salagable region
  
  • still recieves blood flow from collateral arteries
  • must save

Question 7

What factors are a patient a candidate for a thrombolytic “clot buster” ?

Answer 7

• Recombinant Tissue Plasminogen Activator = r-tPA
  
  • ​Onset < 6 hours
  • CT negative for hemmorrhage
  • Not anticoagulated (INR < 1.5)

tPA: Dissolves clot and improves blood flow to brain that is O2 and glucose deproved

Question 8

What are the options if tPA is not administred?

Answer 8

• Keep BP <220/120
• Aspirin 325mg chewed
• DVT prophylaxis
  
  • Heparin 5000 SQ BID

Question 9

What is the course of action if tPA is administered?

Answer 9

• Keep BP < 185/110
• <3hrs
  
  • IV tPA = substantial outcomes
  • 3-4.5 hrs = moderate
  • 3-6 hours - Interarterial tPA (moderate)

Question 10

What are some surgical techniques for Acute stroke?

Answer 10

• Merci clot retrival (TIA’s and mild)
• Carotid endarterectory (mild strokes)
• Stereostatic microsurgery (AVMs/aneurysms
• Angioplasty (party blocked vessles)