13. Stroke Flashcards
what are the 2 types of stroke?
ischemic, hemorrhagic
what are 5 warning signs of stroke?
- sudden confusion, trouble speaking or understanding
- sudden weakness of numbness of the care, arm, or leg esp on one side
- sudden trouble seeing in one or both eyes
- sudden trouble walking, dizziness, loss of balance or coordination
- sudden severe headaches without known cause
a few things that mimic stroke?
- seizures
- brain tumors
- migraine
- hysteria
- vestibulitis
- hypoglycemia
- hypertension/hypotension
- multiple sclerosis
heart attack v. stroke: level of pain?
heart: painful
stroke: no pain, often poor awareness
heart attack v. stroke: public awareness?
heart: public awareness of sx and need for action
stroke: poor recognition of sx and need for action
heart attack v. stroke: bleeding issues?
heart: bleeding into heart doesn’t occur
strok: brain hemorrhage is common
heart attack v. stroke: diagnosis?
heart: diagnosis is easy with EKG and cardiac enzymes
stroke: no ‘EKG’ for the brain
heart attack v. stroke: cause?
heart: in-situ plaque rupture
stroke: causes are numerous
heart attack v. stroke: similarities
time is critical
3 hour time limit for tPA
heart attack and stroke: brought in by ambu vs private car?
ppl brought by ambu are treated faster
what is the best treatment we have for stroke?
risk factor control, preventing an event
warfarin v aspirin for stroke prevention?
warfarin have to treat only 13 ppl to prevent 1 stroke. aspirin have to treat 77 to prevent 1 stroke.
3 causes of hemorrhagic stroke that is subarachnoid?
- aneurysms
- trauma
- drugs
6 causes of hemorrhagic stroke that is intracerebral?
- small artery disease/HTN
- anticoagulants
- trauma
- bleeding disorder
- vascular malformations
- tumors
5 ways to prevent hemorrhagic stroke?
- prevent inappropriate anticoag
- control HTN
- control smoking
- prevent trauma
- prevent illicit drug use
What’s a stroke?
A sudden neurological deficit caused by a blood vessel problem
what is the usual presentation of hypoglycemia?
mainly sleepiness - but can mimic a stroke
hemorrhage. v stroke on CT?
hemorrhage looks white, infarction looks darker grey
Perfusion MRI tells us what?
how much blood flow is actually reaching tissues despite flow occlusion. there may be anastomses, alternate flow.
what is the penumbra?
ischemic but still viable cerebral tissue. surrounds the ischemic center. where interventions are most likely to be effective.
causes of ischemic stroke?
Cardiomyopathies Atrial fibrillation Aortic atherosclerosis Carotid artery atherosclerosis Vertebral artery disease Arterial dissection Intracranial disease Hypercoagulable states Drugs Cerebral venous thrombosis
treatments for stroke due to clot?
tPA, catheters to open up occlusion
what kind of metabolic derangements would be bad in the setting of a stroke?
hyperglycemia, hyperthermia, hypoxia, dehydration
what is the time window for tPA?
3 hrs
what is the time window for intra-arterial thrombolysis?
6 hrs
what is the time window for mechanical devices?
8 hrs
what is the best stroke prevention we have?
warfarin for afib
why is cerebellar hemorrhage so deadly?
obstruction of the 4th ventricle –> higher ICP, compression of the brainstem
Cocaine and AVM: what’s the deal?
the AVM is congenital, but cocaine worsened the problem. hemorrhage.
what are some unique barriers to stroke care in this region?
- shortage of specialists
- low comfort level with stroke care, yet high level of ambivalence
- accuracy of dx is difficult in ambu or ED
- clinical/imaging information is not easily communicated
what recent act in VT aimed to close gaps in stroke care? what is the focus?
Act 61. Focused on ED phase of care
tx of ischemic stroke?
- carotid revascularization
- hemicraniectomy for massive hemispheric infarction (temporary removal of bone to relieve pressure)
- decompression for cerebellar infarction
tx of hemorrhagic stroke? both SAH and ICH
for SAH: clipping aneurysms
for ICH: rapid correction of coagulopathy, BP control, hematoma evacuation in select cases
what are the things that need to be verified before administering tPA?
- really an ischemic stroke? any reason they might get bleeding from this?
- verify timeframe.
