13. Stroke

Question 1

what are the 2 types of stroke?

Answer 1

ischemic, hemorrhagic

Question 2

what are 5 warning signs of stroke?

Answer 2

• 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

Question 3

a few things that mimic stroke?

Answer 3

• seizures
• brain tumors
• migraine
• hysteria
• vestibulitis
• hypoglycemia
• hypertension/hypotension
• multiple sclerosis

Question 4

heart attack v. stroke: level of pain?

Answer 4

heart: painful
stroke: no pain, often poor awareness

Question 5

heart attack v. stroke: public awareness?

Answer 5

heart: public awareness of sx and need for action
stroke: poor recognition of sx and need for action

Question 6

heart attack v. stroke: bleeding issues?

Answer 6

heart: bleeding into heart doesn’t occur
strok: brain hemorrhage is common

Question 7

heart attack v. stroke: diagnosis?

Answer 7

heart: diagnosis is easy with EKG and cardiac enzymes
stroke: no ‘EKG’ for the brain

Question 8

heart attack v. stroke: cause?

Answer 8

heart: in-situ plaque rupture
stroke: causes are numerous

Question 9

heart attack v. stroke: similarities

Answer 9

time is critical

3 hour time limit for tPA

Question 10

heart attack and stroke: brought in by ambu vs private car?

Answer 10

ppl brought by ambu are treated faster

Question 11

what is the best treatment we have for stroke?

Answer 11

risk factor control, preventing an event

Question 12

warfarin v aspirin for stroke prevention?

Answer 12

warfarin have to treat only 13 ppl to prevent 1 stroke. aspirin have to treat 77 to prevent 1 stroke.

Question 13

3 causes of hemorrhagic stroke that is subarachnoid?

Answer 13

• aneurysms
• trauma
• drugs

Question 14

6 causes of hemorrhagic stroke that is intracerebral?

Answer 14

• small artery disease/HTN
• anticoagulants
• trauma
• bleeding disorder
• vascular malformations
• tumors

Question 15

5 ways to prevent hemorrhagic stroke?

Answer 15

• prevent inappropriate anticoag
• control HTN
• control smoking
• prevent trauma
• prevent illicit drug use

Question 16

What’s a stroke?

Answer 16

A sudden neurological deficit caused by a blood vessel problem

Question 17

what is the usual presentation of hypoglycemia?

Answer 17

mainly sleepiness - but can mimic a stroke

Question 18

hemorrhage. v stroke on CT?

Answer 18

hemorrhage looks white, infarction looks darker grey

Question 19

Perfusion MRI tells us what?

Answer 19

how much blood flow is actually reaching tissues despite flow occlusion. there may be anastomses, alternate flow.

Question 20

what is the penumbra?

Answer 20

ischemic but still viable cerebral tissue. surrounds the ischemic center. where interventions are most likely to be effective.

Question 21

causes of ischemic stroke?

Answer 21

Cardiomyopathies
Atrial fibrillation
Aortic atherosclerosis
Carotid artery atherosclerosis
Vertebral artery disease
Arterial dissection
Intracranial disease
Hypercoagulable states
Drugs
Cerebral venous thrombosis

Question 22

treatments for stroke due to clot?

Answer 22

tPA, catheters to open up occlusion

Question 23

what kind of metabolic derangements would be bad in the setting of a stroke?

Answer 23

hyperglycemia, hyperthermia, hypoxia, dehydration

Question 24

what is the time window for tPA?

Answer 24

3 hrs

Question 25

what is the time window for intra-arterial thrombolysis?

Answer 25

6 hrs

Question 26

what is the time window for mechanical devices?

Answer 26

8 hrs

Question 27

what is the best stroke prevention we have?

Answer 27

warfarin for afib

Question 28

why is cerebellar hemorrhage so deadly?

Answer 28

obstruction of the 4th ventricle –> higher ICP, compression of the brainstem

Question 29

Cocaine and AVM: what’s the deal?

Answer 29

the AVM is congenital, but cocaine worsened the problem. hemorrhage.

Question 30

what are some unique barriers to stroke care in this region?

Answer 30

• 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

Question 31

what recent act in VT aimed to close gaps in stroke care? what is the focus?

Answer 31

Act 61. Focused on ED phase of care

Question 32

tx of ischemic stroke?

Answer 32

• carotid revascularization
• hemicraniectomy for massive hemispheric infarction (temporary removal of bone to relieve pressure)
• decompression for cerebellar infarction

Question 33

tx of hemorrhagic stroke? both SAH and ICH

Answer 33

for SAH: clipping aneurysms

for ICH: rapid correction of coagulopathy, BP control, hematoma evacuation in select cases

Question 34

what are the things that need to be verified before administering tPA?

Answer 34

• really an ischemic stroke? any reason they might get bleeding from this?
• verify timeframe.