17: Stroke - Thompson

Question 1

define stroke

Answer 1

any disruption of blood flow to the brain

Question 2

2 types of stroke

Answer 2

• ischemic (thombosis*most common, embolic, hypoperfusion)

- hemorrhagic

Question 3

small stroke in deep penetrating arteries

Answer 3

lacunar stroke

Question 4

old definition of TIA

Answer 4

stroke-like symptoms that resolve in 24 hrs/ most in 3

• 10% have a full stroke in 90 d
• TIAs can go home; strokes stay- basically if symptomatic in ER they stay

Question 5

new definition of TIA

Answer 5

transient episode of neurological dysfunction caused by focal brain, spinal cord, or retinal ischemia, without infarction

Question 6

who stays/who goes home?

Answer 6

ABCD2

age
BP
TIA symptoms
duration and diabetics

more points - higher chance of leading to stroke and you should keep

Question 7

risk factors of thrombolic stroke

Answer 7

HTN
CAD
DM
vascular d
sickle cell
smoking
age

Question 8

risk factors of embolic stroke

Answer 8

a-fib
PFO (patent foramen ovale)
valve replacement
MI
age

Question 9

DDx- what can it be other than stroke?

Answer 9

seizure
hypoglycemia
metabolic d/o
encephalopathy
brain lesion 
sepsis
medication
spinal cord issues

Question 10

s/s stroke

Answer 10

• weakness on one side
• numbness on one side
• issues with speech, thought, motion
• balance problems
• HA
• seizure
• visual changes
• LOC
• NOT* syncope

Question 11

can think of word but hard to get out =

can’t think of words or sentence … speech clear but doesn’t make sense =

Answer 11

expressive/motor aphasia

receptive aphasia

Question 12

what does EMS do if they suspect stroke?

Answer 12

• identify possibility of CVA
• r/o other possibilities with blood sugar, Narcan
• stabilize/rapid transport
• notify hospital

Question 13

what does the ER do with a suspected stroke pt?

Answer 13

vitals/stabilize
quick H&P
immediate head CT
basic labs including coags
EKG

Question 14

only widely used treatment for the treatment of ischemic stroke

Answer 14

thombolytics - TPA (tissue plasminogen activator)

• clot buster for treatment of stroke
• 30% increase in good neuro outcome at 3 mo
• mortality the same
• 6% chanc of bleed compared to 0.6 if no TPA

doesn’t decrease mortality - decreases disability

Question 15

why do CT of head?

Answer 15

make sure that bleed isn’t the cause of stroke

(a bleed will be transported to center to watch or have surgery)

see on CT

• new bleed
• tumor or abscess
• stroke 6-48 hrs old, huge stroke

Question 16

***stroke window =

Answer 16

3 hr window from start of symptoms to start thrombolytics

window can be extended to 4.5 hrs to those under 80, not on a thinner, NIH stroke scale less than 25, non diabetic and no previous stroke

going to bed/napping starts the clock

Question 17

who can’t get TPA?

Answer 17

• bleed, tumor, huge stroke on CT with mass effect, brain swelling
• more than 3(to 4.5) hrs from onset of symptoms
• resolving symptoms or minor symptoms
• INR greater than 1.7

Question 18

______ of acute ischemic strokes get TPA

Answer 18

less than 1%

exclusion is usually time of onset to ER

Question 19

most common area

Answer 19

posterior area of internal capsule

• opposite paralysis
• opposite lower face paralysis

Question 20

____ independent at discharge

Answer 20

72%

50% drove 30 days later too