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NMSK Exam 2: Neuro > 2. Strokes > Flashcards

2. Strokes Flashcards

1
Q

What are the MC RF for a stroke?

A
  1. Previous TIA/stroke
  2. Pregnancy and post-partum
  3. ↑ Age
  4. Athersclerosis (HTN, smoking, DM, hyperlipidemia)
  5. Cardiac disorders
  6. Drug abuse (IV, cocain, meth)
  7. Hypercoagulable states
  8. Inflammatory disorders
  9. Migrane
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2
Q

Which 6 cardiac disorders are a risk factor for stroke?

A
  • 1) Valvular heart disease (dysf. or prosthetic valve)
  • 2) Cardiac dysrhythmia (i.e., atrial fibrillation)
  • 3) Mural thrombus
  • 4) Endocarditis
  • 5) Atrial myxoma
  • 6) Interatrial septal abnormalities
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3
Q

Which 6 inflammatory disorders are risk factors for stroke?

A
  • 1. Giant cell arteritis
  • 2. SLE
  • 3. Polyarteritis Nodosa
  • 4. Granulomatous Angitis
  • 5. Syphilitc Arteritis
  • 6. AIDS
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4
Q

Types of stroke

A
  1. Ischemic stroke (MC)
  2. Hemorrhagic stroke
    1. Intracerebral hemorrhage
    2. Subarachnoid hemorrhage
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5
Q

What are the symptoms of a stroke occuring in the right hemisphere?

A
  1. Left hemineglect (patient cannot recognize the L side of body. Ex. if you touch the R and L hand => ask which I’m touching => they will only say R)
  2. Left-sided sensory and motor symptoms
  3. Left visual field cut
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6
Q

What are the symptoms of a stroke occuring in the left hemisphere?

A
  1. Aphasia
  2. Right sided sensory and motor symptoms
  3. Right visual field cut
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7
Q

What are the symptoms of a stroke occuring in the cerebellum?

A
  1. Ipsilateral ataxia
  2. Vertigo
  3. Nystagmus
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8
Q

What are the symptoms of a stroke occuring in the brainstem?

A
  1. CN findings w/ contralateral hemisensory or hemimotor sx’s
  2. Vertigo
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9
Q

Primary Prevention for a Stroke patient

A
  1. Manage the acute stroke itself
  2. Prevent or control medical complications, which cause 50% of the deaths due to stroke (pneumonia, DVT, PE, UTI)
  3. Rehabilitation
  4. Prevent another stroke
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10
Q

What are the first steps when managing a stroke patient: when a stroke pt NTRs ER?

A
  1. ABCs : airway, breathing & circulation
    1. Elevate HOB to 30 degrees
      1. O2 at 2 liters per NC
  2. Vitals: BP, pulse, cardiac monitor, EKG and O2 saturation
  3. IV access to ALL stroke pts
  4. Neuroexam and rapid transport to CT scan
  5. Labs and EKG
  6. Get pts weight
  7. ID cause and treat fever if present.
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11
Q

How should acute HTN be treated with an ischemic stroke?

Why?

A
  1. Do NOT be treat: let it be high for a couple of weeks.
  2. Area of infarction may have lost autoregulatory function, so that “normal” BP may be relatively hypotensive in the brain. Thus, the brain is trying to ↑ BP to regulate tissue.
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12
Q
  1. What stroke patients should get IV access
  2. What should not be included in the IVF’s?
  3. What about if tPA is needed to be given?
A
  1. All stroke patients need to have IV access
  2. IVF’s should NOT include glucose because hyperglycemia => worse neurologic outcomes
  3. If tPA is needed, 2 IV access sites will be needed to eliminate venipuncture after infusion
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13
Q

What labs are needed in a stroke patient?

A
  1. CBC + differential
  2. PT/PTT
  3. Full chem panel + fingerstick glucose
  4. UA
  5. CXR
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14
Q

John has a stroke. Shortly after, his BP is 165/90. How should you treat?

A

Do not treat. Leave them alone and let it be high for a couple of weeks.

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15
Q
  1. What is the NIH stroke scale used for?
  2. What is the score range?
A
  1. Access risk of bleeding (hemorrhaging) and whether or not to give tPA/ intra-arterial intervention.
  2. 0 (normal) ==> 42 (coma)
    1. Less than 10 = 2-3% risk of hemorrhage
    2. > 20 = 17% risk of hemorrhage.
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16
Q

What questions are important when obtaining a history in a stroke patient?

A
  1. Last time without symptoms?
  2. Did patient have head trauma/seizure when started having symptoms?
  3. Taking warfarin/heparin or a NOAC?
  4. Does pts have sx that suffest MI or intracranial hemorrhage?
17
Q

What must be done if a fever is present in a patient presenting with a stroke?

A

Must be treated, as fever will worsen stroke outcome long-term

18
Q

If the CT = normal in a patient believe to have suffered a stroke, what are some other causes you should consider?

A

Seizure, migraine, hypoglycemia.

19
Q

If the CT = cerebral infarction in a patient believe to have suffered a stroke, what should you consider?

A

Ischemia and infarction can take up to 3 days to show on CT.

  • It patient reports they have only had sx for 2 hours, but shows infarction = question. Maybe previous stroke?
  • If confirmed with history and timing matches = give tPA if needed.
20
Q

Pt shows cerebral infarction on CT, but reports having sx for only 2 hours.

What should you do?

A

Question diagnosis of a stroke or could have been a previous stroke

21
Q

Pt shows cerebral infarction on CT and timing is consistent with the fact that infarction can take up to 3 days to show.

What should you do?

A

If meets criteria for TPA => give.

22
Q

Administering tPA for the treatment of acute ischemic stroke should be given within _______ hours of the onset of symptoms.

A

3 - 4.5 hours (better within 1.5 hours) => pts will do better.

23
Q

Should stroke patients be given anti-coagulative drugs?

A
  • Heparin/Warfarin should NOT be given in acute stroke patients because there is little role, UNLESS you have a conditions (next card) that is required for long-term prevention of strokes.
24
Q

Which clinical situations is warfarin (or one of the new generation anticoagulants - NOAC’s) generally indicated?

*She stressed this!!!

A
  1. A-fib
  2. Prosthetic valve
  3. MI
  4. ASD (Atrial septal defect)
  5. Hypercoagulable state
  6. Large vessel disease
  7. Aortic arch disease
25
Q

Instead of Heparin/Warfarin, what combination therapy of anti-coagulative drugs can we give a patient in the first few weeks after a stroke?

A

ASA + Plavix to avoid long-term complications caused by increase risk of GI bleeding.

26
Q

Why and when should a carotid angioplasty w/ stent placement be considered in a stroke patient?

A
  • Lower risk of complication, than CEA
  • When pt at high risk for surgery
  1. Severe CAD o
  2. Valvular heart disease
  3. Distal carotid disease/ bilateral severe carotid disease
27
Q

What is the significance of endovascular therapy (intra-arterial thrombolysis w/ clot retrieval) in patients with strokes?

A

Multiple studies have showed improvement in patients treated with [endovascular/intra-arterial intervention + tPA], compared to tPA alone

NMSK Exam 2: Neuro (15 decks)

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