Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Senior - E Med > 4 - Stroke Syndromes > Flashcards

4 - Stroke Syndromes Flashcards

1
Q

Sroke is defined as:

A

Any disease process that interrupts blood flow to the brain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What causes the injury with strokes?

A

The injury is cause by:

  • The loss of O2 and glucose substrates necessary for high-energy phosphate production
  • The presence of mediators of secondary cellular injury
  • Edema and mass effect exacerbate the insult
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Subtypes of stroke?

A

Ischemia

Hemorrhagic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Types of ischemic stroke

A
  • thrombotic
  • embolic
  • hypoperfusion

Chart on slide 7

He said ignore the chart and just know that it is clot and hypo-perfusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Types of hemorrhagic stroke?

A

Intracerebral

Subarachnoid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Key component to stroke?

A

Early detection

- bc time is the critical component in care of stroke patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

General and subtle stroke symptoms?

A

General:

  • facial droop
  • arm drift
  • abnormal speech

Subtle symtoms:

  • generalized weakness
  • lightheadedness
  • vague sensory changes
  • altered mental status
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Though they account for over 1/2 or strokes who presents in an atypical manner?

A

Women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Embolic and hemorrhagic strokes present?

A

Suddenly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Thrombotic or hypoperfusion strokes presentation?

A

Waxing and waning or stuttering

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Cerebral aneurysm rupture presentation, a HX of?

A

Valsalva maneuver with immediate ha or sudden onset of symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Cervical artery dissection presentation, a HX of?

A

Recent neck trauma or manipulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Hx that presents a risk for thrombus?

A

HTN
DM
CAD
Transient neuro deficits in the same vascular distribution

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Hx that presents risk factors for Embolus?

A

Afib
Valvular replacement
Recent MI
Transient neurologic deficits in different vascular distribution

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

If you get a hx and r/o stroke mimics and it is likely acute stroke what must you do?

A

Consider the time limits for thrombolytic therapy

Look for inclusion or exclusion criteria for treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Stroke mimics (list)

A
  • Seizures/postictal paralysis
  • Syncope
  • Meningitis/encephalitis
  • Complicated migraine
  • Brain neoplasm/abscess
  • Subarachnoid hemorrhage
  • Hypoglycemia
  • Hyponatremia
  • Hypertensive encephalopathy
  • hyperosmotic coma
  • Wernicke’s encephalopathy
  • Labyrinthistis
  • Drug tox
  • Bell’s palsy
  • Meinere’s disease
  • Demyelinating disease (MS)
  • Conversion d/o

Slide 16 for more info

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What needs to be checked during PE for stroke?

A 
ABC (top priority)
Confirm stroke
ID comorbids
Eval for cardica or vascular disease
Perform a good neuro
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Neuro exam for stroke needs to include?

A

NIHSS

The national institute of heal stroke scale

See slides 18-22

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

NIHSS scores and their meaning

A 
0 -0 - no stroke
1-4 - minor stroke
5-15 - moderate stroke
16-20 - moderate to severe
21-42 - severe stroke
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What vessel is MC involved in stroke?

A

Middle cerebral artery infarction

This is a type of ischemic stroke syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Middle cerebral artery infarction presentation

A

Vary based on which hemisphere is dominant and where exactly the lesion is (typically L hemisphere is dominant)

Typically:

  • hemiparesis
  • facial plegia
  • sensory loss (contralateral)

Homonymous hemianopsia and gaze preference toward the side of the infarct

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Middle cerebral artery infarction

If the dominant hemisphere is involved?

If the non-dominant hemisphere is involved?

A

Dominant
- Aphasia (receptive, expressive or both)

Non-dominant

  • Inattention
  • Neglect
  • Extinction on double-simultaneous stimulation
  • Dysarthria w/o aphasia
  • Constructional apraxia (drawing complex shit)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Symptoms of posterior cerebral artery infarction?

A

Classic symptoms:

  • ataxia
  • nystagmus
  • altered mental
  • vertigo
  • visual field loss
  • unilateral limb weakness
  • CN VII signs
  • lethargy
  • sensory deficits
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Crossed neurological deficits may indicate?

A

Brainstem lesion

Examples:
- ipsilateral CN deficits with contralateral motor weakness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What sign is thought to be specific for distal posterior circulation stroke?

Why?

A

Visual field loss
- described as contralateral homonymous heminopsia and unilateral cortical blindness

B/c the visual centers of the brain are supplied by posterior cerebral artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

PE for posterior cerebral artery infarction may find?

A
  • Light-touch and pinprick sensation loss
  • Alexia w/o agraphia (loss of reading w/o loss of writing)
  • inability to name colors
  • unilateral 3rd nerve palsy
  • hemiballismus (type of chorea)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Presentation of basilar artery infarction stroke

A

MC symptoms

  • unilateral limb weakness
  • dizziness
  • dysarthria
  • diplopia
  • HA

MC signs

  • CN VII signs
  • dysarthira
  • babinski sign
  • oculomor signs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Dysphagia, n/v, dizziness and horner’s syndrome are positively correlated with?

A

Basilar artery occlusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Rare but serious presentation of basilar artery infarction?

A

Locked in syndrome

Characterized by complete muscle paralysis except for upward gaze and blinking, lack of communication but are completely aware of surroundings

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Which type of stroke is associated with more favorable prognosis?

A

Lacunar infarction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is lacunar infarction?

A

“Mini stroke”

Pure motor and sensory deficits caused by infarction of small penetrating arteries

Commonly associated with chronic hypertension and increasing age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Who gets carotid and vertebral artery dissections?

A

Young and middle aged pts usually

With a hx of recent minor neck trauma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

How does carotid and vertebral artery dissection present?

A

Unilateral HA
Neck pain
Face pain

Symptoms may be transient or persistent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

New onset HA or neck pain of unclear etiology should get?

A

Imagin of neck vessels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Presentation of carotid artery dissection?

A

Fronto-temporal HA
- thunderclap ha

Temporal arteritis
Preexisting migraine
Partial horners syndrome (miosis and ptosis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Carotid dissection can progress to?

A 
Cerebral ischemia 
Retinal infarction (rare)
37
Q

Symptoms of vertebral artery dissection?

A 
Neck pain (66%)
HA (65%) (usually occipital)

Other S/S

  • unilateral facial parestheisa
  • dizziness
  • vertigo
  • N/V
  • diplopia
  • visual disturbances
  • ataxia
  • limb weakness
  • numbness
  • dysarthria
  • hearing loss
38
Q

Test of choice for carotid, vertebra or basilar artery dissection?

A

MRI angiography
CT/CT angiography

Neurology will tell you which one is best

39
Q

Color duplex US?

A

May not detect important vascular lesions

40
Q

Untreated vertebral artery dissection may result in infarction in the regions of the brain supplied by?

A

Posterior circulation

41
Q

Intracerebral hemorrhage and ischemic infarction are both?

A

Very different in terms of management but may be clinically indistinguishable

Get a noncontrast CT to differentiate them

42
Q

If a intracerebral hemorrhage pt has HA, N/V you should?

A

Be concerned, these often precede neurologic deficit and they go downhill quickly

43
Q

Subarachnoid HA have the “worst HA of my life” and careful hx taking will usually ID?

A

An association with valsalva type activities

44
Q

Examples of activities associated with the valsalva maneuver?

A

Defecation
Sex
Weight lifting
Coughing

45
Q

What is the goal timeline for stroke?

A

Decide treatment w/in 60 min

46
Q

Study of choice for suspected acute stroke?

A

Non-contrast CT

Ideally should be reviewed by the most senior person w/in 45 min

47
Q

Problem with non-contrast CT in stroke patients?

A

Most acute ischemic strokes are not visualized by non-contract brain CT in the early hours of a stroke

48
Q

Though not the preferred study what study is the most accurate for detection of acute infarction?

A

Diffusion-weighted MRI

49
Q

Thought the AHA/ASA recommend either CT or MRI what is the only study necessary to administer rtPA?

A

Non-contrast CT

50
Q

Hydration for strokes?

A

Correct dehydration

Euvolemic pts get maintenance fluids

Dont use volume expansion or hemodilution

51
Q

2013 AHA/ASA O2 sat recommendations?

A

> 94%

No hyperbaric O2

52
Q

Fever and stroke?

A

Associated w higher morbidity and mortality - find and fix

53
Q

Ischemic HTN is a concern when?

A

Pts are candidates for reperfusion intervention

54
Q

Permissive HTN for pts?

  • candidates
  • Not candidates

for reperfusion therapy?

A

Not candidates for reperfusion:
SBP < 220
DBP < 120

Candidates for Reperfusion therapy:
SBP <185
DBP <110

If needed reduce by 15% over 24hrs

55
Q

If target BP of <185/110 cannot be met?

A

The pt is no longer a candidate for rePA therapy

56
Q

BP meds for stroke?

A

Labetalol 10-20mg IV over 1-2 min
- can repeat once

Nicardipine 5mg/hr

  • titrate up 2.5mg/hr q 5-15 min
  • when target reached reduce to 3mg/hr
57
Q

____ is common in acute stroke?

A

Ischemic hyperglycemia

58
Q

Stroke glucose level recommendations?

A

Keep blood glucose between 140 mg/dl and 180mg/dl

No need to stress the brain further

59
Q

Aspirin and stroke?

A

Current AHA/ASA guidelines recommend 325mg w/in 24-48hrs

But…
No antiplatelets w/in 24hrs of rtPA

60
Q

Inclusion criteria for IV Recombinant Tissue Plasminogen Activator (rtPA) in acute ischemic stroke?

A

Measurable diagnosis of acute ischemic stroke
- NIHSS score

Onset of symptoms <3hrs
- ideally witnessed

Age >/= 18

61
Q

Exclusion criteria for rtPA?

A
  • Head trauma w/in 3 mo
  • Poss subarachnoid
  • Noncompressible bleed <7 days ago
  • Hx of intracranial hemorrhage
  • Intracranial neoplasm
  • Arteriovenous malformation
  • Aneurysm
  • Recent head/spinal surg
  • Uncontrolled BP
  • Active internal bleed
  • platelets < 100,000
  • heparin w/in 48hrs w prolonged aPTT
  • INR >1.7
  • use of thrombin inhibitors or factor Xa
  • glucose <50
  • multiloba infarction
62
Q

Relative exclusion criteria for rtPA?

A
  • minor stroke
  • pregnancy
  • seizure at onset
  • maj surg/trauma w/in 14 days
  • GI/urinary tract hemorrhage w/in 21 days
  • MI w/in 3 o
63
Q

If a pt wakes up with stroke symptoms when do you “clock” their stroke time?

A

Should be “clocked” from the time at which the pt was last known to be w/out symptoms (so probably before bed)

64
Q

IOT administer rtPA you must know?

A

Time of symptom onset

65
Q

NIHSS score needed to give rtPA?

A

Between 4 and 22

66
Q

Dont withold rtPA for labs except on?

A

Glucose

Good thing its bedside, take that lab people

67
Q

Dose of rtPA?

A

0.9mg/kg IV
Max dose of 90mg

Admin 10% bolus over 1 min
Remaining 90% over 60 min

68
Q

What must be monitored ruing admin of rtPA?

A

BP q 15 min for 1st 2 hrs

So admit them to ICU

69
Q

Post-rtPA bleeding suspected?

A

Stop rtPA

Order CBC with platelet count
Fibrinogen level
Typing and cross-match for blood

Emergent neuro, neurosurgery and hematology consults needed

70
Q

Pts with massive middle cerebral artery infarct?

A 
No rtPA (80% mortality)
- thrombolytics are contraindicated with hemorrhagic stroke

May be candidates for Decompression

71
Q

What are endovascular therapies for ischemic stroke?

A

Mechanical clot disruption/extraction

72
Q

What are some advantages to mechanical clot removal?

A
  • Expanded tx window
  • pts w contraindications for thrombolytics
  • eval the vein
  • lower thrombolytic drug use
73
Q

What is the time limit for mechanical clot removal?

A

None have been established

74
Q

What is a TIA?

A

Transient episode of neurological dysfunction caused by focal brain, spinal cord or retinal ischemia w/out acute infarction

Consider Analogous to unstable angina

75
Q

TIA-ABCD2 score?

A

7 point score given based on:

  • Age (>60)
  • BP (>140/90)
  • clinical stroke features
  • duration (> 1 hr)
  • diabetes

See slide 68

76
Q

TIA ABCD2 score interoperation?

A

2 day risk:

  • 0-3: 1%
  • 4-5: 4.1%
  • 6-7: 8.1%

7 day risk:

  • 0-3: 1.2%
  • 4-5: 5.9%
  • 6-7: 11.7%

<4 maybe admit
>4 admit

77
Q

TIA tx?

A 
Aspirin
Or
Aspirin + dipyridamole
And 
Warfarin

Benefits of heparins outweigh the risk of intracranial bleeds

78
Q

MC cause of ischemic stroke in kids?

A

Sickle cell disease

79
Q

Tx for SCD stroke?

A

Same as regular except you must put them on O2 and get them emergency consult with hematology and stroke neurologist

80
Q

Women are at an increased stroke risk when?

A

They are pregnant and postpartum (+6weeks)

Greatest risk is during postpartum

81
Q

Pregnant stroke tx?

A

rtPA doesnt cross placenta

ED tx: call obstetrics, stroke neuro, and neonatologist

82
Q

Stroke clinical features

- traditional symptoms

A
  • Sudden numbness (arm, leg, whatever)
  • Sudden altered mental (WOMEN)
  • Sudden aphasia
  • Sudden memory deficit, spacial orientation, perceptions
  • Sudden visual deficit or diplopia (MEN)
  • Sudden Dizziness, gait, ataxia (MEN)
  • Sudden severe HA
83
Q

Stroke clinical features

- nontraditional symptoms

A
  • LOC/syncope
  • Generalized weakness (WOMEN)
  • SOB
  • Sudden pain face, chest, wherever
  • Seizure
  • Falls/accidents
  • Sudden hiccups
  • Sudden fatigue
  • Sudden palpitations
  • Altered mental
84
Q

Stroke symptoms more common in WOMEN?

A

Sudden altered mental status

Generalized weakness

85
Q

Stroke symptoms more common in MEN?

A

Sudden numbness/weakness face, arm, leg

Sudden visual deficit or diplopia

Sudden dizziness, gait disturbances, ataxia

Men more commonly present with traditional symptoms

86
Q

Which artery typically caused very minimal motor dysfunction which can mask awareness of the stroke?

A

Posterior cerebral artery

87
Q

Which type of stroke has a high risk of death and poor outcome?

A

Basilar artery occlusions

88
Q

I will give you three seconds, exactly three fucking secinds, to wipe that stupid grin off your face

A

or I will gouge out your eyeballs and skull-fuck you!

Senior - E Med (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions