420 Ischemic Stroke Flashcards
A decrease in cerebral blood flow to zero causes death of brain tissue within how many minutes? (H20 C420 P3079)
4-10 mins
A decrease of cerebral value to this value will cause brain infarction within an hour (H20 C420 P3079)
<16-18 mL/100 g tissue per minute
Defined as the ischemic but reversibly functional tissue surrounding a core area of infarction (H20 C420 P3079)
Ischemic penumbra
Hyperglycemia (blood glucose above this value) dramatically worsens brain injury during ischemia (H20 C420 P3080)
> 11.1 mmol/L (>200 mg/dL)
When faced with competing demands of myocardium and brain, this drug class can be a first step to decrease cardiac work and maintain blood pressure (H20 C420 P3080)
Beta1-adrenergic blocker
In ischemic stroke, cerebral edema peaks on the second and third day but can cause mass effect for how many days? (H20 C420 P3080)
~10 days
Hemicraniectomy reduces mortality in ischemic stroke by 50%. However, patients of this age benefit less. (H20 C420 P3080)
> 60 years
Predictor of deterioration requiring hemicraniectomy in acute ischemic stroke (H20 C420 P3080)
Size of the diffusion-weighted imaging of brain infarction
The presence of these symptoms should alert the physician to consider cerebellar stroke due to vertebral artery dissection (H20 C420 P3080)
Head or neck pain
Major surgery in the preceding how many days is a contraindication to IV rTPA in AIS (H20 C420 P3081)
14 days
Gastrointestinal bleeding in the preceding how many days is a contraindication to IV rTPA in AIS (H20 C420 P3081)
21 days
Sustained BP above these values despite treatment is a contraindication to IV rTPA in AIS (H20 C420 P3081)
> 185/110 mmHg
For decline in neurologic status or uncontrolled BP during rTPA infusion, this is given and the brain is reimaged emergently (H20 C420 P3081)
Cryoprecipitate
Standard dosing of IV rTPA (H20 C420 P3081)
0.9 mg/kg (max 90 mg), 10% as blous then the rest as 60 min infusion
Lower dose of rTPA that is safer in Asians and has similar outcomes (H20 C420 P3081)
0.6 mg/kg
Endovascular therapy improved outcomes for internal carotid and MCA occlusions proven by CTA, with or without pretreatment of IV t-PA, if performed within how many hours of stroke onset? (H20 C420 P3081)
6 hours
The only antiplatelet agent that has been proven to be effective for the acute treatment of ischemic stroke (H20 C420 P3082)
Aspirin
Hypothermia in acute ischemic stroke is associated with an increase in this complication that could adversely impact stroke outcomes (H20 C420 P3082)
Pneumonia
The use of this physical therapy has beens shown to improve hemiparesis following stroke (H20 C420 P3082)
Constrained movement therapy
Of the routine diagnostics for patients with acute ischemic stroke, only these two are necessary prior to IV rTPA (H20 C420 P3082)
Brain imaging, capillary blood glucose
The most significant cause of cardioembolic strokes in most parts of the world (H20 C420 P3082)
Nonrheumatic atrial fibrillation
A left atrium of this diameter is an indication for oral anticoagulation in rheumatic mitral valve disease regardless whether atrial fibrillation is present (H20 C420 P3084)
55 mm
Dominant vascular mechanism causing large-vessel brain ischemia (H20 C420 P3083)
Artery-to-artery embolism
Most common sources of embolus causing stroke in carotid atherosclerosis [2] (H20 C420 P3083)
Common carotid bifurcation, proximal internal carotid artery
Most dissections causing stroke heal spontaneously, and stroke and TIA is uncommon beyond: (H20 C420 P3085)
2 weeks
Size of embolic large enough to occlude the stem of the MCA (H20 C420 P3082)
3-4 mm
Principal risk factors of small-vessel stroke [2] (H20 C420 P3085)
Hypertension, age
Small-vessel stroke syndrome from an infarct in the posterior limb of the internal capsule and pons (H20 C420 P3085)
Pure motor hemiparesis
Pure sensory stroke syndrome arise from an infarct in this area (H20 C420 P3085)
Ventral thalamus
An infarct in the ventral pons or internal capsule produces this small-vessel stroke syndrome (H20 C420 P3085)
Ataxic hemiparesis
Infarction in the ventral pons or in the genu of the internal capsule produces this small-vessel stroke syndrome (H20 C420 P3085)
Dysarthria and a clumsy hand
Women who take contraceptive pills and have this mutation may be at particularly high risk for sinus thrombosis (H20 C420 P3085)
G20210 mutation
Treatment of choice for venous sinus thrombosis with concomitant intracranial hemorrhage (H20 C420 P3085)
Intravenous heparin
Treatment of children with sickle cell anemia (SS disease) with high blood flow within the MCAs (H20 C420 P3086)
Aggressive exchange transfusions
These arteries develop a rich collateral circulation around the occlusive lesion in Moyamoya disease (H20 C420 P3087)
Lenticulostriate arteries
Moyamoya disease occurs mainly in Asian children or young adults, but the appearance may be identical in adults who have atherosclerosis, particularly in associatian with this comorbidity (H20 C420 P3087)
Diabetes
MRI findings in posterior reversible encephalopathy syndrome are characteristic with the edema present in these lobes (H20 C420 P3087)
Occipital lobes
Treatment for producing remission in reversible cerebral vasoconstriction syndrome (H20 C420 P3087)
Oral calcium channel blockers
This disease is readily seen on CT or MRI scans as areas of white matter injury surrounding the ventricles and within the corona radiata (H20 C420 P3087)
Leukoaraiosis or periventricular white matter disease
This inherited disorder presents as small-vessel disease, progressive dementia, and extensive symmetric white matter changes in the 4th or 5th decade of life. It is caused by one of several mutations in Notch-3.
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL)
Most transient ischemic attaks last <1 hour, The standard definition of duration is: (H20 C420 P3087)
<24 h
In the first 3 months following TIA, the risk of stroke is: (H20 C420 P3087)
~10-15%
Prevention of stroke following TIA (H20 C420 P3087)
Aspirin & clopidogrel (better than aspirin alone)
Most transient ischemic attaks last <1 hour, The standard definition of duration is: (H20 C420 P3087)
<24 h
In the first 3 months following TIA, the risk of stroke is: (H20 C420 P3087)
~10-15%
Prevention of stroke following TIA (H20 C420 P3087)
Aspirin & clopidogrel (better than aspirin alone)
Target blood pressure in prevention of stroke (H20 C420 P3088)
<130/80 mmHg
SPRINT found 43% decrease in stroke and heart attacks if SBP is lowered to this value (H20 C420 P3088)
<120 mmHg
Preferred drug classes [2] for secondary prevention of stroke (H20 C420 P3088)
Thiazide diuretics, ACE inhibitors
The most significant risk factor for stroke (H20 C420 P3088)
Hypertension
This primary prevention trial found that giving rosuvastatin to patients with LDL <130 mg/dL and elevated CRP decreased stroke occurrence by 51% (H20 C420 P3088)
JUPITER
The SPARCL trial showed benefit in secondary stroke reduction for patients with recent stroke or TIA who were prescribed with this drug (and dose) (H20 C420 P3088)
Atorvastatin 80 mg daily
The use of this OHA lowered vascular events in patients with stroke and insulin resistance (H20 C420 P3088)
Pioglitazone
This antiplatelet agent is no longer used for secondary stroke prevention due to adverse effects such as neutropenia and thrombotic thrombocytopenic purpura (H20 C420 P3088)
Ticlodipine
Long term combination therapy with aspirin and clopidogrel versus clopidogrel alone does not improve stroke prevention and increases major bleeding complications. However, short term combination therapy with clopidogrel 300 mg LD + 75 mg OD and aspirin 75 mg OD given is beneficial when given for the first: (H20 C420 P3088)
21 days
The principal side effect of dypiridamole (H20 C420 P3088)
Headache
Ambulatory Holter monitoring for how many weeks is a reasonable strategy to determine the best prophylactic strategy in cryptogenic embolic stroke (H20 C420 P3089)
3-4 weeks
Both NASCET and ECST showed a substantial benefit for carotid endarterectomy in patients with this degree of carotid stenosis in symptomatic patients (H20 C420 P3090)
≥70%
If the perioperative stroke rate exceeds this value for any particular surgeon, the benefits of carotid endarterectomy are questionable (H20 C420 P3090)
≤6%
With smoking cessation, the baseline risk of stroke is reached after how many years of postcessation? (H20 C420 P3085)
5 years
Both ACAS and ACST showed benefit of endarterectomy in asymptomatic patients with this degree of carotid stenosis (H20 C420 P3090)
> 60%
