9. Clinical Approach to Stroke Flashcards
There are two major subtypes of strokes, including hemorragic (20%) which includes intracerebral hemorrhage and subarachnoid hemorrhage, and ischemic stroke (80%) including large vessel artherosclerosis with thromboembolism**, small vessel (lacunar) disease, cardioembolism, nonatherosclerotic vasculopathies like syphilis, and what states?
Hypercoagulable states- sticky blood
Most common risk factors for stroke include increasing age, previous TIA or stroke, athersclerosis (HTN, smoking, DM, hyperlipidemia), valvular heart disease (prosthetic valve), cardiac dysrhythmia (A Fib), mural thrombus, endocarditis, atrial myxoma and interatrial septal abnormalities (PFO), as well as drug abuse including IVDA, and what other two?
Cocaine and Amphetamines
Other risk factors for stroke includes oral contraceptives, pregnancy/postpartum period, fibromuscular dysplasia, hypercoag states like thrombocytosis, polycythemia, sickle cell, leukocytosis, protein C/S deficiency, homocysteine, anticardiolipin/phospholipid abs, inflam disorders including giant cell, SLE, polyarteritis nodosa, granulomatous angiitis and what two that are common and starred?
HIV/Syphilis
migraines too!
Where is the stroke located if there are the following symptoms? aphasia, right sided sensory symptoms, righ sided motor symptoms, right visual field cut..
left hemisphere stroke
Where is the stroke located if there are the following symptoms? *left hemineglect (body does not recognize left side), left sided sensory symptoms, left sided motor symptoms, left visual field cut
Right hemisphere stroke
Where is the stroke located if there are the following symptoms?
ipsilateral ataxia, vertigo and nystagmus
Cerebellar Stroke
Where is the stroke located if there are the following symptoms? cranial nerve findings with contralateral hemisensory or hemimotor symptoms along with vertigo
Brainstem Stroke
if grape jelly is seen it is due to hemorrhage, if the tissue is pink/rose colored is it due to primary ischemic stroke. When there is a brain insult, what are the 3 most common things that it will do/cause?
The brain bleeds, swells and SEIZES
Management of stroke in emergent diagnosis and treatment, always first check ABCs- airway, breathing, circulation, along with BP pulse, cardiac monitor, EKG, and O2 sat.. the area of infarction may have lost autoregulatory function so that normal BP may be relatively hyposensitive in the brain causing acute HTN during acut ischemic stroke and in most cases what should be done?
NOTHING- leave HTN alone - may improve on its own weeks later
During stroke management, IV access is important to have, IV fluids should NOT include glucose as hyperglycemia is associated with worse neurologic outcomes, if tPA is consideration, two IV access sites will be needed to eliminate?
venipuncture after infusion
Stroke management includes neuro exam and RAPID transport to CT, labs include CBC, PT/PTT, full chem panel and glucose, UA, CXR… What scale is used and is important if tPA or intrarterial intervention is considered, scores range from 0-42(coma) and can be used to predict hemorrhagic conversion?
NIH Stroke Scale
score < 10 = 2-3% risk hemorrhage
score >20 = 17% risk
Summary acute stroke management: maintain airway, breathing, circulation, *elevated head of bed to 30 degrees to decrease ICP, O2 at 2 liters per NC, obtain vitals and establish IV w NS, labs - CBC PT PTT Chem profile, EKG, obtain pt weight, try to ID cause and treat fever is present, and obtain?
history
IV thrombolytic therapy tPA- should be given if criteria is met and its been less than 3 hours since symptoms started.. Criteria includes >18, have diagnosis of ischemic stroke, no stroke or head trauma in past 3 mos, no surgeris, no intracranial hemorrhage… etc
MEOW - she didnt go over it in class
Acute anticoagulation with heparin was used in the past, studies used to show a 50% reduction in the chance of neurologic worsening for TIA and stroke in progression, but the studies has methodological flaws and so there is littler role for acute anticoagulation for?
stroke patients ***dont use (heparin) during stroke
There are some clinical situations in which warfarin* or one of the newer anticoagulants- NOACs (such as dagibatran, riveroxaban, apixaban) are indicated, and include MI, atrial septal defect, hypercoagulable state, large vessel disease (carotid/vertebral dissection), aortic arch disease, and what other two which are the MOST common?
Atrial Fibrillation and Prosthetic Valve
