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NEUROLOGY II > ACUTE ISCHEMIC STROKE > Flashcards

ACUTE ISCHEMIC STROKE Flashcards

1
Q

This phase of AIS treatment reduce risk of death through diagnosis, hospital choice, and impact of time-to-time treatment

A

Pre-hospital phase (symptom onset to hospital door)

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2
Q

this phase of AIS treatment absolutely focuses on the recanalization of the artery or reduction of swelling due to bleeding

A

Hyperacute phase (door to first hour)

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3
Q

this phase of AIS treatment reduce death risk by neurological screening + close monitoring of cardiac and respiratory systems

A

Acute phase
1-24 hours after admission

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4
Q

this phase of AIS treatment reduce risk of death by close monitoring of cardiac and respiratory systems and prevent recurrent stroke

A

Post-acute phase (24-72 hours after admission)

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5
Q

what is the BE FAST acronym for stroke recognition?

A

BALANCE loss; headache or dizziness
EYES (blurred vision ,double vision, vision changes)
FACE one side of face is drooping
ARMS - arm or leg weakness
SPEECH - speech difficulty/ slurred speech
TIME - time to call ambulance

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6
Q

T/F: In hyperacute stroke, Diagnosis of ischemic stroke is done on CT imaging

A

F
It is done CLINICALLY

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7
Q

4 Steps for therapeutic decision making in hyperacute stroke

A

Diagnosis
Exclude Bleeding
Assess severity
Identify Contraindication

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8
Q

Once the patient with a suspected stroke arrives, they must be evaluated by a physician within ___ minutes (first encounter)

A

10 minutes

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9
Q

The brain attack team must arrive within ___ minutes after the door time

A

15 minutes

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10
Q

In ___ minutes after door time, the patient has to be imaged (Head CT or MRI)

A

25 minutes

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11
Q

The result of the imaging scan must be available within ___ minutes

A

45 minutes

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12
Q

Decision of administering IV alteplase must be made in __________

A

under 60 mins

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13
Q

What are the steps for immediate stabilization?

A

assess ABC
vital signs
O2 to maintain >94%
IV access
get blood samples
Check CBG and correct hypo- or hyperglycemia
obtain 12-LEAD ECG
Perform neurological screening assessment
Activate Brain Attack team

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14
Q

This is a surrogate marker to determine if patient is eligible for rtPA or thrombectomy

A

Ictus

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15
Q

Worst score for National Institute of Health Stroke Scale (NIHSS)

A

42 (Worst)
0 (no symptoms)
11 item analysis

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16
Q

T/F: Scores in the National Institute of Health Stroke Scale (NIHSS) is only based on the patient’s responses and not on the observer’s interpretations

A

T

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17
Q

T/F: NIHSS is more sensitive for posterior circulation strokes

A

F
It is more sensitive for anterior circulation strokes

posterior circulation strokes have lower scores even if they are large in size

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18
Q

T/F: Stroke is a clinical diagnosis but the type of stroke will depend on the neuroimaging

A

T

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19
Q

T/F: Neuroimaging cannot diagnose the etiology of stroke

A

F

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20
Q

4 Ps to assess in neuroimaging

A

Parenchyma (Brain)
Pipes (Vessels)
Perfusion (if the perfusion is good)
Penumbra (Presence of penumbra to be saved)

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21
Q

T/F while waiting for availability of brain imaging, a first aid therapy can first be given to patients with suspected AIS

A

F
imaging first before any therapy

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22
Q

In CT scan, infarct is seen as (hypo/hyper) dense

A

HYPODENSE

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23
Q

In CT scan, bleed is seen as (hypo/hyper) dense

A

HYPERDENSE

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24
Q

T/F: The basal ganglia are almost always involved in PCA infarction

A

F
MCA infarction

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25
Q

This is one of the earliest and most frequently seen signs in MCA infarction

A

Blurred Basal Ganglia on CT

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26
Q

This is very sensitive to ischemia as it is the furthest removed from collateral flow

A

Insula (insular ribbon sign)

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27
Q

Insular ribbon sign indicative of subtle early sign of infarction in the territory of what artery?

A

MCA

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28
Q

Purpose of CT Angiography in bleeds

A

looks for macrovascular causes of ICH or SAH

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29
Q

Purpose of CT Angiography in infarcts

A

detects large vessel occlusion

30
Q

This can is the only imaging study that can tell if there is still a penumbra to be saved

A

CT Perfusion

31
Q

T/F: Alberta Stroke PRogramme Early CT Score gives a clue on how big the stroke is

A

T

32
Q

T/F: The only goal in CT Scan is to detect/exclude a bleed since infarcts cannot be detected

A

T

33
Q

________ is more sensitive and specific than CT within the first few hours after onset of stroke

A

MRI

34
Q

T/F: It is possible in CT scant o age or look at how old a stroke is since it employs different contrasts

A

F
MRI - uses different sequences

35
Q

In MRI, acute stroke appears (dark/white) in DWI

A

white

36
Q

In MRI, acute stroke appears (dark/white) in ADC

A

dark

37
Q

Changes in T2 and Flair MRI compared to the same areas in DWI and ADC results suggest an (acute/old) stroke

A

Old

38
Q

Lesion is seen in DWI but not on FLAR + with penumbra -> will tpa be given?

A

yes

39
Q

Lesion is seen in both DWI and FLAIR -> no penumbra -> will TPA be given?

A

no

40
Q

T/F: If DWI and FLAIR MRI results mismatch, it could be assumed that the stroke happened for more than 5 hours

A

F

If there’s mismatch, the stroke has NOT been around for longer than 4-5 hours -> can still qualify for TPA

41
Q

Imaging used in patients suspected of AIS with high creatinine

A

MRA an- as it can be used without contrast

42
Q

This type of infarct is usually caused by an embolic source involving large vessels

A

Large territorial infarct

43
Q

This type of infarct is due to emboli formed in the heart and “showers” into the brain

A

Multiple Small Embolic Infarcts (Cardioembolic infarct)

44
Q

This type of infarct is usually caused by a thrombotic source

A

Small Vessel disease/lacunar stroke

45
Q

T/F Multiple small embolic infarcts behave differently from other types of strokes

A

F
Small Vessel Disease/Lacunar Stroke

46
Q

This type of infarct involves areas in between distribution of the major vessels, and is usually caused by a decrease in flow

A

Watershed Infarct

47
Q

This type of infarct is due to vein occlusion

A

Venous Stroke

48
Q

This is the only assessment that must precede VI alteplase

A

blood glucose

49
Q

Strategies performed when recanalization is the goal

A

Medical: Thrombolysis
Endovascular: Thrombectomy

50
Q

T/F: A patient can be have thrombectomy and thrombolysis if indicated

A

T

51
Q

Alteplase must be given in people at least ___ years old, within ___ hours after onset

A

19 years old
4.5 hours

52
Q

T/F: Having multi lobar infarction (>1/3 cerebral hemisphere) on CT is an absolute contraindication to rtPA

A

T

53
Q

T/F: Previous history of ICH is an absolute contraindication to rtPA

A

T

54
Q

T/F: Having significant head trauma or prior stroke within 6 months is an absolute contraindication to rtPA

A

F

within 3 months

55
Q

T/F: Having arteriovenous malformation is an absolute contraindication to rtPA

A

T

56
Q

Administration and dosage of alteplase:

A

Infuse 0.9 mg/kg (max dose of 90 mg) over 60 mins, with 10% of the dose given as a bolus over 1 minute

57
Q

Measure BP and perform neurological assessments every ___ minutes during and after IV alteplase infusion for __ hours, then every ___ minutes for 6 hours, then hourly until ___ hours after alteplase treatment

A

every 15 mins during and after infusion for 2 hours; every 30 mins for 6 hours; hourly until 24 hrs after alteplase tx

58
Q

Increase BP monitoring and administer antihypertensive meds if SBP is >___ mmHg or DBP is >___ mmHg

A

SBP > 180 mmhg
DBP > 105 mmhg

59
Q

T/F: CT or MRI follow up scan must be done 48 hours after IV alteplase tx

A

F= must be done at 24 hrs after IV alteplase tx, before starting anticoagulants or antiplatelets

60
Q

Sweet spot for alteplase administration

A

<90 min from time of onset and between 90-180 mins, with small/short thrombus at MCA distal M1/M2

61
Q

T/F: larger infarct = higher NIHSS score = High chance of hemorrhagic transformation

A

T

62
Q

T/F: Hi-1 and Hi-2 infarcts are big infarcts -> neurosurgery or hematology service might be needed

A

F = it’s PH1 and PH2 infarcts

H1 and H2 infarcts are small -> repeat scan after 24 hrs before starting antiplatelet/coagulatng

63
Q

Dosage of tenecteplase

A

by weight = 0.25/kg

64
Q

T/F: Thrombectomy cannot be given WITH alteplase

A

F
it can be given with or without alteplase

65
Q

Inclusion criteria (6) for thrombectomy

A
  1. pre-stroke mRS 0-1 - px is functionally independent before stroke
  2. Causative occlusion of the ICA or MCA segment (m1) - large vessel occlusion
  3. age >/18 yo
  4. NIHSS >/6 = as there would be no diff in thrombectomy and medical management if too mild
  5. ASPECTS>/6
  6. Can be initiated within 6 hrs of symptom onset via groin puncture
66
Q

T/F: Relative inclusion criteria for thrombectomy includes: causative occlusion of M2, M3, ACA, VA, BA, PCA (not LVO)

A

T

67
Q

T/F: Thrombectomy can be treated within 6 hrs as relative indication if mRS >1, NIHSS <6, Aspects <6, causative occlusion of ICA or M1

A

T

68
Q

T/F: Collateral flow is established depending on TPA administration

A

F
Collateral flow is established and improved regardless of TPA administration and MT

69
Q

For General supportive care: supplemental oxygen should be provided to maintain oxygen saturation at:

A

> 98%

70
Q

It is reasonable to treat hyperglycemia to achieve CBG ________ mg.dL

A

140-180 mg/dl

71
Q

T/F: Aspirin and other antiplatelets should be started within ___ to ___ hours after stroke onset (secondary prevention)

A

24 to 48 hours

NEUROLOGY II (4 decks)

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