Acute Stroke Flashcards
% of strokes that are ischemic vs hemorrhagic
ischemic=85%, hemorrhagic=15%
leading causes of strokes
atherosclerosis, cardioembolism (from AFib, low EF, patent foramen ovale)
less common causes of strokes
cervical artery dissection, endocarditis, vasculitis, hypercoagulable state, global hypoperfusion
does CTA or MRA require contrast?
CTA does, MRA does not
what might an echo show in a stroke workup?
vegetation, mural thrombus, patent foramen ovale
what % of ambulatory 30 day monitoring finds AFib?
up to 16%
the surrounding tissue from a stroke with low perfusion which can be restored if blood flow is quickly achieved
penumbra
tPA window for a stroke event
FDA- 3 hours, AHA/ASA- 4.5 hours
3 inclusion criteria for tPA
- ischemic stoke causing neurological deficit
- within time window
- over age 18
9 exclusion criteria for tPA
- Head trauma or stroke in previous 3 months
- sx of subarachnoid hemorrhage
- arterial puncture at non compressible site within 7 days
- Hx of intracranial hemorrhage
- Refractory HTN over 185/110
- Active bleeding on exam
- Acute bleeding diathesis
- Blood glucose <50
- CT showing multilobar infarction
intra-arterial mechanical thrombectomy window
6 hours
T/F- you cannot do thrombectomy after tPA
False. You can do both
causes of hemorrhagic stroke`
hypertension, trauma, bleeding diathesis, illicit drug use, amyloid angiopathy, tumor, vascular malfomations
Indications for neurosurgery referral in hemorrhagic stroke
cerebellar hemorrhage, brain stem compression, coma, midline shift, elevated ICP
causes of SAH
aneurysm rupture, trauma, vascular malformations
presentation of SAH
sudden severe headache, possible LOC, seizure, N/V, focal neuro deficit, stiff neck
Findings on LP for SAH
xanthochromia, elevated RBCs in all 4 tubes unchanged
study to perform if suspect SAH but CT negative
LP
next study to perform if CT or LP indicates SAH
CT angiography or cerebral angiography to look for aneurysm which could be repaired
medication to avoid cerebral vasospasm
nimodipine for 21 days
treatment of hydrocephalus
insert external ventricular or lumbar drain
ATACH-2 Trial findings
Reducing BP in intracerebral hemorrhage to 110-139 did not change death or disability than reducing to 140-179 mm Hg
