Acute Stroke

Question 1

% of strokes that are ischemic vs hemorrhagic

Answer 1

ischemic=85%, hemorrhagic=15%

Question 2

leading causes of strokes

Answer 2

atherosclerosis, cardioembolism (from AFib, low EF, patent foramen ovale)

Question 3

less common causes of strokes

Answer 3

cervical artery dissection, endocarditis, vasculitis, hypercoagulable state, global hypoperfusion

Question 4

does CTA or MRA require contrast?

Answer 4

CTA does, MRA does not

Question 5

what might an echo show in a stroke workup?

Answer 5

vegetation, mural thrombus, patent foramen ovale

Question 6

what % of ambulatory 30 day monitoring finds AFib?

Answer 6

up to 16%

Question 7

the surrounding tissue from a stroke with low perfusion which can be restored if blood flow is quickly achieved

Answer 7

penumbra

Question 8

tPA window for a stroke event

Answer 8

FDA- 3 hours, AHA/ASA- 4.5 hours

Question 9

3 inclusion criteria for tPA

Answer 9

1. ischemic stoke causing neurological deficit
2. within time window
3. over age 18

Question 10

9 exclusion criteria for tPA

Answer 10

1. Head trauma or stroke in previous 3 months
2. sx of subarachnoid hemorrhage
3. arterial puncture at non compressible site within 7 days
4. Hx of intracranial hemorrhage
5. Refractory HTN over 185/110
6. Active bleeding on exam
7. Acute bleeding diathesis
8. Blood glucose <50
9. CT showing multilobar infarction

Question 11

intra-arterial mechanical thrombectomy window

Answer 11

6 hours

Question 12

T/F- you cannot do thrombectomy after tPA

Answer 12

False. You can do both

Question 13

causes of hemorrhagic stroke`

Answer 13

hypertension, trauma, bleeding diathesis, illicit drug use, amyloid angiopathy, tumor, vascular malfomations

Question 14

Indications for neurosurgery referral in hemorrhagic stroke

Answer 14

cerebellar hemorrhage, brain stem compression, coma, midline shift, elevated ICP

Question 15

causes of SAH

Answer 15

aneurysm rupture, trauma, vascular malformations

Question 16

presentation of SAH

Answer 16

sudden severe headache, possible LOC, seizure, N/V, focal neuro deficit, stiff neck

Question 17

Findings on LP for SAH

Answer 17

xanthochromia, elevated RBCs in all 4 tubes unchanged

Question 18

study to perform if suspect SAH but CT negative

Answer 18

LP

Question 19

next study to perform if CT or LP indicates SAH

Answer 19

CT angiography or cerebral angiography to look for aneurysm which could be repaired

Question 20

medication to avoid cerebral vasospasm

Answer 20

nimodipine for 21 days

Question 21

treatment of hydrocephalus

Answer 21

insert external ventricular or lumbar drain

Question 22

ATACH-2 Trial findings

Answer 22

Reducing BP in intracerebral hemorrhage to 110-139 did not change death or disability than reducing to 140-179 mm Hg