Approach to Stroke Flashcards
Types of Stroke
Hemorrhagic (20%)- Emboli, Intracerebral or Arachnoid Hemorrhage
Ischemic (80%)- Thrombotic, Lacunar arteries (Charcot Microhemorrhages) , cardioembolism (Paradoxical embolism), Vasculitides, Hypercoagulability
Risk Factors for Stroke
Age
Previous TIA/Stroke
Atherosclerosis (HTN, Hyperlipidemia, Smoking, DM)
Cardiac DO’s that put a person at risk of stroke
A fib
Prosthetic Heart Valve
Endocarditis
Other common reasons for increased risk of stroke
Oral Contraceptives
Fibromuscular dysplasia (beads on a string)
Pregnancy/Post Partum
What symptoms would be seen in a stroke in the dominant (left) hemisphere?
Aphasia
Contralateral loss of sensory/motor/visual field
What symptoms would be seen in a stroke in the non dominant (right) hemisphere?
Left-sided hemineglect
Left sided symptoms
Cerebellar stroke symptoms
Ipsilateral ataxia
vertigo
What are some common medical complications that arise in stroke patients?
Pneumonia DVT PE UTI Ulcers
T/F: You should include glucose in IVF’s for a stroke patient
False- hyperglycemia is associated with worse near outcomes
According to the NIH stroke scale, what is the chance of an ischemic stroke becoming hemorrhagic with a score<10?
2-3%
> 20 goes up to 17% and should consider intra-arterial intervention
Things to do in an acute stroke patient
Maintain ABC's Elevate bed to 30 degrees 2L/min O2 by NC Vitals IV access x2 EKG Treat Fever if present (regardless of origin)
Ddx that should be considered along with stroke
Seizure
Migraine
Hypoglycemia
t-PA criteria
> 18y/o
Ischemic stroke with neuro deficits
No major surgery preceding 2w
BP<185/110
Other anti-coags beside heparin and warfarin to consider giving patients
Aspirin
Clopidogrel (P2Y12i)
Enoxaparin (LMWH)
Any of the DOAC’s- Dabigatran, Riveroxaban, Apixaban
What conditions necessitate FULL Anti coagulation for extended time?
A fib
Prosthetic valve
MI
ASD
