CC - Early recognition of Stroke Flashcards
What are the non-modifiable risk factors for stroke?
Age, sex, race/ethnicity, family history
What are the modifiable risk factors for stroke?
Hypertension, diabetes, smoking, hyperlipidemia, carotid stenosis, atrial fibrillation
What are the Symptoms of a Stroke?
1) Sudden numbness or weakness of face, arm, or leg, especially on one side of the body. 2) Sudden confusion or trouble speaking or understanding speech. 3) Sudden trouble seeing in one or both eyes. 4) Sudden trouble walking, dizziness, or loss of balanc
What are the stroke subtypes?
1) ischemic stroke; small vessel thrombosis, large vessel thrombosis, embolic stroke 2) hemorrhagic stroke; intracerebral hemorrhage, subarachnoid hemorrhage
What are the stroke mimics?
1) hypoglycemia 2) mass lesions 3) seizures and postictal states 4) migrane 5) psychogenic hemiparesis
What are the common presentations of stroke?
1) left middle cerebral artery 2) right middle cerebral artery 3) posterior cerebral artery 4) basilar artery 5) lacunar syndromes
What are the common stroke presentations for left middle cerebral arteries?
1) right hemiparesis 2) aphasia 3) anterior and posterior divisions
What is involved in the right hemiparesis from the left middle cerebral artery?
Face=Hand>Arm>Leg
What is involved in the aphasia from the left middle cerebral artery?
Often mistaken as confusion; expressive and receptive aphasia
Expressive aphasia
difficulty producing language or no language output
Receptive aphasia
poor comprehension and / or incomprehensible speech
Stroke of the anterior division of the left middle cerebral artery
left head and eye deviation
Stroke of the posterior division of the left middle cerebral artery
visual field deficit, aphasia
What are the common stroke presentations for right middle cerebral arteries?
1) left hemiparesis 2) neglect 3) anterior and posterior division problems
Left hemiparesis in right middle cerebral artery stroke
face = hand >arm>leg
What is neglect in right middle cerebral artery stroke
doesn’t acknowledge left visual space or denies their own body parts
Anterior division for right middle cerebral artery stroke
Right head and eye deviation
Posterior division for right middle cerebral artery stroke
Visual field deficit, neglect
What are the stroke common presentations for the Posterior Cerebral Artery?
1) Visual field deficit or cortical blindness if bilateral 2) May have Hemihypaesthesia: Complete loss of sensation of the contralateral face, arm, trunk and leg
What are the stroke common presentations for basilar artery?
(brainstem strokes) 1) Altered Consciousness or Coma. 2) Often bilateral signs. 3) Cranial Nerve signs and “crossed” signs.
For basilar artery stroke what is an example for cranial nerve signs and crossed signs?
1) Right facial weakness and left arm and leg weakness. 2) Loss of pin sensation on left face and right arm and leg. 3) Oculomotor palsy, nystagmus, palate or tongue weakness.
Lacunar Syndromes:
1) Pure Motor Hemiplegia: Internal Capsule (Face=Arm=Leg) 2) Pure Sensory Hypaesthesia: Thalamus (Face=Arm=Leg) 3) Dysarthria Clumsy Hand Syndrome: Pons 4) Ataxic Hemiparesis
Lacunar Syndromes - Pure Motor Hemiplegia
Internal Capsule (Face=Arm=Leg)
Lacunar syndromes - Pure Sensory Hypaesthesia
Thalamus (Face=Arm=Leg)
Lacunar syndromes - Dysarthria Clumsy Hand Syndrome
Pons
Aphasia usually corresponds to what?
left hemispheric stroke (right sided weakness)
Neglect (hemi‐inattention) usually indicates what?
Right hemispheric stroke
Do patients usually look toward or away the lesion?
Towards the lesion (frontal eye fields)
Crossed signs indicate what?
brainstem involvement
Vertigo of central origin almost always is associated with what?
other cranial nerve deficits
Vertical nystagmus is what?
brainstem ischemia until proven otherwise
What are the early CT changes of a stroke?
1) early infarct signs 2) hypodensity of grey or white matter 3) obliteration of cortical sulci 4) obscured basal ganglia 5) loss of insular ribbon
What are the inclusion criteria for thrombolytic therapy?
1) acute ischemic stroke (not mimic) 2) Age< 3 hours 4) CT normal or indicates early focal infarction 5) NIHSS < 24 6) absence of exclusionary criteria 7) informed consent (patient and/or family)
What are the Thrombolytic Therapy Exclusion criteria?
1) CT signs of Homorrhage or Very Large Infarction 2) Undetermined Time of Onset 3) Uncontrollable Hypertension or Blood Sugar 4) Recent Trauma, Major Surgery or Bleeding 5) Abnormal Coagulation Profile 6) Rapidly Resolving Deficit 7) Hemodynamic Compromi
What are the Benefits of thrombolytic therapy?
1) Treatment group had 30% more patients rated as good outcome at 3 months 2) Risks: Intracerebral Hemorrhage 3) placebo 1% (other bleeding) vs. treatment 6% (50% fatal)
Primary and Secondary Prevention.
1) Control of modifiable risk factors: HTN, DM, CAD, Obesity 2) Antihypertensive, cholesterol lowering medications 3) Antiplatelet medication 4) Anticoagulants 5) Carotid Endarterectomy
