CC2: Early Recognition of Stroke

Question 1

T/F: Stroke is the leading causes of disabilities

Answer 1

True

Question 2

ischemic vs hemorrhagic strokes - which is more common?

Answer 2

Ischemic strokes make up 83% of strokes

Question 3

What are some non-modifiable and modifiable risk factors for stroke?

Answer 3

non-modifiable: age, sex, family history

modifiable: hypertension. diabetes, atrial fibrillation, smoking, carotid stenosis, hyperlipidemia

Question 4

What are some symptoms associated with strokes?

Answer 4

SUDDEN numbness or weakness, esp on one side of the body. SUDDEN confusion or trouble speaking, SUDDEN trouble seeing, SUDDEN headache

Question 5

Ischemic strokes can be due to small vessel thrombosis, large vessel thrombosis or embolic stroke. Which is the most common?

Answer 5

Embolic stroke = 33%
large vessel thrombosis = 30%
small vessel thrombosis = 20%

Question 6

What are some conditions that stroke mimics (5)?

Answer 6

• hypoglycemia
• mass lesion
• seizures and post-ictal states
• migraine
• psychogenic hemiparesis

Question 7

What are some symptoms associated with stroke involving the left middle cerebral artery? Be more specific in term of if the anterior or posterior division of the left middle cerebral artery is affected.

Answer 7

-right hemiparesis (face and hand are more affected than the arm and leg since those are in the territory of anterior cerebral artery’s perfusion)
-aphasia
-anterior division: left head & eye deviation due to
difficulty turning eyes to right; right eye can still look to left so deviates to left
-posterior division: visual field deficit, aphasia

Question 8

What are some symptoms associated with stroke involving the right middle cerebral artery? Be more specific in term of if the anterior or posterior division of the right middle cerebral artery is affected.

Answer 8

• Left hemiparesis (face and hand more affected than arm and leg)
• Left hemineglect
• anterior division: right head and eye deviation
• posterior division: visual field deficit
• aphasia

Question 9

What are some symptoms associated with stroke in the posterior cerebral artery?

Answer 9

• visual field deficit

- may have hemihypaesthesia = complete loss of sensation of contralateral face, arm, trunk & leg

Question 10

What are some symptoms associated with stroke in basilar artery?

Answer 10

• altered consciousness or coma
• often BILATERAL signs
• Cranial nerve signs & crossed signs (brainstem involvement)

Question 11

What are lacunar strokes?

Answer 11

usually small strokes affecting lenticulostriate arteries
can lead to pure motor hemiplegia when affecting the internal capsule
can lead to pure sensory hypaestheisa when affecting thalamus

Question 12

What can cause intracerebral hemorrhage?

Answer 12

• Hypertension leading to stroke in lenticulostriate arteries.
• very easy to see on CT scan
• treated differently than ischemic strokes

Question 13

Thrombolytic therapy (TPA) is used to break clots. 30% more pt rated good outcomes when treated. What are some inclusion criteria?

Answer 13

• acute ischemic stroke (NIHSS < 24)
• age < 80
• onset < 3 hrs
• CT = normal or early focal infarction
• absence of exclusionary criteria
• informed consent

Question 14

Thrombolytic therapy (TPA) is used to break clots. What are some exclusion criteria?

Answer 14

• hemorrhage
• very large infarct
• undetermined time of onset
• uncontrollable HTN or blood sugar
• recent trauma/major surgery
• hemodynamic compromise