CC2: stroke Flashcards
are ischemic or hemorrhagic strokes more common?
ischemic strokes- 83%
list 3 non modifiable risk factors for stroke
age
sex
family hx
list 6 modifiable risk factors for stroke
HTN diabetes smoking hyperlipidemia carotid stenosis atrial fibrillation
list symptoms of a stroke
-sudden numbness or weakness of face/arm/leg
-sudden confusion or trouble speaking/understanding
-sudden trouble seeing
-sudden trouble walking, dizziness or loss of balance/coordination
-sudden severe headache
SUDDEN
out of the 3 types of ischemic stroke (small vessel thrombosis, large vessel thrombosis and embolic stroke) which is most common?
embolic stroke 33%
list 5 disease processes that mimic a stroke
- hypoglycemia
- mass lesions
- seizures & postictal stress
- migraine
- psychogenic hemiparesis
what are the symptoms of a stroke in the anterior division of the left middle cerebral artery?
Left head & eye deviation
aphasia
right hemiparesis (worst in hand & face)
what are the symptoms of a stroke in the posterior division of the left middle cerebral artery?
visual field deficit aphasia right hemiparesis (worst in hand & face)
what are the symptoms of a stroke in the anterior division of the right middle cerebral artery?
left hemiparesis
spatial neglect
right head & eye deviation
what are the symptoms of a stroke in the posterior division of the right middle cerebral artery?
left hemiparesis
spatial neglect
visual field defect
what are the symptoms of a stroke in the posterior cerebral artery
- Visual field deficit or cortical blindness is bilateral
- May have hemihypaesthesis
what does hemihypaesthesis mean?
complete loss of sensation of the contralateral face, arm, trunk & leg
what are the symptoms of a basilar artery stroke?
- Altered consciousness or coma
- Often bilateral signs
- Loss of pain sensation on Left face and right arm/leg
- Oculomotor palsy, nystagmus, palate or tongue weakness
what is the presentation of lacunar stroke in the internal capsule?
pure MOTOR hemiplegia (face=arm=leg)
what is the presentation of lacunar stroke in the thalamus?
pure sensory hypaesthesis (face=arm=leg)
what is the presentation of lacunar stroke in the pons?
dysarthria clumsy hand syndrome
aphsia with right sided weakness usually corresponds to what?
left hemispheric stroke
neglect (hemi-inattention) usually corresponds to what?
right hemispheric stroke
patients with frontal eye field deficits, do they usually look towards or away from the lesion
towards the lesion
if the patient has “crossed signs”, what does this indicate?
brainstem involvement
what is vertigo of central origin usually associated with?
other cranial nerve defects
if patient has vertical nystagmus, what should you assume?
brainstem ischemia
what does nystagmus mean?
involuntary eye movements
look on wikipedia for a weird picture/video
on a CT scan, what are usual signs of stroke?
- hypodensity of grey & white matter (can’t tell the difference)
- obliteration of cortical sulci
- obscured basal ganglia
- loss of insular ribbon
what condition would warrant the argument AGAINST thrombolytic treatment?
if instead of a stroke (or in combo) there is an intracerebral hemorrhage (in a study it was 50% fatal in these patients)
list some major indicators FOR thrombolytic treatment
- acute ischemic stroke (NOT anything that could be mimicking it)
- less than 80 years old
- onset less than 3 hours
- CT normal or indicates early focal infarct
- NIHSS less than 24
list some major indicators AGAINST thrombolytic treatment
- CT signs of hemorrhage or large infarct
- undetermined time of onset
- uncontrolled HTN or blood sugar
- recent trauma, major surgery or bleeding
- abnormal coag profile
- rapidly resolving deficit
- hemodynamic compromise from MI
list some primary & secondary prevention methods for stroke
- control of modifiable risk factors
- antihypertension, cholesterol lowering & medications
- antiplatelet medication
- anticoagulants
- carotid endarterectomy
