CC2: stroke

Question 1

are ischemic or hemorrhagic strokes more common?

Answer 1

ischemic strokes- 83%

Question 2

list 3 non modifiable risk factors for stroke

Answer 2

age
sex
family hx

Question 3

list 6 modifiable risk factors for stroke

Answer 3

HTN
diabetes
smoking
hyperlipidemia
carotid stenosis
atrial fibrillation

Question 4

list symptoms of a stroke

Answer 4

-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

Question 5

out of the 3 types of ischemic stroke (small vessel thrombosis, large vessel thrombosis and embolic stroke) which is most common?

Answer 5

embolic stroke 33%

Question 6

list 5 disease processes that mimic a stroke

Answer 6

• hypoglycemia
• mass lesions
• seizures & postictal stress
• migraine
• psychogenic hemiparesis

Question 7

what are the symptoms of a stroke in the anterior division of the left middle cerebral artery?

Answer 7

Left head & eye deviation
aphasia
right hemiparesis (worst in hand & face)

Question 8

what are the symptoms of a stroke in the posterior division of the left middle cerebral artery?

Answer 8

visual field deficit
aphasia
right hemiparesis (worst in hand & face)

Question 9

what are the symptoms of a stroke in the anterior division of the right middle cerebral artery?

Answer 9

left hemiparesis
spatial neglect
right head & eye deviation

Question 10

what are the symptoms of a stroke in the posterior division of the right middle cerebral artery?

Answer 10

left hemiparesis
spatial neglect
visual field defect

Question 11

what are the symptoms of a stroke in the posterior cerebral artery

Answer 11

• Visual field deficit or cortical blindness is bilateral

- May have hemihypaesthesis

Question 12

what does hemihypaesthesis mean?

Answer 12

complete loss of sensation of the contralateral face, arm, trunk & leg

Question 13

what are the symptoms of a basilar artery stroke?

Answer 13

• 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

Question 14

what is the presentation of lacunar stroke in the internal capsule?

Answer 14

pure MOTOR hemiplegia (face=arm=leg)

Question 15

what is the presentation of lacunar stroke in the thalamus?

Answer 15

pure sensory hypaesthesis (face=arm=leg)

Question 16

what is the presentation of lacunar stroke in the pons?

Answer 16

dysarthria clumsy hand syndrome

Question 17

aphsia with right sided weakness usually corresponds to what?

Answer 17

left hemispheric stroke

Question 18

neglect (hemi-inattention) usually corresponds to what?

Answer 18

right hemispheric stroke

Question 19

patients with frontal eye field deficits, do they usually look towards or away from the lesion

Answer 19

towards the lesion

Question 20

if the patient has “crossed signs”, what does this indicate?

Answer 20

brainstem involvement

Question 21

what is vertigo of central origin usually associated with?

Answer 21

other cranial nerve defects

Question 22

if patient has vertical nystagmus, what should you assume?

Answer 22

brainstem ischemia

Question 23

what does nystagmus mean?

Answer 23

involuntary eye movements

look on wikipedia for a weird picture/video

Question 24

on a CT scan, what are usual signs of stroke?

Answer 24

• hypodensity of grey & white matter (can’t tell the difference)
• obliteration of cortical sulci
• obscured basal ganglia
• loss of insular ribbon

Question 25

what condition would warrant the argument AGAINST thrombolytic treatment?

Answer 25

if instead of a stroke (or in combo) there is an intracerebral hemorrhage (in a study it was 50% fatal in these patients)

Question 26

list some major indicators FOR thrombolytic treatment

Answer 26

- 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

Question 27

list some major indicators AGAINST thrombolytic treatment

Answer 27

- 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

Question 28

list some primary & secondary prevention methods for stroke

Answer 28

- control of modifiable risk factors - antihypertension, cholesterol lowering & medications - antiplatelet medication - anticoagulants - carotid endarterectomy