Cerebrovascular Accidents Flashcards
obstruction within an intracranial blood vessel
ischemic stroke
ruptured intracranial blood vessel
hemorrhagic stroke
what is the most common type of stroke?
ischemic
temporary obstruction within an intracranial blood vessel
transient ischemic attack (TIA)
where does an embolic stroke usually come from?
the heart
what causes an thrombotic stroke?
atherosclerosis
what are the 3 causes of an ischemic stroke?
thrombus
embolus
systemic hypo-perfusion
what can be used to determine the need for anticoagulation vs antiplatelet therapy?
CHADS
what would we do for a patient with a CHADS score 2 or more? (2)
oral anticoagulant
(-aban)
what is the most common location of an ischemic stroke in the anterior cerebral circulation?
middle cerebral artery
in anterior circulation, which artery does a stroke come from?
internal carotid
in posterior circulation, which artery does a stroke come from?
vertebral-basilar artery
what is the treatment for carotid stenosis in ischemic stroke?
endarterectomy
a patient presents with aphasia, amaurosis fugax, hemiparesis and contralateral weakness. what are they experiencing?
anterior stroke
a patient presents with diplopia, bilateral vision loss, ataxia, loss of consciousness, and vomiting. what are they experiencing?
posterior stroke
what is the most important thing to know in history of a patient with a stroke?
last known well
what are 3 important parts of the physical exam in a patient with possible stroke?
cardiopulmonary exam
funduscopic exam (papilledema)
neuro exam
what are the 3 exam findings for the diagnosis of acute stroke by NIHSS?
facial paresis
arm drift/weakness
abnormal speech
why is the NIHSS score important?
correlates to stroke outcome
what are 4 urgent tests to do for a patient with stroke?
head CT without contrast
brain MRI
finger stick BG
oxygen sat
what are 4 other tests that can be run for a patient with stroke?
ECG
CBC + platelets
troponin
PT/PTT/INR
what is the treatment of choice for an ischemic stroke? what are the 3 indications?
TPA
last known well less than 3 hrs ago
no blood on CT head
disabling deficit
what are 4 exclusion criteria in which TPA cannot be used 3-4.5 hours after the last known well?
over 80 yo
hx of prior stroke
hx of diabetes
any anticoagulant use before admission
when can intra arterial TPA be used for ischemic stroke?
up to 6 hours after last known well
when can mechanical thromectomy be used for ischemic stroke?
up to 8 hours after last known well
what is the antiplatelet regimen for an ischemic stroke? (3)
aspirin
clopidogrel (plavix)
aggrenox
in ischemic stroke, what anticoagulation can be used if the patient has atrial fibrillation? (4)
warfarin
pradaxa
xarelto
eliquis
what is the management for a hemorrhagic stroke?
determine cause
maintain normal BP
stop troublesome meds
manage ICP
when should surgical intervention occur for a hemorrhagic stroke?
within 48-72 hours
how can coagulopathy be corrected in hemorrhagic stroke if a patient is on warfarin?
2 units FFP + IV vitamin K
how can coagulopathy be corrected in hemorrhagic stroke if a patient is on heparin or LMWH?
protamine sulfate
