Cerebrovascular Disease: Continuum Deck 2 (epidemiology, TIA

Question 1

5 proven stroke prevention strategies

Answer 1

dietary modification, exercise, ASA, statin, antihypertensive agent

Question 2

Mediterranean diet

Answer 2

olive oil, fruits, vegetables, nuts and whole grains with moderate fish and poultry.

Question 3

Statin induced ck elevation approach

Answer 3

if CK >4x NL then stop and recheck in 6 weeks then try a low dose high potency statin (rosuva>lipitor with regards to SE profile)

Question 4

BP goals

Answer 4

<140/90 (if lacunar then 130/90)

Question 5

Is there a difference in outcomes base on minor ischemic stroke and TIA ?

Answer 5

no

Question 6

Stroke mimics are more likely if what two symptoms are absent ?

Answer 6

speech and motor

Question 7

What percent of people who present with TIAs will ahve recurrent events in the next 90 days ?

Answer 7

10% highest in the first 24 hours)

Question 8

What amount of stenosis in a vessel places a patient at risk for recurrent events ?

Answer 8

50%

Question 9

Two trials that used DAPT for 21 days after TIA/small stroke (abcd = 4/minor symptoms)

Answer 9

CHANCE and FASTER (ended d/t slow recruitment )

Question 10

SAMMPRIS

Answer 10

Aggressive medical therpy (DAPT 90 days) along > stenting both groups took ASA however (reason for point trial)

Question 11

Orolingual angioedema % and increased risk by 2 things

Answer 11

1-8% and fronto/insular stroke and patient taking ace-i

Question 12

When does angioedema occurr and what do you do ?

Answer 12

within 2 hours give 50/50/10 (benadryl,ranitidine,dexamethasone) for severe cases ad 0.3 mg epinephrine IM`

Question 13

Definition of symptomatic ICH

Answer 13

within 36 hours of tPA/stroke (6.4%)

Question 14

Four types of HT per ECASSII

Answer 14

HT1 scattered petechiae
HT2 more confluent but heterogenous
PH 1 vs 2 is 30% of infarct volume

Question 15

Tx for concerning hemorrhagic conversion

Answer 15

10g cryopercipitate (if fibrinogen <150 can repeat,alternatives are tranexamic acid 10mg/kg over 20 min or e-aminocaproic acid 5g)

Question 16

Is there a difference in HT between thrombectomy vs tpa ?

Answer 16

HERMES said no

Question 17

NIH for malignant infarction ? DWI ml for fulminant edema ?

Answer 17

Dominant hemisphere NIH >20
Nondominant NIH <15
>80ml at 6 hours on dwi

Question 18

Rx for malignant infarcrtion ?

Answer 18

Mannitol 0.5 to 1 g/kg every 4-6 hours with goal osml of 310-320
3% Hypertonic Saline for goal sodium of 150-155

Question 19

Indications for decompressive hemicraniectomy

Answer 19

<60 y/o who deteriorate within 48 hours (mrs <4

Question 20

Early deaths d/t stroke % for PE

Answer 20

13-25% in weeks 2-4

Question 21

DVT risk on days

Answer 21

2-7

Question 22

When shoud DVT Ppx begin

Answer 22

ON PRESENTATION unless they get Tpa the 24 hours if ICH 1 to 4 days

Question 23

If patient fails swallow screen beyon dvt ppx what else should be done ?

Answer 23

IV fluids and early NG tube

Question 24

What percent of patients will have a fall in 6 months post stroke ?

Answer 24

70%

Question 25

What percent of patients develop seizures ?

Answer 25

10% most in the first 24 hours

Question 26

Significant AHI for stroke risk ?

Answer 26

> 5

Question 27

Depression % and what can be done ?

Answer 27

55% and fluoxetine per FLAME trial improves motor recovery