Ch. 15 Neuro Flashcards
What percent of strokes are ischemic vs hemorrhagic?
85% ischemic
15% hemorrhagic
What is the most common cause of stroke in the US?
thrombotic – results from clot formation at the site of an ulcerated atherosclerotic plaque
What are the two types of thrombotic strokes?
Lacunar - stroke of a small terminal vessel
Cortical
How is Cerebral Perfusion Pressure calculated?
CPP = MAP - ICP
What is the NIH Stroke Scale range?
0 to 42
What is amaurosis fugax?
transient monocular blindness from embolization of carotid plaque to the ophthalmic artery
How is TIA defined?
transient neurologic deficits lasting < 1 hour with no evidence of infarction on brain
imaging studies (MRI)
What is Wernicke aphasia?
receptive aphasia – an inability to comprehend language input; speech is fluent but disorganized
Where is Wernicke’s ares?
Temporal lobe
What is Broca aphasia?
expressive aphasia – inability to communicate verbally. Speech is halting and
produced with great effort
Where is Broca area?
frontal lobe
The hallmark of ________ circulation
stroke is crossed deficits (eg, sensory loss
on right side of face vs left side of body).
posterior
In hypertensive patient, where you are trying to lower BP to give TPA, which two medications are first line?
Labetalol, Nicardipine
What artery is implicated with:
Contralateral weakness of leg > arm and face with minimal sensory findings
Anterior cerebral artery
What artery is implicated with:
Contralateral weakness AND numbness of arm and face > leg
Middle cerebral artery (most common)
In a middle cerebral artery stroke you may see a gaze preference for which side?
Gaze preference toward size of infarct
What artery is implicated in clumsy hand–dysarthria syndrome?
Lacunar artery?
What artery is implicated if:
Contralateral visual field and light touch/pinprick deficit with minimal weakness
Posterior Cerebral Artery
What artery is implicated if:
Crossed deficits: ipsilateral cranial nerve deficits with contralateral weakness
Vertebrobasilar artery
What artery is implicated in “Locked in” syndrome?
(complete paralysis of voluntary muscles except eye movement; normal level of consciousness)
Basilar artery
What artery is implicated:
Sudden inability to walk or stand with
headache, vertigo, nausea/vomiting,
abnormal gait, CN abnormalities
Cerebellar artery
What glucose level is a contraindication to tPA?
> 400
What is the dose for tPA for stroke?
0.9 mg/kg with 10% given as bolus, remaining infused over 60 minutes.
Ex: 80 kg person: 72 mg total; 7.2 mg bolus, 64.8 mg infusion over remaining hour
If symptomatic intracranial hemorrhage (SICH) is confirmed with non-contrast CT, which thrombolytic and anti-platelet reversal agents should be considered?
FFP, platelets, cryoprecipitate