Chapter 33: Stroke

Question 1

Acute Ischmemic Stroke

Answer 1

Can be caused by a thrombus that forms during a cerebral atherosclerotic infarction. Sometimes referred to as a non cardioembolic stroke

Question 2

Cardioembolic stroke

Answer 2

Is an ischemic stroke that occurs when an embolus forms in the heart and travels to the brain.

Question 3

Intracerebral hemorrhage (ICH) and Subarachnoid hemorrhage (SAH), subdural hematoma

Answer 3

All hemorrhagic strokes (bleeding in the brain) due to a ruptured blood vessel

Question 4

Risk Factors for Stroke

Answer 4

• Hypertension
• AFib
• Gender (females>males)
• Ethnicity (highest risk in African Americans)
• Age>=55
• Atherosclerosis
• Diabetes
• Prior stroke or TIA
• Smoking
• Dyslipidemia
• Patent foramen ovale (PFO)
• Sickle Cell disease

Question 5

Signs and Symptoms of Stroke

ACT F.A.S.T

Answer 5

F- face (ask the person to smile, does one side droop or is it numb? is the smile uneven?)
A- arms (ask the person to raise both arms. Does one arm drift downward?)
S- speech (ask the person to repeat a simple sentence. Are the words slurred? is the sentence repeated correctly?)
T- time (If the person shows any of these symptoms, even if they go away call 911 immediately)

Question 6

Alteplase MOA and administration

Answer 6

It is a recombinant tissue plasminogen activator (tPA or rtPA), it binds to fibrin in a thrombus and converts plasminogen to plasmin resulting in fibrinolysis.
*It is the only fibrinolytic FDA approved to to treat acute ischemic stroke
Clot must be confirmed on brain imaging and the time criteria are met
-can be administered within 3 hrs of symptoms onset
-can be administered with in 4.5 hrs of symptoms onset in select patients
-can be administered within 60 minutes of hospital arrival
-BP should be <185/110 before initiation

Question 7

Alteplase Dosing, CI, SE

Answer 7

0.9mg.kg (max 90 mg)
Must rule out intracranial hemorrhage before use
CI: active internal bleeding, hx of recent stroke, severe uncontrolled htc (bp>185/110, INR >1.7, tx dose of LMWH (w/i 24hrs), direct thrombin inhibitor or DOAC in 48 hrs
SE: major bleeding

Question 8

Mannitol

Answer 8

Used to lower intracranial pressure.
Works by producing an osmotic diuresis by increasing the osmotic pressure of of the glomerular filtrate in the kidneys. Induces ICP by withdrawing water from the brain and excreting it in the urine
CI: severe renal disease
Inspect for crystals prior to administration, use a filter for administration

Question 9

Nimodipine

Answer 9

DHP CCB that is more selective for cerebral arteries due to increased lipophilicity. Only indicated for subarachnoid hemorrhage (SAH) to prevent vasospasm
Boxed warning: do not administer IV, death and serious life-threatening adverse events have occurred when inadvertently injected contents of capsules.