Clin: Stroke Flashcards
When should a carotid angioplasty w/ stent placement be considered in a stroke patient?
- When pt at high risk for surgery
- Severe CAD or valvular heart disease, distal carotid disease, or bilateral severe carotid disease
What are some conditions that can present w/ focal neuro deficits that may be confused with stroke?
1) Migrane w/ aura (primary headace disorder)
2) Hyperglycemia
3) Hepatic abnormalities
Which clinical situations is warfarin (or one of the new generation anticoagulants - NOAC’s) generally indicated?
*She stressed this!!!
- Atrial fibrillation
- Prosthetic valve
- MI
- Atrial septal defect
- Hypercoagulable state
- Large vessel disease
- Aortic arch disease
What is the NIH stroke scale used for?
What is the score range?
- Important if tPA or intra-arterial intervention is a consideration
- Range from 0 (normal) to 42 (coma)
- Used to predict hemorrhagic conversion as well as indication for potential intra-arterial intervention
What does a score of <10 and >20 on the NIH stroke scale tell you?
- Score <10 = 2-3% risk of hemorrhage
- Score >20 = 17% risk of hemorrhage
What is the significance of endovascular therapy (intra-arterial thrombolysis w/ clot retrieval) in patients with strokes?
Multiple studies have showed improvement in patients treated with endovascular/intra-arterial intervention in addition to tPA when compared to tPA alone
Administering tPA for the treatment of acute ischemic stroke should be given within _______ hours of the onset of symptoms.
3 hours (better within 1.5 hours)
*She said up to 4.5 hours
How should acute HTN be treated with an ischemic stroke?
Why?
- Should NOT be treated
- Area of infarction may have lost autoregulatory function, so that “normal” BP may be relatively hypotensive in the brain
If the CT findings are normal in a patient believe to have suffered a stroke, what are some other causes you should consider?
Seizure, migraine, hypoglycemia, etc.
Which 6 cardiac disorders are a risk factor for stroke?
1) Valvular heart disease (dysf. or prosthetic valve)
2) Cardiac dysrhythmia (i.e., atrial fibrillation)
3) Mural thrombus
4) Endocarditis
5) Atrial myxoma
6) Interatrial septal abnormalities
Fibromuscular dysplasia is a risk factor for _______
Stroke
What are the symptoms of a stroke occuring in the left hemisphere?
- Aphasia
- Right sided sensory and motor symptoms
- Right visual field cut
Which legal and illegal drugs are risk factors for strokes?
- IVDA
- Cocaine
- Amphetamines
- Oral contraceptives
How should IV’s be utilized in the treatment of stroke patients?
What should not be included in the IVF’s?
What about if tPA is to be given?
- All stroke patients need to have IV access
- IVF’s should NOT include glucose as hyperglycemia is associated with worse neurologic outcomes
- If tPA is a consideration, 2 IV access sites will be needed to eliminate venipuncture after infusion
Which 2 anticoagulants can be used in combination during the first few weeks after stroke?
ASA + Plavix
