Clin: Stroke - Hon Flashcards
what is the leading cause of long-term disability in the U.S?
stroke
what is the greatest risk factor for stroke?
previous stroke
- 25% of survivors will have another one
- also increasing age, and anything that causes atherosclerosis
what kid of stroke:
- intracerebral (cortical vs. subcortical)
- subarachnoid
hemorrhagic (20% of cases)
what kind of stroke:
- large artery atherosclerosis with thromboembolism
- small vessel (lacunar disease)
- cardioembolism
- nonatherosclerotic vasculopathies
- hypercoagulable state
ischemic (80% of cases)
what cardiac disorders are risk factors for stroke?
- valvular heart disease
- cardiac dysrhythmia
- mural thrombus
- endocarditis
- atrial myxoma
- inter-atrial septal abnormalities
what hypercoagulable states are risk factors for stroke?
- thrombocytosis
- polycythemia
- sickle cell disease
- leukocytosis
- protein C, protein S deficiencies
- homocysteine
- anticardiolipin/antiphospholipid Ab’s
what two STI’s did Hon say can do anything, anytime, anywhere in the nervous system (central or peripheral)?
HIV and syphillis
what inflammatory disorders are risk factors for stroke?
- giant cell arteritis
- SLE
- polyarteritis nodosa
- granulomatous angiitis
- AIDS
- syphilitic arteritis
where is the stroke?
- aphasia
- right sided sensory symptoms
- right sided motor symptoms
- right visual field cut
LEFT hemisphere
where is the stroke?
- left hemineglect (can’t recognize own body parts)
- left sided sensory symptoms
- left sided motor symptoms
- left visual field cut
RIGHT hemisphere
where is the stroke?
- ipsilateral ataxia, vertigo, nystagmus
cerebellum
where is the stroke?
- cranial nerve findings with contralateral hemisensory or hemimotor symptoms
- vertigo
brainstem
where is one of the most classic sites for hemorrhage?
basal ganglia
what accounts for 50% of deaths attributable to stroke?
medical complications
- pneumonia, DVT, PE, UTI, decubitus ulcers
what is common in acute ischemic stroke, and should NOT be treated?
acute HTN
- the area of infarction may have lost autoregulatory function, so that “normal” BP may be relatively hypotensive in the brain -> might even need to raise BP if too low!
ALL stroke patients need to have IV access
- what should NOT be included in the fluid?
- *NO glucose**
- hyperglycemia is associated with worse neurologic outcomes
NOTE: if TPA is a consideration, two IV access sites will
what labs should be run for stroke pt?
- CBC w/diff
- PT, PTT
- full chemistry panel and finger stick glucose
- UA
- CXR
what is important if tPA or intra-arterial intervention is a consideration?
NIH stroke scale
- score ranges from 0 (normal) - 42 (coma)
- can be used to predict hemorrhagic conversion as well as indication for potential intra-arterial intervention
what are some other important protocols for stroke pt?
- elevate head of bed to 30 degrees
- O2 @ 2L per NC
- obtain pt weight
- try to identify cause and treat fever if present
what questions are important to ask in the history?
- when was last time pt known to be w/out sx?
- did head trauma or seizure occur at onset of sx?
- is patient on warfarin/heparin or NOAC (thrombin inhibitor)?
- does pt have sx suggestive of M.I?
- does pt have sx suggestive of intracranial hemorrhage?
what should be done if CT findings show cerebral infarction?
if pt meets all tPA criteria, consider administering tPA if absolutely sure of time of deficits
what should be done if CT findings are normal?
- consider another cause: seizure, migraine, hypoglycemia
- if history most consistent with ischemia, consider tPA or other therapies (ASA, Aggrenox, Ticlid, Plavix)
the results of parts 1 and 2 of NINDS rt-tPA stroke study support the use of tPA for the treatment of acute ischemic stroke in patients who met the eligibility requirements, if treatment is initiated within how many hours of onset?
3, but better within 1.5 hrs
what is the eligibility criteria for IV tPA?
- age > 18
- diagnosis of ischemic stroke with clinically apparent neurological deficits
- no stroke or head trauma in preceding 3 months
- no major surgery in preceding 14 days
- no hx of intracranial hemorrhage
- no rapidly resolving sx or only minor sx of stroke
- no sx of SAH
- no GI or GU hemorrhage in preceding 21 days
- no seizure at onset of sx
