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NMSP Exam 1 > Clinical Approach to Stroke > Flashcards

Clinical Approach to Stroke Flashcards

1
Q

What are some causes of hemorrhagic stroke?

A
  • Intracerebral hemorrhage

- Subarachnoid hemorrhage

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2
Q

What are some causes of ischemic stroke?

A
  • Large artery atherosclerosis with thromboembolism
  • Small vessel disease
  • Cardioembolism
  • Nonatherosclerotic vasculopathies
  • Hypercoagulable states
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3
Q

What are some risk factors for stroke?

A
  • Increasing age
  • Previous TIA or stroke
  • Atherosclerosis –> HTN, smoking, diabetes mellitus, hyperlipidemia
  • Cardiac disorders
  • Drug abuse
  • OCPs
  • Pregnancy/postpartum period
  • Fibromuscular dysplasia
  • Hypercoagulable states
  • Inflammatory disorders
  • Migraine
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4
Q

What cardiac disorders could cause stroke?

A
  • Valvular heart disease
  • Cardiac dysrhythmia
  • Mural thrombus
  • Endocarditis
  • Atrial myxoma
  • Interatrial septal abnormalities
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5
Q

What are some symptoms of a stroke in the left hemisphere?

A
  • Aphasia
  • Right sided sensory and motor symptoms
  • Right visual field cut
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6
Q

What are some symptoms of a stroke in the right hemisphere?

A
  • Left hemineglect
  • Left sided sensory and motor symptoms
  • Left visual field cut
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7
Q

What are some symptoms of a stroke in the cerebellum?

A
  • Ipsilateral ataxia
  • Vertigo
  • Nystagmus
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8
Q

What are some symptoms of a stroke in the brainstem?

A
  • Cranial nerve findings with contralateral hemisensory or hemi motor symptoms
  • Vertigo
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9
Q

What is part of the general management in stroke?

A
  • Primary prevention
  • Management of the acute stroke itself
  • Prevention or control of medical complications
  • Rehabilitation
  • Prevention of recurrent stroke
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10
Q

What is the emergent treatment for a stroke?

A
  • ABCs
  • BP, pulse, cardiac monitor, EKG, O2 sats
  • IV access
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11
Q

What is important to remember in a stroke?

A
  • Acute HTN is common in acute ischemic stroke and in most cases should not be treated since treating it could cause hypotension in the brain
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12
Q

What should NOT be included in the IV fluids? Why?

A
  • Glucose because hyperglycemia is associated with worse neurologic outcomes
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13
Q

What labs are needed in diagnosing a stroke?

A
  • CBC with diff
  • PT, PTT
  • Full chem panel and fingerstick glucose
  • UA
  • CXR
  • CT
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14
Q

Why is the NIH stroke scale important?

A
  • Important if tPA or intra-arterial intervention is a consideration
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15
Q

What is the NIH stroke scale for?

A
  • Scores range from 0 (normal) to 42 (coma) and can be used to predict hemorrhagic conversion as well as indication for potential intra-arterial intervention
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16
Q

What should be done to help treat a patient for a stroke?

A
  • Maintain ABCs
  • Elevate head of bed to 30 degrees to decrease ICP
  • O2 at 2 liters per NC
  • Obtain vitals and establish IV with NS
  • Obtain labs and patient weight
  • EKG
17
Q

What is important in the history when diagnosing or treating a stroke?

A
  • When was last time patient was without symptoms?
  • Did head trauma or seizure occur at onset?
  • Is patient on blood thinner?
  • Does patient have symptoms suggestive of MI?
  • Does patient have symptoms suggestive of intracranial hemorrhage?
18
Q

What is done if there is cerebral infarction seen on CT?

A
  • If patient meets all tPA criteria consider administering tPA if absolutely sure of time deficits began
19
Q

What is done if there is a normal CT but a stroke is on differential?

A
  • Consider another cause like seizure, migraine, hypoglycemia
20
Q

When should tPA therapy be given?

A
  • Within 3-4 hours of the onset of symptoms
21
Q

Should anticoagulation be given to someone with a stroke?

A
  • No
22
Q

When should anticoagulation be given?

A
  • A Fib
  • Prosthetic valve
  • MI
  • Atrial septal defect
  • Hypercoagulable state
  • Large vessel disease
  • Aortic arch disease
23
Q

What is the new treatment method for stroke?

A
  • Endovascular therapy –> intra-arterial thrombolysis and clot retrieval

NMSP Exam 1 (12 decks)

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