Clinical Approach to Stroke Flashcards
What are some causes of hemorrhagic stroke?
- Intracerebral hemorrhage
- Subarachnoid hemorrhage
What are some causes of ischemic stroke?
- Large artery atherosclerosis with thromboembolism
- Small vessel disease
- Cardioembolism
- Nonatherosclerotic vasculopathies
- Hypercoagulable states
What are some risk factors for stroke?
- 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
What cardiac disorders could cause stroke?
- Valvular heart disease
- Cardiac dysrhythmia
- Mural thrombus
- Endocarditis
- Atrial myxoma
- Interatrial septal abnormalities
What are some symptoms of a stroke in the left hemisphere?
- Aphasia
- Right sided sensory and motor symptoms
- Right visual field cut
What are some symptoms of a stroke in the right hemisphere?
- Left hemineglect
- Left sided sensory and motor symptoms
- Left visual field cut
What are some symptoms of a stroke in the cerebellum?
- Ipsilateral ataxia
- Vertigo
- Nystagmus
What are some symptoms of a stroke in the brainstem?
- Cranial nerve findings with contralateral hemisensory or hemi motor symptoms
- Vertigo
What is part of the general management in stroke?
- Primary prevention
- Management of the acute stroke itself
- Prevention or control of medical complications
- Rehabilitation
- Prevention of recurrent stroke
What is the emergent treatment for a stroke?
- ABCs
- BP, pulse, cardiac monitor, EKG, O2 sats
- IV access
What is important to remember in a stroke?
- 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
What should NOT be included in the IV fluids? Why?
- Glucose because hyperglycemia is associated with worse neurologic outcomes
What labs are needed in diagnosing a stroke?
- CBC with diff
- PT, PTT
- Full chem panel and fingerstick glucose
- UA
- CXR
- CT
Why is the NIH stroke scale important?
- Important if tPA or intra-arterial intervention is a consideration
What is the NIH stroke scale for?
- 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
What should be done to help treat a patient for a stroke?
- 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
What is important in the history when diagnosing or treating a stroke?
- 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?
What is done if there is cerebral infarction seen on CT?
- If patient meets all tPA criteria consider administering tPA if absolutely sure of time deficits began
What is done if there is a normal CT but a stroke is on differential?
- Consider another cause like seizure, migraine, hypoglycemia
When should tPA therapy be given?
- Within 3-4 hours of the onset of symptoms
Should anticoagulation be given to someone with a stroke?
- No
When should anticoagulation be given?
- A Fib
- Prosthetic valve
- MI
- Atrial septal defect
- Hypercoagulable state
- Large vessel disease
- Aortic arch disease
What is the new treatment method for stroke?
- Endovascular therapy –> intra-arterial thrombolysis and clot retrieval
