Clinical Approach to Stroke (Hon)

Question 1

What are the subtypes of stroke?

Which is more common?

Answer 1

1) Hemorrhagic Stroke

2) Ischemic Stroke (more common)

Question 2

What are risk factors for atherosclerosis?

Answer 2

1) HTN
2) Smoking
3) Diabetes Mellitus
4) Hyperlipidemia

Question 3

What cardiac dysrhythmia is a risk factor for stroke?

Answer 3

Atrial Fibrillation

Question 4

Abuse of what drugs are risk factors for stroke?

Answer 4

1) IV drugs
2) Cocaine
3) Amphetamines

Question 5

What are sx of Left Hemisphere stroke

Answer 5

Aphasia
Right sided sensory sx
Right sided motor sx
Right visual field cut

Question 6

What are the sx of Right Hemisphere Stroke

Answer 6

Left Hemineglect (don’t recognize left side of body)
Left sided sensory sx
Left sided motor sx
Left visual field cut

Question 7

What are the sx of cerebellar stroke?

Answer 7

Ipsilateral Ataxia, Vertigo, Nystagmus

Question 8

What Sx are in Brainstem stroke?

Answer 8

Cranial Nerve findings with Contralateral hemisensory/hemimotor Sx, and Vertigo

Question 9

What is common in acute ischemic stroke and in most cases should not be treated?

Why should it not be treated?

Answer 9

1) Acute HTN

2) Decreasing Blood pressure would decrease perfusion leading to further ischemia and thus infarction

Question 10

What should the IV fluids not include in stroke patients because it is associated with worse neurologic outcomes?

Answer 10

Glucose

*ALL STROKE PATIENTS NEED IV ACCESS

Question 11

Determining where the patient is on the NIH stroke scale is important for?

Answer 11

If using tPA or intra-arterial intervention

Question 12

What does a score of < 10 on the NIH stroke scale entail?

A score > 20?

What are the main evaluation/Tx of stroke?

Answer 12

1) 2-3% risk of hemorrhage
2) 17% risk of hemorrhage
3) ABC, Elevate HOB to 30 Degrees, O2

Question 13

What are some other causes that can present like stroke?

Answer 13

1) Seizure
2) Migraine
3) Hypoglycemia
4) Hepatic issues

Question 14

When should tPA be given to a stroke patient?

Answer 14

Within 3-4.5 hours of the onset of symptoms

Question 15

What are clinical situations in which warfarin (or one of the newer generation anticoagulants) is generally indicated?

Answer 15

1) Atrial Fibrillation
2) Prosthetic Valve
3) M.I.
4) Atrial septal defect
5) Hypercoagulable state
6) Large vessel disease
7) Aortic arch disease

M HAAALP

Question 16

What combination therapy can be used especially in the first few weeks after stroke although you want to avoid long-term use due to increased risk of GI bleed?

Answer 16

Aspirin and Clopidogrel