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

Aphasia, right sided sensory symptoms, right sided motor symptoms, and right visual field cut are symptoms of stroke in what location?

Answer 5

Left Hemisphere

Question 6

Left hemineglect, left sided sensory symptoms, left sided motor symptoms, and left visual field cut are symptoms of stroke in what location?

Answer 6

Right Hemisphere

Question 7

Ipsilateral ataxia, vertigo, and nystagmus are symptoms of stroke in what location?

Answer 7

Cerebellar

Question 8

Cranial nerve findings with contralateral hemisensory or hemimotor symptoms, and vertigo are symptoms of stroke in what location?

Answer 8

Brainstem

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) The area of infarction may have lost autoregulatory function, so that “normal” BP may be relatively hypotensive in the brain

Question 10

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

Answer 10

Glucose

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?

Answer 12

1) 2-3% risk of hemorrhage

2) 17% risk of hemorrhage

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

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