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Emma H&N II > Clinical Stroke > Flashcards

Clinical Stroke Flashcards

1
Q

modifiable risk factors of stroke

A
  • age (>55)
  • diabetes
  • african american descent
  • male
  • sickle cell disease
  • family hx of stroke
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2
Q

non modifiable risk factors

A
  • previous stroke/TIA
  • high BP
  • heart disease
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3
Q

symptoms of stroke

A

SUDDEN

  • blurred/decreased vision in one or both eyes
  • weakness/numbness/paralysis of face/body on one or both sides of the body
  • difficulty speaking or understanding
  • dizziness or loss of balance
  • unexplained change in pattern of headache
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4
Q

signs/symptoms of intracerebral hemorrhage

A
  • may have sudden onset with smooth progression of deficit
  • focal deficits
  • headache (bc incr. ICP)
  • nausea/vomiting
  • decreased consciousness
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5
Q

causes of intracerebral hemorrhage

A
  • HYPERTENSION
  • congophilic angiopathy
  • hemorrhagic masses (tumor)
  • hemorrhagic transformation of infarct
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6
Q

treatment of intracerebral hemorrhage

A
  • BP management

- supportive

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7
Q

aneurysms (size, peak onset, location)

A
  • 2mm to 3 cm
  • 90% on circle of willis
  • 35 to 65 years old
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8
Q

symptoms of cerebral aneurysms

A
  • asymptomatic
  • mass effect
  • rupture
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9
Q

symptoms of subarachnoid hemorrhage

A
  • SUDDEN ONSET headache
  • stiff neck
  • photophobia
  • nausea/vomiting
  • transient loss of consciousness
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10
Q

diagnosis of subarachnoid hemorrhage

A
  • history (50% have sentinal bleed)
  • CT scan
  • lumbar puncture: RBCs, xanthochromia
  • angiography
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11
Q

Hunt and Hess classification of subarachnoid hemorrhage

A

Grade 1: asymptomatic, mild headache, slight nuchal rigidity

Grade 2: moderate/severe headache, nuchal rigidity, no neurological deficit other than cranial nerve palsy

Grade 3: drowsiness, confusion, mild focal neurologic deficit

Grade 4: stupor, moderate/severe hemiparesis

Grade 5: coma decerebrate posturing

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12
Q

major concerns of subarachnoid hemorrhage

A
  • rebleeding
  • vasospasm
  • seizure
  • increased ICP
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13
Q

atriovenous malformation (AVM) - general definition

A
  • tangle of abnormal vessels
  • form from aberrant communication between arterial and venous systems
  • abnormally thin walled vessels
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14
Q

AVM symptoms

A
  • subarachnoid hemorrhage
  • intraparenchymal hemorrhage
  • seizures
  • headaches
  • focal deficit
  • cranial bruits
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15
Q

AVM treatment

A

obliteration of malformation by:

  • surgical excision
  • endovascular thrombosis
  • radiation
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16
Q

common mechanisms of cerebral ischemia

A
  • lipohyalinosis
  • embolism
  • decreased perfusion through a fixed stenosis
17
Q

lacunar stroke

A
  • small infarct
  • deficit could be large
  • associated with hypertension, diabetes, cholesterol
18
Q

other causes of cerebral ischemia

A
  • vasculitis
  • collagen vascular disease
  • meningitis
  • arterial dissection
  • hematologic disorders
  • hypercoagulable states
  • vasospasm
  • reversible cerebral vasoconstriction
19
Q

mimics of cerebral ischemia

A
  • migraine
  • seizure
  • subdural hematoma
  • tumor
  • syncope
  • cardiac arrhythmia
  • panic attack
  • hypoglycemia
  • demyelinating disease
  • amyloid angiopathy
  • brain abscess
  • encephalitis
20
Q

treatment of carotid artery stenosis

A
  • medical management
  • surgical intervention

Medical management:

  • risk factor control
  • antiplatelet agent
  • HMG-CoA reductase inhibitor
21
Q

high risk cardiac conditions associated with cerebral embolism

A
  • atrial myxoma
  • infective endocarditis
  • dilated cardiomyopathy
  • atrial fibrillation
  • anterior MI with thrombus
  • ventricular aneurysm
  • prosthetic cardiac valves
  • nonbacterial thrombotic endocarditis
22
Q

investigations for hypercoagulative states

A

-protein S
-protein C
-antithrombin III
-Factor V Leiden
-antiphospholipid antibodies
prothrombin gene mutation
-antiphosphatidylserine antibodies

23
Q

ischemic penumbra

A
  • infarctic core in ischemic zone expands
  • penumbra = difference between ischemic zone and infarctic core
  • main target for treatment
24
Q

strategies for acute stroke treatment

A
  • revascularization: “plumbing approach”: thrombolytics

- preventing damage from ischemic cascade: “neuroprotection”

25
Q

stroke patients treated with thrombolytics within ______ (timeframe) of symptom onset had a 30% better chance of recovery without symptoms

A

stroke patients treated with thrombolytics within 3 HOURS of symptom onset had a 30% better chance of recovery without symptoms

26
Q

risk of IV-tPA

A
  • could cause an ischemic stroke to become a hemorrhagic stroke
  • still so much benefit
27
Q

Middle cerebral a.

A

lateral surface of brain, basal ganglia, internal capsule

supplies arm/face area sensory/motor strip

28
Q

Anterior cerebral a.

A

medial surface of brain, some lateral surface

supplies leg area sensory/motor strip

infarct –> contralateral weakness/sensory loss worse in LEGS

29
Q

Posterior cerebral a.

A

medial surface of occipital lobe (*primary visual cortex and visual association cortex on medial surface. Also inferior surface of temporal lobes and thalamus)

infarct –> contralateral HEMIANOPIA
-bilateral –> cortical blindness (Anton’s)

30
Q

lenticulostriate a.

A

main blood supply of internal capsule (fibers going to all areas - arm, leg, face)

Emma H&N II (49 decks)

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