[CLMD] Stroke [Hon]

Question 1

What are the two subtypes of stroke?

Which is more common?

Answer 1

1. Ischemic stroke (more common)
2. Hemorrhagic stroke

Question 2

What are the risk factors for stroke?

(there are a lot, don’t panic, just wanted to list them all in one place)

Answer 2

Increasing age

Previous TIA or stroke

Atherosclerosis

Cardiac disorders

Drug abuse

Oral contraceptives

Pregnancy

Fibromuscular dysplasia

Hypercoagulable states

Inflammatory disorders

Migraine

Question 3

State the area affected with stroke based on the following symptoms

[Aphasia, right sided sensory symptoms, right sided motor symptoms, right visual field cut]

Answer 3

Left hemisphere

Question 4

State the area affected with stroke based on the following symptoms

[Left hemineglect, left sided sensory symptoms, left sided motor symptoms, left visual field cut]

Answer 4

Right hemisphere

Question 5

State the area affected with stroke based on the following symptoms

[Ipsilateral ataxia, vertigo, nystagmus]

Answer 5

Cerebellar

Question 6

State the area affected with stroke based on the following symptoms

[Cranial nerve findings w/ contralateral hemisensory or hemimotor symptoms, vertigo]

Answer 6

Brainstem

Question 7

What are the (3) things the brain will do when it’s insulted?

Answer 7

Bleed

Swell

Seize

Question 8

What is your NUMBER 1 consideration when diagnosing and treating a stroke patient?

Answer 8

ABC’s = Airway, breathing and circulation

Question 9

What should NOT be treated in an acute stroke patient?

Answer 9

ACUTE HTN

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

Question 10

All stroke patients need to have __________

Answer 10

All stroke patients need to have IV access

Question 11

NIH Stroke scale

What are the score ranges?

What does a score <10 mean?

What does a score >20 mean?

Answer 11

What are the score ranges = 0 (normal) to 42 (coma)

What does a score <10 mean = 2-3% risk of hemorrhage

What does a score >20 mean= 17% risk of hemorrhage

Question 12

What is a summary of steps you want to take to manage an acute stroke?

Answer 12

• Elevate head of bed to 30 degrees
• O2 @ 2L per NC
• IV with normal saline
• Obtain patient weight
• Labs
• TREAT FEVER if present
• Gather history

Question 13

What are examples of other agents to administer to a stroke patient if they don’t meet the criteria for tPA?

Answer 13

• Aspirin
• Aggrenox
• Ticlopidine
• Clopidogrel
• Dipyridamole
• Warfarin
• Low molecular weight heparin
• Riveroxaban
• Apixaban

Question 14

What are situations where you would want to prescribe anticoagulation therapy?

Answer 14

A fib

Prosthetic valve

MI

Atrial septal defect

Hypercoagulable state

Large vessel disease

Aortic arch disease

Question 15

What is one of the most promising therapies for removing clots?

Answer 15

Endovascular therapy

(Intra-arterial thrombolysis with clot retrieval)