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CU Child Neuro Vascular > CVA: Continuum Deck > Flashcards

CVA: Continuum Deck Flashcards

1
Q

% of strokes that are cardioembolic

A

20-30%

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2
Q

Sources of embolic

A

any where proximal to the ischemic territory ( atria, ventricles, valves, aorta, extracranial cervical arteries

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3
Q

Embolic strokes are more likely to cause what two things ?

A

seizures and hemorrhagic transformations

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4
Q

Lab work up for cardioembolic stroke

A

CBC, BC, ESR, CRP, PT/INR, TSH, Lipids, Hypercoag (APC resistant)

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5
Q

risk of stroke in a-fib w/o AC

A

5%

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6
Q

Important scores in CE stroke

A

hasbled, chadsvasc

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7
Q

Four main ACs

A

warfarin, dabigatrin (pradaxa), apixaban (eliquis), rivaroxaban (xarelto)

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8
Q

AC with shortest half-life and once daily dosing

A

Xarelto (rivaroxaban) (5-9 hours)

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9
Q

Renal dosing for ACs

A

Crcl <30 Dabigatran 75mg/d Crcl <50 Xarelto 15mg/d Creatine >1.5, age >80, <132 lbs Eliquis 2.5mg

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10
Q

how many times would someone have to fall for the risk to outweigh the benefit for AC and subdural hematomas

A

295 times

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11
Q

When to resume AC after stroke

A

14 days but bigger strokes may need 4 weeds but asa should be administered in the meantime

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12
Q

atheroma definitions

A

>4mm, noncalcified, mobile components

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13
Q

LKW (time not hours) +/- AC (take last dose ?)

A

First two critical questions

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14
Q

Alert, commands, eyes, head/gaze deviation, limb position and presence of purposeful movements

A

Things to observe initially on the way to the CT

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15
Q

LKW/AC ? , Vitals CAB and <185/110, glucose, Observe then NIH

A

Stroke alert first 5 steps

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16
Q

PT/PTT/INR, Plt, CBC, CMP, troponins

A

You only need a glucose but order these 5 additional labs.

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17
Q

BP, Glucose, and 2 IVs

A

Three things you need from the nurse first

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18
Q

does the presentation make neuroanatomic sense ?

A

Key to stroke syndromes

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19
Q

Acute focal infarction of the cerebral, spinal or retinal tissue.

A

What is stroke ?

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20
Q

ACA/MCA syndrome, amoaurosis fugax/altitudinal field cuts

A

ICA syndrome S/Sx

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21
Q

Right leg weak/numb, transcortical motor aphasia, ideomotor apraxia (i/l or c/l)

A

L ACA stroke S/Sxs

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22
Q

Left leg weak/numb, motor neglect, ideomotor apraxia (i/l or c/l)

A

R ACA stroke S/Sxs

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23
Q

Right face/arm >leg numb/weak, aphasia and left gaze preference

A

L MCA stroke S/Sxs

24
Q

Left Face/arm >leg numb/weak, left hemineglect, right gaze preference, agraph/astereo

A

R MCA stroke S/Sxs

25
Q

Right hemianopsia, alexia w/o agraphia, MIDBRAIN (WEBER) CN 3 I/L with mydriasis and hemiparesis

A

L PCA stroke S/Sxs

26
Q

left hemianopsia and/or Weber syndrome CN 3, mydriasis and hemiparesis

A

R PCA stroke S/Sxs

27
Q

I/L limb and gait ataxia

A

SCA stroke S/Sxs

28
Q

Vertigo, I/L deafness, and/or i/l facial weakness/ataxia

A

AICA stroke S/Sxs

29
Q

I/L limb and gait ataxia and/or Wallenberg syndrome (lateral medulla)

A

Vert/PICA

30
Q

Pontine with impaired lateral gaze, horizontal diplopia and dysconjugate gaze, dysarthria, locked in

A

Basilar

31
Q

dietary modification, exercise, ASA, statin, antihypertensive agent

A

5 proven stroke prevention strategies

32
Q

olive oil, fruits, vegetables, nuts and whole grains with moderate fish and poultry.

A

Mediterranean diet

33
Q

if CK >4x NL then stop and recheck in 6 weeks then try a low dose high potency statin (rosuva>lipitor with regards to SE profile)

A

Statin induced ck elevation approach

34
Q

<140/90 (if lacunar then 130/90)

A

BP goals

35
Q

no

A

Is there a difference in outcomes base on minor ischemic str

36
Q

speech and motor

A

Stroke mimics are more likely if what two symptoms are absen

37
Q

10% highest in the first 24 hours)

A

What percent of people who present with TIAs will ahve recur

38
Q

50%

A

What amount of stenosis in a vessel places a patient at risk

39
Q

CHANCE and FASTER (ended d/t slow recruitment )

A

Two trials that used DAPT for 21 days after TIA/small stroke

40
Q

Aggressive medical therpy (DAPT 90 days) along > stenting both groups took ASA however (reason for point trial)

A

SAMMPRIS

41
Q

1-8% and fronto/insular stroke and patient taking ace-i

A

Orolingual angioedema % and increased risk by 2 things

42
Q

within 2 hours give 50/50/10 (benadryl,ranitidine,dexamethasone) for severe cases ad 0.3 mg epinephrine IM`

A

When does angioedema occurr and what do you do ?

43
Q

within 36 hours of tPA/stroke (6.4%)

A

Definition of symptomatic ICH

44
Q

HT1 scattered petechiaeHT2 more confluent but heterogenousPH 1 vs 2 is 30% of infarct volume

A

Four types of HT per ECASSII

45
Q

10g cryopercipitate (if fibrinogen <150 can repeat,alternatives are tranexamic acid 10mg/kg over 20 min or e-aminocaproic acid 5g)

A

Tx for concerning hemorrhagic conversion

46
Q

HERMES said no

A

Is there a difference in HT between thrombectomy vs tpa ?

47
Q

Dominant hemisphere NIH >20 Nondominant NIH <15>80ml at 6 hours on dwi

A

NIH for malignant infarction ? DWI ml for fulminant edema ?

48
Q

Mannitol 0.5 to 1 g/kg every 4-6 hours with goal osml of 310-3203% Hypertonic Saline for goal sodium of 150-155

A

Rx for malignant infarcrtion ?

49
Q

<60 y/o who deteriorate within 48 hours (mrs <4

A

Indications for decompressive hemicraniectomy

50
Q

13-25% in weeks 2-4

A

Early deaths d/t stroke % for PE

51
Q

2-7

A

DVT risk on days

52
Q

ON PRESENTATION unless they get Tpa the 24 hours if ICH 1 to 4 days

A

When shoud DVT Ppx begin

53
Q

IV fluids and early NG tube

A

If patient fails swallow screen beyon dvt ppx what else shou

54
Q

70%

A

What percent of patients will have a fall in 6 months post s

55
Q

10% most in the first 24 hours

A

What percent of patients develop seizures ?

56
Q

>5

A

Significant AHI for stroke risk ?

57
Q

55% and fluoxetine per FLAME trial improves motor recovery

A

Depression % and what can be done ?

CU Child Neuro Vascular (3 decks)

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