Early Management of Acute Ischemic Stroke - Lopez

Question 1

how many strokes are there per year?

Answer 1

> 800k

75-80% are first strokes

Question 2

What is the prevalence of stroke?

Answer 2

over 4.5 million survivors of stroke

Question 3

what is the mortality of stroke?

Answer 3

160,000 stroke deaths each year

Question 4

Stroke is the (blank)th cause of death

Answer 4

4th

Question 5

what percent of stroke patients actually receive IV tPA?

Answer 5

only 5%

Question 6

What are the reasons pts don’t get tPA?

Answer 6

1. contraindicated b/c INR, surgery
2. late presentatoin
3. provider reluctance
4. lack of access to stroke center

Question 7

where is the stroke belt in the US?

Answer 7

southeastern US

Question 8

What are the risk factors that make up the stroke belt?

Answer 8

black
low SES
Chronic diseases
Soil, maybe

Question 9

what are the warning signs of stroke?

Answer 9

SUDDEN:
numbness/weakness of face/arm/leg, trouble seeing in one or both eyes, confusion, trouble speaking or understanding, trouble walking, dizziness, loss of balance or coordination, sudden severe HA

Question 10

What are the three components to the Cincinnati Stroke Scale?

Answer 10

Facial droop
Motor weakness/arm drift
speech

Question 11

one or more of the FAST symptoms are present in what percent of stroke?

Answer 11

88%

Question 12

what are the stroke mimmickers

Answer 12

Seizure
Migraine
Hypoglycemia
Tumor
Multiple sclerosis
Encephalitis
Intracranial (e.g., subdural or epidural) hematoma
Intoxication or other encephalopathy

Question 13

is it okay to give tPA in stroke mimmickers/

Answer 13

yes!

Question 14

What percent of strokes are ischemic and what percent are hemorrhagic?

Answer 14

83% ischemic

17% hemorrhagic

Question 15

What are the two types of hemorrhagic stroke/

Answer 15

SAH

intraperenchymal hemorrhage

Question 16

What is the breakdown of thrombotic and embolic ischemic strokes?

Answer 16

52% thrombotic

32% embolic

Question 17

What are the common etiologies of ischemic stroke?

Answer 17

Large artery atherosclerosis
Cardioembolism
Small-vessel occlusion
Stroke of other determined etiology (i.e.,dissection)
Undetermined etiology

Question 18

Smaller penetrating vessels are more often damaged by (HTN/atherosclerosis)

Answer 18

HTN

Question 19

HTN leads to hypertrophy of the (media/adventitia) and deposition of fibrinoid material into the vessel wall, which narrows the lumen

Answer 19

media

Question 20

what are the other etiologies of ischemic stroke?

Answer 20

Fibromuscular dysplasia
Overgrowth of media and intima
Arteritis
Takayasu’s
Giant-cell
Dissection
Decreased systemic perfusion
Other: Fabry’s disease