Early Recognition of Stroke Flashcards
1
Q
stroke in the US
A
- 600,000 new or recurrent strokes each year
- 158,448 deaths in 1998- 1 of every 14.8 deaths
- fourth leading cause of death
- leading cause of disability
- 4.5 mil stroke survivors alive today
- 83% ischemic, 17% hemorrhagic
- effective prevention therapy available
- emphasis must be on prevention
2
Q
risk factors for stroke
A
non-modifiable:
-age, sex, race, family history
modifiable:
-HTN, diabetes, smoking, hyperlipidemia, carotid stenosis, a fib
3
Q
symptoms of stroke
A
- sudden numbness or weakness of face, arm, or leg, esp on one side of the body
- sudden confusion or trouble speaking or understanding speech
- sudden trouble seeing in one or both eyes
- sudden trouble walking, dizziness, or loss of balance or coordination
- sudden severe headache with no known cause
- treatment can be more effective if given quickly
4
Q
stroke subtypes
A
- ischemic-small vessel thrombosis 20%, large 30%, embolic stroke 33%
- hemorrhagic stroke- intracerebral 10%, subarachnoid 7%
5
Q
stroke mimics
A
- hypoglycemia
- mass lesions
- seizures and postictal states
- migraine
- psychogenic hemiparesis
6
Q
mca left
A
-arm, face, eye fields
7
Q
common presentations-Left MCA
A
- right hemiparesis: face=hand >arm >leg
- aphasia (often mistaken as confusion)
- expressive- difficulty producing language or no language output
- receptive-poor comprehension and/or incomprehensible speech
- ant division- left head and eye deviation (if lesion is on left of frontal eye fields, right will be unopposed so patient will look toward left)
- posterior division- visual field deficit, aphasia
8
Q
right MCA common presentation
A
- left hemiparesis: face=hand>arm>leg
- neglect: doesn’t acknowledge left visual space or denies their own body parts
- anterior division-right head and eye deviation
- posterior division- visual field deficit, neglect
9
Q
post cerebral artery common presentations
A
- visual field deficit or cortical blindness if bilateral
- may have hemihypaesthesia-complete loss of sensation of the contralateral face, arm, trunk, and leg
10
Q
basilar artery common presentations
A
- altered consciousness or coma
- often bilateral sign
- cranial nerve signs and crossed signs
- right face and left arm/leg
- loss of pin sensation on left face and right arm/leg
- oculomotor palsy, nysagmus, palate or tongue weakness
11
Q
lacunar syndromes
A
- pure motor hemiplegia: internal capsule face=arm=leg
- pure sensory hypaesthesia: thalamus face=arm=leg
- dysarthria clumsy hand syndrome: pons
- ataxic hemiparesis
12
Q
clinical pearls
A
- aphasia usually corresponds to left hemispheric stroke
- neglect usually indicates right hemispheric stroke
- patients usually look toward the lesion (frontal eye fields)
- crossed signs indicate brainstem involvement
- vertigo of central origin almost always is associated with other cranial nerve deficits
- vertical nystagmus is brainstem ischemia until proven otherwise
13
Q
early CT changes of stroke
A
- early infarct signs
- hypodensity of grey or white batter
- obliteration of cortical sulci
- obscured basal ganglia
- loss of insular ribbon
14
Q
hyperdense MCA
A
-more likely to hemorrhage with TPA because so much clot
15
Q
inclusion for thombolytic therapy
A
- acute ischemic stroke- not mimic
- age < 80
- onset <24
- absence of exclusionary criteria
- informed consent
