ICS-Stroke

Question 1

What is the definition of a stroke?

Answer 1

Rapidly developing highly focal CNS disorders. This happens by occlusion or rupture of an artery or uncommonly a vein (typically in obstetrics)

Question 2

What part of the nervous system is rarely affected by stroke?

Answer 2

PNS

Question 3

What is the #4 cause of death in the US?

Answer 3

Stroke

Question 4

Physical exam findings to look for in stroke patients?

Answer 4

1) Rapid onset 2) Weakness in face and extremities 3) Asymmetrical reflexes 4) + Babinski on one side (toes go up on one side) 5) Difficulty speaking

Question 5

What are the most common types of stroke?

Answer 5

Ischemic (87%) and Hemorrhagic (13%)

Question 6

What is the spectrum of brain damage that can result from a stroke?

Answer 6

Silent stroke, transient ischemic attacks and fixed damage.

Question 7

How long do you have after occlusion before brain tissue dies?

Answer 7

Technically 24 hours, 6 hours in reality

Question 8

A patient comes to see you with weakness and sensory loss on the left side of his body. Why would you want to send him for imaging even if you strongly suspect stroke?

Answer 8

Intracerebral hematomas present the exact same way strokes do, you can only differentiate them with imaging. This patient may have had destruction of the internal capsule and thalamus which would cause these symptoms.

Question 9

A 47 year old woman comes to the ED at 2am with a thunderclap headache and GCS of 13. Her CT scan is shown below. What are the primary causes of this patient’s headache?

Answer 9

Rupture of berry aneurism at arterial junctions and head injury can cause sub-arachnoid hemorrhage.

Question 10

What are the best ways to prevent stroke in at-risk patients?

Answer 10

Control HTN, lower cholesterol, control diabetes, stop smoking, control A-fib and exercise.

Question 11

What are the best ways to prevent recurrence of stroke in patients who have had a stroke before?

Answer 11

All primary preventative measures + anticoagulants (Aspirin, Warfarin, clopedogrel)

Question 12

How are patients with recurrent stroke managed surgically?

Answer 12

Endarterectomy and stenting.

Question 13

What complications are patients at risk for after they have had a stroke?

Answer 13

DVT (5-7 days after), PE (1 month after), Urinary incontinence, depression and recurrent stroke.

Question 14

How quickly do you hope to give tPA to a patient with stroke?

Answer 14

3-4 hours