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CNS > Ischemic & Hemorrhagic Strokes > Flashcards

Ischemic & Hemorrhagic Strokes Flashcards

1
Q

Epidemiology of Stroke

A

15 million person/year [1/3 die, 1/3 left permanently disabled]
2/3 of stroke deaths and disability in developing countries

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2
Q

Define stroke

A

A sudden focal neurological deficit or acute neurological impairment caused by the interruption of blood flow to a specific region of the brain

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3
Q

Define TIA

A

Any focal deficit that resolves completely and spontaneously within 24 hours

[60% of patients have evidence of brain infarctions]

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4
Q

In order, list each type of stroke from most common to least common

A

Ischemic stroke [80%]
Intracerebral stroke [15%]
Subarachnoid hemorrhage [5%]

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5
Q

What are the common causes of Strokes?

A

Arthrothromboembolism [50%]
Intracranial small vessel disease [25%]
Cardiac source of embolism [20%]
Rare causes [5%]

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6
Q

Thrombic ischemic stroke

A

causes by an acute occluding clot that is superimposed on chronic narrowing of vessels

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7
Q

What is the etiology of cardioembolism?

A

Atrial fibrillation
Mitral stenosis
Anterior wall myocardial infarction
Dilated cardiomyopathy
Prosthetic valve
Patent foramen ovale
Endocarditis

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8
Q

What is the cause of damage in hemorrhagic strokes?

A
  • direct trauma to brain cells, expanding mass effects,
  • elevated intracranial pressure,
  • damaging mediators released,
  • vascular spasm,
  • loss of blood supply distally
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9
Q

What are the risk factors for strokes?

A
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10
Q

A patient is admitted with signs of stroke. Investigations show that the internal cerebral artery is affected. What are these signs?

A

Ispilateral retinal ischemia

Sensorimotor dysfunction similar to MCA and ACA

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11
Q

A patient is admitted with signs of stroke. Investigations show that the middle cerebral artery is affected. What are these signs?

A
  • Contralateral face, arm>leg
  • Aphasia (dominant hemisphere)
  • Contralateral sensory loss
  • Cortical sensory loss (non-dominant hemisphere)
  • Contralateral visual field defect
  • Gaze deviation ipsilateral to the lesion
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12
Q

A patient is admitted with signs of stroke. Investigations show that the anterior cerebral artery is affected. What are these signs?

A
  • Contralateral leg weakness
  • Contralateral leg sensory loss
  • Apraxia
  • Abulia [bilateral]
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13
Q

A patient is admitted with signs of stroke. Investigations show that the posterior cerebral artery is affected. What are these signs?

A
  • Contralateral homonymous hemianopia
  • Visual agnosia
  • Cognitive dysfunction
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14
Q

What arteries supply the cerebrum?

A
  • Anterior circulation (internal carotid arteries)
  • Posterior circulation (vertebral arteries)
  • Collaterals (anastomoses)
    • Circle of Willis (via anterior communicating and posterior communicating arteries)
    • Borderzone anastomoses between peripheral branches of the anterior, middle and posterior cerebral arteries.
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15
Q

What is the investigative protocool for a patient with a suspected stroke?

A
  1. Admit patient to Acute Stroke Unit
  2. Always ABCs first with vital signs
  3. Oxygen delivery if hypoxemic
  4. IV access/Labs/Glucose
  5. Start IV fluids with normal saline, avoid hypotonic fluids
  6. Neurological screening assessment
  7. CT scan of brain /CT angiogram
  8. 12 lead ECG
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16
Q

When is the ideal time for CT scan for a patient suscpected with a stroke?

A

complete scan within 25 minutes of arrival and have the scan read within 45 minutes of arrival

17
Q

What is the management plan of a patient with a hemorrhage seen on a CT scan?

A
  1. Consult neurology/neurosurgery
  2. Mannitol to lower ICP
  3. Nimodipine for SAH
  4. BP management
  5. May need higher than normal systemic BP to maintain cerebral perfusion
  6. Supportive measures
18
Q

What is the management plan for a patient suscpected of a stroke but with no hemorrhage on CT?

A
  • Probable acute ischemic stroke
  • consider fibrinolytic therapy
  • Inclusion criteria
  • Meets inclusion/exclusion criteria
  • Deficits not rapidly improving or normal
    • Candidate for fibrinolytic therapy
    • Review risks/benefits with family
    • Give tPA
  • If not a candidate
    • Give aspirin
19
Q

What is the mangement plan for all stroke patients?

A
  • Admit to monitored bed
  • Monitor and treat BP if indicated
  • Monitor neurological status and CT if deterioration
  • Monitor blood glucose and treat if needed
  • Hydrate and initiate supportive therapy and treat comorbidities
20
Q

What comorbdities should be managed as part of secondary prevention of strokes?

A
  • HTN
  • Hyperlipidemia
  • DM
  • CAD
21
Q

What are the long term effects of strokes?

A
  1. Physically dependent due to loss of power and immobility
  2. Malnutrition due to feeding difficulties
  3. Dressing problems
  4. Disorientation
  5. Poor communication
  6. Incontinence
  7. DVT
  8. Bed sores
  9. Contractures
  10. Pneumonia
  11. Depresion
  12. Unemployement
22
Q

Secondary Prevention of Strokes

A
  1. Stop smoking
  2. Manage comorbidieties
  3. AFib [aspirin vs. warfarin]
  4. TIAs
23
Q

Atrial Fibrillation

A

High Risk Patients

  • WARFARIN
    • Previous stroke, TIA, or systemic emboli ]
    • H/O Hypertension
    • Poor LV systolic function
    • Age > 75 years
    • Rheumatic/Prosthetic Valve disorder

Moderate Risk Patients

  • If one risk factor [warfarin/aspirin]
  • If more than one risk factors [warfarin]
    • 65-75 yeras
    • CAD with preserved LV systolic function

Low Risk Patients

  • Aspirin
    • < 65 years
    • No CAD
24
Q
A

CNS (10 decks)

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