Ischemic Stroke

Question 1

Ischemic Stroke
General Consideration

Answer 1

**5th leading couse of death US
High risk for long term disability
RF: OSA Afib , Trigeminal herpes zoster ….

Question 2

Lacunar Infarction
General

Answer 2

• Small Lesions (less 1.5 cm diameter )
• Occur in distribution of short penetrating arterioles
• Due to Hx of poorly controlled HTN and/or DM
• Expected neurologic deficit in progress over 24 to 36 hrs before stabilizing
• Prognosis: partial or complete resolution over 4 to 6 wks

Question 3

Lacunar Infarction
Clinical Findings

Answer 3

(**Hemi motor, sensory, ataxia, dysarthria ) **

• Contralateral pure motor hemiparesis
• Pure hemisensory deficit
• Ipsilateral ataxia with hemiparesis
• Dysarthria
• Hand clumsiness

Question 4

Non - Lacunar

Answer 4

• Early mortality
• High risk for recurrence

Question 5

Anterior Cerebral Infarction

Answer 5

**Weakness, Cognition **

• Weakness and cortical sensory loss in contralateral leg
• Mild proximal weakness of arms
• Contralateral Grasp reflex
• Paratonic rigidity
• Lack of initiative
• Confusion
• Urinary incontinence

Question 6

Middle OCClusion Cereral

Answer 6

• Contralateral Hemiplegia
• Hemisensory Loss
• Homonymous hemianopia
• Eyes will deviate to side of Lesion (damage Hemisphere . deviation of see stroke )
• Dominant Hemisphere (Left Side )

o Left Side Controls RT hand therefore it’s Dominant
o Global Aphagia Present
* Non-Dominant (RT Side )
o RT side control Left arm therefore it’s non-dominant
o Preserved Speech and Comprehension

Question 7

Cereballum

SCA, AICA, PICA

Answer 7

• Cerebral : function brain and body store half of neurons whole body
• Vertigo, Nausea, Vomiting, Nystagmus (rapid movement of eye), ipsilateral limb ataxia,
• Contralateral spinothalamic sensory loss in limbs
• Definess due to cochlear infarction

Alle sensory (N/V/D; Vertigo )

Question 8

Massive Cerebellar Infarction

Answer 8

• Obstruction hydrocephalus
• Coma
• Herniation
• Death

Question 9

Posterior Cerebral Artery

Answer 9

*** Tholamic Syndrome **

o Central post-stroke pain
o Nociceptive pain and Hyperpathia
o Affect Sensation and temperature
o Burning or lingling pain sensation
o Discomfort to temperature changes
o Hemeparalesis

Question 10

Verteral Artery Occlusion

Answer 10

*** Clinically Silent **
* Depend on site of insult and collateral flow
* Small serery atherosclerotic

Question 11

Posterior Iferior Cereberlar artery

Answer 11

*** Lateral Medulla Syndrome **
o Dysphagia
o Limp ataxia
o Horner Sydrome

Question 12

B/L Verteral or Basilar Artery

Answer 12

• Pinpoint pupils
• Sensory loss
• Coma

Question 13

Labs

Answer 13

CBC, BMP, Blood culture lipid Profile , PT/INR
Hepergoagulale work Up ( high Risk Factors )

Question 14

DX

Answer 14

• EKG
• ECHO with Bubble STudy
• Blood culture

Question 15

Imaging

Answer 15

• CT head prior to ASA or antithrombolitics given
• CTA
• MRI Head
• MRA head / neck with constrast

Question 16

Afib r/O

Answer 16

Ishcemic Stroke
Non -Lactrimal Stroke
Enlarge Left Atrium
Order continues monitoring
Anyone with Ischemic Stroke ECHO To be order with Bubble STudy

Question 17

tPA

Answer 17

• tPA: 0.9mg/kg, max 90 mg .
• Bolus 10% over 1 mint and
• remainder over 1 hr
• Timing : 3 hrs of onset - effective up to 4.5 hrs ( off labol )
• Disability at 90 days
• Timing very importan t

SBP : >185 Labetolo Cardene
DBP >110

Question 18

parmasive HTN

Answer 18

• Maintain adequate cerebral perfusion pressure (CPP) to prevent further Ischemia

Allow for Permissive HTN within 72 hrs
I**Intervenne : if :
SBP >/= 220 (lower to 170-200)
Lower to 170 to 200

**After 72 hrs reduce to <140/90 **

Question 19

Endovascular Intervention

Answer 19

• Thrombectomy /Embolectomy Within 6 hrs onset
• Present b/w 6 to 24 with large Ischemic Penumbra idenfitied

Question 21

Early democpressive Hemicraniectomy

Answer 21

• For marlignant middle cerebral artery infarctions
• Done Within 48 hrs stroke onset
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