Ischemic Stroke Flashcards

1
Q

Stroke

A
  • acute onset of neuro dysfunction
  • 24 hours or more
  • ischemia/hemorrhage
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2
Q

Transient episodeof neuro dysfunction

  • focal brain, spinal cord, retinal ischemia
  • no acute infarction
  • no Imaging evidence of damage
A

TIA

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3
Q

CVA? Ministroke?

A

NO

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4
Q

Majority of strokes?

A

Ischemic strokes

2) primary hemorrhages
3) subarachnoid hemorrhages

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5
Q

Ischemic stroke

A

“Blockage stroke”

Also hypoperfusion/hypotension

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6
Q

Arteries to brain

A

Common carotid R/L
Left vertebral artery R/L
Internal external carotid R/L

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7
Q

Main Circle of willis arteries to brain

A

ACA
MCA
PCA

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8
Q

Most reliable stroke symptom

A

ACUTE ONSET

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9
Q

Medical risk factors

A
HTN
Afib
Hyperlipidemia
DM
Carotid Stenosis
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10
Q

Behavioral riskfactors

A

Cig smoking
Sedentary lifestyle
Illicit drugs
ETOH heavy

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11
Q

Other risk factors

A

Pre-eclampsia/eclampsia
Migraines w/ aura
Cardiac (list)
Genetic (list)

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12
Q

Stroke subtypes

A
  • Large artery atherosclerosis
  • cardioembolism
  • lacunar infarctions
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13
Q

Large artery atherosclerosis

Extracranial

A

Carotid a

Vertebral a

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14
Q

Lacunar infarction (small vessel)

A

Large arteries becoming blocked or hardened

  • brain stem pons
  • deep structures (putamen)
  • thalamus

DM/HTN

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15
Q

Acute Stroke Management

A
  • activate brain attack
  • Start ABCs
  • Assess patient + perform a basic neuro exam
  • NIHSS exam
  • Basic Hx
  • establish last known normal time
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16
Q

Acute Imaging

Negative CT rule out ischemic stroke?

A

NO

Good for hemorrhagic stroke

17
Q

Diffusion weighted imaging MRI

A

MOST sensitive!

But CT scan best – time
If CT neg, still treat

18
Q

Apparent diffusion coefficient

A

Dark = stroke

19
Q

Diffusion Weighted Imaging

A

White = stroke

20
Q

rT-Pa

A
  • give w/in 3-4.5 hours of onset = up recovery at 90 days
  • no improvement after 24hours
  • *some have hemorrhages
21
Q

Tissue loss /time

A

1.9 million neurons/minute

NOT TOTALLY TRUE

22
Q

Giving blood thinner Tpa

NOT to

A

High risk bleeder

  • prev surgery
  • anticoag Rxs
  • Etc.
23
Q

Acute endovascular thrombectomy (catheter)

A

(Pulling out clot with catheter)

Up to 6 hours from onset

  • unless posterior (basilar stroke)
  • must be proximal
24
Q

Early stroke management goal

A
  • BP management
  • Dysphagia/Aspiration Pneumonia
  • DVT/PE
  • recurrent stroke
25
Q

BP management

A

Balancing hypoperfusion and hemorrhage

  • BP goal w/ rt-Pa = less 180/105
  • w/o rt-PA = less 220/120
26
Q

DVT prophylaxis

A

LMW heparin/unfrac heparin
Ealry ambulation
Pneumatic compression device SCD= down VTE

27
Q

Recurrent stroke managemetn

A

Many w/in 3 months
Most 2-5 days after onsel
Aspirin 325mg w/in first 48 after stroke

28
Q

A fib management

A

Cardiac monitoring inpatient + outpatient
-24/48 Holter, 30d loop recorder, implantable monitor

*anticoags

29
Q

Coumadin vs others

A

If stop others, they stop that day

If miss coumadin, it will linger a few days

30
Q

Carotid stenosis management

A
  • Carotid imaging - MRA,CTA, Ultrasound, Conventional Cerebral angiogram
  • Think Carotid endarterectomy - depending on stenosis degree of symptomatic Internal carotid artery (ICA same side as stroke)
31
Q

Preventing a recurrent stroke management

A

Work up for risk factors

  • HTN
  • Afib
  • CAD
  • DM
  • Hyperlipidemia
  • Smoking
  • Diet/exercise
32
Q

Last known normal

A

If they went to sleep, and woke up w/ stroke, it was when they went to sleep

33
Q

Internal carotid artery to

A

Brain = anterior circulation

34
Q

External carotid artery to

A

Scalp

35
Q

Vertebral artery (vertebrobasilar system) to

A

Brain = posterior circulation

36
Q

Stroke s/s

A

ACUTE

37
Q

Ischemic stroke subtype =

Cardioembolism - Where?

A

Common in LAA (left atrial appendage)

38
Q

Early ischemic stroke management

Dysphagia / Aspiration Pneumonia

A

Bedside swallow evaluation + formal speech evaluation

B/F ORAL MEDS

39
Q

Migrane w/ aura people

More likely to have

A

Foramen ovale

UP stroke risk