Ischemic stroke - simpson Flashcards

1
Q

Definition of ischemic stroke

A

Fixed focal neurological deficit with evidence of acute infarction (that persists after the precipitating event, eg a neurologic deficit remains)

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2
Q

Definition of TIA (Transient Ischemic Attack)

A

A brief episode of neurological dysfunction caused by focal brain or retinal ischemia, with clinical symptoms typically lasting less than one hour, and without evidence of acute infarction (ie no sequelae)

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3
Q

Localize the stroke (which artery): Sudden leg paralysis or foot drop, without any associated pain that does not fit with a neurogenic pattern.

A

ACA

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4
Q

Localize the stroke (which artery): vision problems

A

PCA

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5
Q

Gerstmann’s syndrome?

A

Can’t WRITE, Can’t RIGHT, Can’t HANDle MATH

Agraphia (can’t write)
Right-left disorientation
Finger agnosia (can’t recognize fingers)
Acalculia (math)

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6
Q

What differential diagnoses must be considered when stroke-like symptoms are seen?

A

Stroke, TIA, migraine, seizure, MS, Psychiatric, metabolic

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7
Q

What are modifiable risk factors for stroke?

A

HTN!!!

Lipids, alcohol abuse, inactivity, diabetes, obesity, SMOKING

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8
Q

What are causes of stroke in “young” patients?

A

Vasculopathies, FMD (Fibromuscular dysplasia), Moya-Moya, arterial dissection, hematologic causes (Protein C, S, sickle cell, Factor V leiden, antiphospholipid ab, oral contraceptives, malignancy) infectious endocarditis, substance abuse, congenital heart defects,

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9
Q

What is important to know about FMD (Fibromuscular dysplasia)?

A

Women 30s/40s. Hypertrophy of the tunica media resulting in segmental occlusion or stenosis (seen as a “crunchy cheeto” on angiography). Classically involves the renal a, but carotid and vertebral commonly involved.

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10
Q

What is important to know about moya-moya?

A

Means “puff of smoke” and causes occlusion of the MCA in young people. Arteriogram looks like a “puff of smoke.” Occlusion is due to intimal thickening.

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11
Q

A young person suffers an carotid dissection while playing tennis. What might this look like on angiogram? What underlying conditions might you look for?

A

Might see a flame-shaped lesion (left) where the artery seems to stop. Classic for dissection.

Patients with other arterial vasculopathies (FMD, Marfan’s, Coarctation, intracranial aneurysms, etc.) have a higher incidence of spontaneous dissection supporting a structural defect in the arterial media as the primary cause

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12
Q

A 32 y/o female presents with a history of thrombocytopenia, two miscarriages, and a large vessel thrombosis. What is your clinical suspicion?

A

antiphospholipid antibodies

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13
Q

What is the first line treatment in stroke prevention?

A

Aspirin 81mg/day

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14
Q

What is the second line treatment in stroke prevention?

A

Clopidogrel ($$)

**NOt sure about primary vs. secondary prevention.

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15
Q

What patients are considered for carotid endarterectomy?

A

Perform for people who have a SYMPTOMATIC stroke (70-99% in the notes…but she said don’t do it if no symptoms). Don’t generally treat asymptomatic patients

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16
Q

I think I’m having a stroke! Should I take tPA?

A

No. to difficult to differentiate hemorrhagic from ischemic. Must wait until ED.

17
Q

What is the most important treatment for emergent ischemic stroke? What is the timeline for administration?

A

tPA!!! ASAP until 4.5 hours.