Ischemic stroke - simpson Flashcards
Definition of ischemic stroke
Fixed focal neurological deficit with evidence of acute infarction (that persists after the precipitating event, eg a neurologic deficit remains)
Definition of TIA (Transient Ischemic Attack)
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)
Localize the stroke (which artery): Sudden leg paralysis or foot drop, without any associated pain that does not fit with a neurogenic pattern.
ACA
Localize the stroke (which artery): vision problems
PCA
Gerstmann’s syndrome?
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)
What differential diagnoses must be considered when stroke-like symptoms are seen?
Stroke, TIA, migraine, seizure, MS, Psychiatric, metabolic
What are modifiable risk factors for stroke?
HTN!!!
Lipids, alcohol abuse, inactivity, diabetes, obesity, SMOKING
What are causes of stroke in “young” patients?
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,
What is important to know about FMD (Fibromuscular dysplasia)?
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.
What is important to know about moya-moya?
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.
A young person suffers an carotid dissection while playing tennis. What might this look like on angiogram? What underlying conditions might you look for?
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
A 32 y/o female presents with a history of thrombocytopenia, two miscarriages, and a large vessel thrombosis. What is your clinical suspicion?
antiphospholipid antibodies
What is the first line treatment in stroke prevention?
Aspirin 81mg/day
What is the second line treatment in stroke prevention?
Clopidogrel ($$)
**NOt sure about primary vs. secondary prevention.
What patients are considered for carotid endarterectomy?
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