Ischemic Strokes Clinical

Question 1

What are the major classifications of strokes?

Answer 1

Ischemic:

• blood supply is cut off due to an infarct (reduction due to lack of blood flow)
• MOST COMMON
• takes seconds to experience symptoms
• produces long term sequel

Hemorrhagic:
- blood supply is cut off due to an internal bleed that prevents blood from getting to where it needs to go

Hypoxic:

• blood supply is not cut off, but poor oxygen concentration causes infarcts.
• also can be caused due to just general lack of blood flow from a primary pathogenicity

Question 2

What is the difference between a transient ischemic attack (TIA) and a stroke?

Answer 2

TIA:

• produces neurological defects that resolve completely in a short period after reversing a cause of a TIA (usually within an hour)
• No signs of brain damage upon imaging the brain

Actually stroke:

• produces neurological defects that persists even after fixing the cause of damage
• there are permanent signs of damage on imaging

Question 3

Watershed infarct

Answer 3

Example of hypoxic strokes

Is a stroke within vulnerable border areas between parts of the brain that surround the primary cerebral arteries

Often caused by global infarcts such as systemic hypotension or hypoperfusion

Question 4

Lacunae infarcts

Answer 4

Infarcts of the brain that occur in very small vessels, not in the cerebral arteries or in the circle of Willis.

Question 5

Symptoms of an anterior watershed infarct

Answer 5

located at ACA-MCA junction

Results in:

• contralateral hemiparesis
• expressive language and behavior changes

Question 6

Symptoms of a posterior watershed infarct

Answer 6

located at MCA-PCA junction

Results in:

• visual defects
• language defects

Question 7

Risk factors for ischemic strokes

Answer 7

HTN (#1 risk factor)

Increased age

Being male

Born low weight

Smoking

Haven got any cardiac dysfunction (especially CAD and atrial fibrilation)

Having sickle cell

Having high cholesterol

Having diabetes

Being on oral contraceptives

Being fat and or having OSA

Question 8

Primary differences between embolic and thrombotic strokes

Answer 8

Thrombotic:

• gradual presents symptoms
• usually occurs while sleeping
• usually is due to HTN and/or CAD

Embolic:

• sudden onset of symptoms
• usually occurs while awake
• usually due to cardio pathogenicity

Question 9

Symptoms of a stroke that suggest either an anterior or posterior stoke

Answer 9

Note: that these symptoms only suggest one side is more likely. These symptoms can be present in both anterior and posterior

Anterior leaning symptoms:

• headaches
• aphasia
• peripheral sensory defects
• hemiparesis

Posterior leaning symptoms

• vertigo
• visual defects
• altered consciousness
• drop attacks
• diplopia
• dysarthria
• often symptoms are crossed bodies (face symptoms are on one side, body is on the other)*

Question 10

What is the “penumbra” of a stroke patient?

Answer 10

Penumbra means the brain tissues that surround already dead brain tissues.
- the tissues that make up the penumbra can go either way, so you have to work to save this

Question 11

When should you use tPA for ischemic strokes?

Answer 11

Indications

• diagnosis of an ischemic stroke with onset of symptoms- drug time being less than 4 hrs
• patients under the age of 18
• there is no hemorrhages or edema (especially in the MCA territory)

Contraindications:

• BP is sustained at 185/110 or higher even after treatment
• is currently bleeding
• has a recent head injuries and/or a history of intracerebral hemorrhages
• has had surgery within 14 days
• has had GI bleeds within 21 days
• history of recent MIs