Lec 2: Stroke Syndrome Flashcards
Stroke prevalence in the Philippines
a. 1.4 per 100
b. 1.4 per 1000
c. 14 per 100
d. 0.14 per 100
e. 140 per 1000
A. 1.4 per 100
Previous stroke increases chance of another stroke by: A. 5x B. 10x C. 15x D. 20x
B. 10x
Episode of neurologic dysfunction caused by focal brain or spinal or retinal ischemia without evidence of acute infarction (by imaging)
TIA
The probability of stroke occurring within 30 days after a TIA
7-15%
Thrombi are dissolved by substances such as
Protein C and Protein S
transient monocular blindness; retinal artery affected
amaurosis fugax
What type of hemorrhagic stroke? Commonly caused by uncontrolled hypertension
Intracerebral hemorrhage
What type of hemorrhagic stroke? Base of the brain
Subarachnoid hemorrhage
What type of hemorrhagic stroke? Commonly caused by trauma
Subarachnoid hemorrhage
What type of Intracranial hemorrhage? Typically biconvex in shape
Extradural/epidural
What type of Intracranial hemorrhage? Crescent shaped/concave configuration
Subdural
What type of Intracranial hemorrhage? Normally contains CSF
Subarachnoid
common cause of stroke in the young
over-the-counter decongestants
small vessels involved in hypertensive ICH
- Lenticulostriate arteries
- Thalamoperforant
- Thalamogeniculate
- Basilar penetrants
Most common site affected by ICH
Putamen (40-50%)
What type of ICH? Usually presents with contralateral hemiparesis
A. Putaminal Hemorrhage
B. Thalamic Hemorrhage
C. Pontine Hemorrhage
D. Cerebellar Hemorrhage
A.
What type of ICH? Presents with prominent sensory deficit involving all modalities
A. Putaminal Hemorrhage
B. Thalamic Hemorrhage
C. Pontine Hemorrhage
D. Cerebellar Hemorrhage
B (Thalamus is involved in sensory perception and in motor coordination)
What type of ICH? Presents with deep coma with quadriplegia
A. Putaminal Hemorrhage
B. Thalamic Hemorrhage
C. Pontine Hemorrhage
D. Cerebellar Hemorrhage
C
What type of ICH? Presents with occipital headache,
repeated vomiting, nystagmus and ataxia of gait
A. Putaminal Hemorrhage
B. Thalamic Hemorrhage
C. Pontine Hemorrhage
D. Cerebellar Hemorrhage
D
What is the management for 2 hours post ictus?
A. conservative or medical
B. surgery
A.
What is the management for 24 hours post ictus?
A. conservative or medical
B. surgery
B. hematoma has grown big and surgery is indicated
What is the order of events in hemorrhagic stroke?
Vascular rupture -> Hematoma formation -> Hematoma expansion -> Edema formation
What is the function of Hibernating penumbra?
Causes hypometabolism to conserve energy
states that, in an incompressible cranium, the blood, CSF, and brain tissue exist in a state of volume equilibrium, such that any increase in volume of one of the cranial constituents must be compensated by a decrease in volume of another
Monro-Kellie hypothesis
Patient is GCS 5. Would you recommend surgery?
Yes
Volume of hematoma is 60cc. Would you recommend surgery?
Yes (Surgery if >50, Medical if <30)
When do you treat BP in ICH?
Treat if SBP >180 (Lower to 140 mmHg in 1st week)
Thin-walled focal dilatations that protrude from the arteries of the Circle of Willis
Aneurysmal Subarachnoid Hemorrhage
Signs of inc ICP
- Neck rigidity
- focal deficits (CN palsies)
- Meningeal signs
What is the Hunt & Hess Scoring? Coma, decerebrate rigidity, moribound appearance
5
What is the Hunt & Hess Scoring? Moderate to severe headache, nuchal rigidity, CN palsy
2
What is the Hunt & Hess Scoring? Drowsiness, confusion, mild focal signs
3
gold standard for diagnosing source of SAH
4 vessel cerebral angiogram
episode of neurologic dysfunction caused by focal brain or spinal or retinal ischemia without evidence of acute infarction (by imaging)
Transient Ischemic Attack
Manifestations of anterior circulation stroke EXCEPT: A. aphasia B. Nystagmus C. Sensory alteration D. Mononuclear blindness E. Facial droop
B. Nystagmus
Manifestations of posterior circulation stroke EXCEPT: A. vertigo B. Diplopia C. Unilateral weakness D. nystagmus E. Dysphagia
C. weakness for posterior circulation stroke is usually crossed ie. weakness in the left side of the face and right arms and legs
